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Addiction, In the News, Public Health

Stanford experts skeptical about motives behind e-cigarette health warnings

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Quotes can sometimes make or break a news article. I was skimming a New York Times article on new, harsh health warnings from tobacco companies when a quote from Stanford otolaryngologist Robert Jackler, MD, stopped me in my tracks.

“When I saw it, I nearly fell off my chair,” Jackler told the Times. What made a renowned expert in tobacco advertising fall off his chair? I was hooked (and not on cigarettes, thankfully) and had to keep reading.

It turns out that Jackler had spotted the warning on MarkTen e-cigarette packs, which details many of the deleterious effects of nicotine, calling it “very toxic by inhalation, in contact with the skin, or if swallowed.” The product is not to be used by children, women who are pregnant or breast-feeding, anyone with heart disease or high blood pressure, or those taking medication for depression or asthma. The list goes on.

These warnings are voluntary, explained the Times‘ Matt Richtel, who also wrote:

Experts with years studying tobacco company behavior say they strongly suspect several motives, but, chiefly, that the e-cigarette warnings are a very low-risk way for the companies to insulate themselves from future lawsuits and, even more broadly, to appear responsible, open and frank. By doing so, the experts said, big tobacco curries favor with consumers and regulators, earning a kind of legitimacy that they crave and have sought for decades. Plus, they get to appear more responsible than the smaller e-cigarette companies that seek to unseat them.

The tobacco companies say they are striving to be honest and open. With another choice quote, Stephanie Cordisco, president of the R. J. Reynolds Vapor Company, told the Times: “We’re here to make sure we can put this industry on the right side of history.”

Not so, Stanford science historian Robert Proctor, PhD, responded. He called the voluntary warnings “totally Orwellian.”

“They do everything for legal reasons, otherwise they’d stop making the world’s deadliest consumer products,” Proctor said.

Becky Bach is a former park ranger who now spends her time writing about science and practicing yoga. She is an intern in the Office of Communications and Public Affairs. 

Previously: How e-cigarettes are sparking a new wave of tobacco marketing, E-cigarettes and the FDA: A conversation with a tobacco-marketing researcher and What the experience of Swedish snuff can teach us about e-cigarettes
Photo by Lindsay Fox

CDC, In the News, Infectious Disease, Pediatrics, Public Health

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

Q&A about enterovirus-D68 with Stanford/Packard infectious disease expert

SONY DSCToday’s New York Times features a story on the accelerating spread of enterovirus-D68, a virus that is causing severe respiratory illness in children across the country. As the Times reports, some emergency departments in the Midwest have been so swamped with cases that they’ve had to divert ambulances to other hospitals. Although California is still only lightly affected, the state’s first four cases were confirmed by the California Department of Public Health late last week, with more expected to surface.

To help parents who may be wondering how to prevent, spot and care for EV-D68 infection, Yvonne Maldonado, MD, service chief of pediatric infectious disease at Lucile Packard Children’s Hospital Stanford, answered some common questions about the virus:

Enteroviruses are not unusual. Why is there so much focus from health officials on this one, EV-D68?

The good news is that this virus comes from a very common family of viruses that cause most fever-producing illnesses in childhood. But it’s been more severe than other enteroviruses. Some hospitals in other parts of the country have had hundreds of children coming to their emergency departments with really bad respiratory symptoms. The fact that it’s been so highly symptomatic and that there has been a large volume of cases is why it has gotten so much attention.

Have any patients at Lucile Packard Children’s Hospital Stanford been affected with EV-D68?

As of today (Sept. 26), we have not yet had a documented case at our hospital. However, there have been a total of 226 confirmed cases in 38 states across the country. Some children who have this virus are probably not being tested, so the real number of cases nationwide is likely to be higher.

If your child has respiratory symptoms and you suspect EV-D68, what should you do?

The virus causes symptoms such as coughing, sneezing and runny nose. In some cases but not all, kids also have a fever. If your child has respiratory symptoms with or without a fever, especially if he or she also has a history of asthma, monitor your child at home. If you feel that he or she has been sick for a long period, is getting worse or is experiencing worsening of asthma or difficulty breathing, go see your pediatrician.

Which groups are most at risk?

Children with a history of asthma have been reported to have especially bad respiratory symptoms with this virus. It can affect kids of all ages, from infants to teens. So far, only one case has been reported in an adult, which makes sense because adults are more likely to have immunity to enteroviruses. We do worry more about young infants than older children, just because they probably haven’t seen the virus before and can get sicker with these viral infections.

How can the illness be prevented?

This virus is spread by contact with secretions such as saliva. If your children are sick, they should stay home from school to avoid spreading the illness to others. To avoid getting sick, stay at least three feet from people with symptoms such as coughing and runny nose, wash your hands frequently, and make sure your kids wash their hands often, too.

What is the treatment for EV-D68?

There is no treatment that is specific to the virus. At home, parents can manage children’s fevers with over-the-counter medications, make sure they drink lots of fluids to avoid dehydration, and help them get plenty of rest. For children who are very ill, doctors will check for secondary illnesses such as bacterial pneumonia, which would be treated with antibiotics, and may hospitalize children who need oxygen or IV hydration to help them recover.

Previously: Tips from a child on managing asthma
Photo by Michelle Brandt

Cancer, Global Health, Health Policy, Infectious Disease, Public Health

Treating an infection to prevent a cancer: H. pylori and stomach cancer

Treating an infection to prevent a cancer: H. pylori and stomach cancer

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The number of newly diagnosed stomach cancer cases in the United States is less than a tenth of the number of prostate cancer cases or breast cancer cases, which may be part of the reason it doesn’t get the same attention as breast and prostate cancer. But the mortality rate is much higher for stomach (or gastric) cancer. Nearly 11,000 Americans will likely die from gastric cancer this year, with only 28 percent of cases surviving five years or more. For comparison, the five-year survival rate for prostate cancer is nearly 99 percent and for breast cancer, it’s more than 89 percent.

On a global scale, an estimated 700,000 people will die from gastric cancer this year, as Stanford infectious disease specialist Julie Parsonnet, MD, and her co-authors note in a Viewpoint piece in the most recent issue of the Journal of the American Medical Association. The authors also point out that worldwide, about 77 percent of gastric cancer cases are linked to chronic infections of Helicobacter pylori, a helix-shaped bacteria that was identified in the early 1980s and found to be linked to gastric ulcers a few years later, as well as to gastritis, an inflammation of the stomach lining that is a precursor to stomach cancer.

Researchers are still trying to understand exactly how H. pylori causes cancer or even how it colonizes the gastrointestinal track – they believe it’s picked up via food or water. Until recently, there was a dearth of randomized clinical trials that looked at the effectiveness of screening and treatment for H. pylori as a method for preventing stomach cancer.

Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy

In the opinion piece, the authors describe the recommendations of a working group that met in December 2013 at the behest of the International Agency for Research on Cancer. Taking the burden of the disease and the availability of treatment options in consideration, the group considered gastric cancer “a logical target for intervention,” according to the authors of the JAMA piece. They go on to write:

Screening and treatment for H pylori is generally acceptable and affordable. An inexpensive serological test can determine who may be infected, with a sensitivity and specificity that could be sufficient for population-based prevention programs. Low-cost treatment regimens using 2 or 3 generic antibiotics plus a proton pump inhibitor for 7 to 14 days can eradicate the infection in more than 80% of cases, depending on the antibiotic resistance patterns of H pylori within the population. Economic modeling studies indicate that H pylori screening and treatment strategies are cost-effective under a large range of assumptions about effectiveness and costs. However, the models are limited by reliance on observational data rather than randomized trial results, by a lack of information on possible adverse effects of treatment, and by limited data from lower-income countries.

Researchers still have many gaps in their understanding of the best methods to prevent stomach cancer, but several trials may answer some of those questions in the coming decade.

Stomach cancer is not the only cancer known to be linked with an infection. Doctors routinely test whether women who come in for a PAP smear are infected with the human papilloma virus (HPV), which is linked to cervical cancer. Chronic hepatitis B and C infections are known to be linked to liver cancer. In time, screening for H. pylori to prevent stomach cancer may become routine. Until then, Parsonnet and her coauthors say in their conclusion, “Ignoring gastric cancer in the hope that it will soon disappear is not a tenable health policy.”

Previously: Researchers identify potential drug target in ulcer bug that infects half the world’s population, Good-bye cancer, good-bye stomach: A survivor shares her tale and Image of the Week: Helicobacter pylori colonizing the stomach
Photo by Shuman Tan and Lydia-Marie Joubert

In the News, Public Health

Healthy gut bacteria help chicken producers avoid antibiotics

Healthy gut bacteria help chicken producers avoid antibiotics

chicks for productionIf you watch TV, you’ve probably seen actress Jamie Lee Curtis selling Activa, Dannon’s probiotic yogurt – or perhaps you’ve  taken probiotic supplements to help you recover after a nasty intestinal infection. Probiotics are microorganisms that are thought to help improve the bacterial balance in our guts. It’s not clear whether they are effective in humans, but they do appear to work in chickens.

Recently, the third-largest chicken producer in the nation, Perdue Farms, announced that it had eliminated almost all antibiotics from its farm operations – a move that has been in the works at the company for a dozen years. As NPR’s The Salt blog recently reported, the company has turned, instead, to probiotics to help keep the chickens healthy:

“As we took antibiotics out of the feed, we put some other things in, such as probiotics,” says Bruce Stewart-Brown, an executive at Perdue Farms. “We’ve increased the amount of probiotics by five times over the past five years. It’s a significant part of our program.”

Since the 1970s, farmers have given low doses of antibiotics to livestock animals to help them grow faster and bigger, a practice called “sub-therapeutic” use. And for almost as long, the practice has been viewed with suspicion by many concerned that it may encourage antibiotic resistance. Approximately 15-17 million pounds of antibiotics are given to livestock in the U.S. every year, according to Stuart Levy, MD, of Tufts University, director of the Alliance for the Prudent Use of Antibiotics.

In December, the FDA asked antibiotic producers to label their drugs so that they did not promote “sub-therapeutic” doses to fatten animals and earlier this month, the White House issued a report on combatting antibiotic resistance. One of the criticisms of the plan was that it didn’t make strong recommendations for reducing sub-therapeutic use of antibiotics in livestock animals.

Probiotics are a more expensive intervention than sub-therapeutic antibiotics, but offer an alternative – at least in chickens, as The Salt reports:

Stewart-Brown says that he was initially skeptical about probiotics. “Eight years ago, I would have said that they’re not working in poultry. They’re not very useful. Today, I’m saying that they are useful. Expensive, but useful. “Chickens that got probiotics stayed healthier and grew faster than birds that didn’t.

Perdue’s experiment with probiotics is probably the largest of its kind among commercial producers. How they fare may be a bell weather of what’s to come for other agricultural livestock producers and provide them with a route away from antibiotic overuse.

Previously: Interactive online map helps researchers track spread of antibiotic-resistant bacteria and Some unlikely sources for antibiotics
Photo by Loaf

Ask Stanford Med, In the News, Infectious Disease, Public Health, Stanford News

A conversation on West Nile virus and its recent California surge

A conversation on West Nile virus and its recent California surge

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Ebola isn’t the only virus commanding media attention: West Nile virus, now in its 15th year in the United States, may be surging to unprecedented levels in California, fueled in part by the state’s earth-parching drought.

It’s a big deal elsewhere as well, with parts of Texas, Louisiana and Midwestern states like Nebraska are also being hit. But California – and its 237 cases as reported by the CDC –  has taken the lead, in part because the drought brings birds and mosquito together at the scarce sources of water, according to reports by the Wall Street Journal and San Francisco’s NPR-affiliate KQED. Some regions, including a few communities close to Stanford, are now spraying for the mosquitoes.

I recently chatted with infectious disease expert Lucy Tompkins, MD, PhD, about the disease and how to prevent it. (Tompkins, a fly fisherwoman, knows quite a bit about mosquitoes).

What are the symptoms of West Nile?

The majority of people who get bitten don’t have any symptoms. About 20 percent of those bitten develop what is called West Nile fever with a fever, aches, fatigue, maybe a headache and sometimes a rash. It was previously felt this was completely benign but there may be long-term effects. Less than one percent are  the serious  cases with involvement of the brain and nervous system, which has a high mortality rate. That’s particularly common in people who are immunosuppressed due to transplants or high use of prednisone or even to those over 50 years. It can be a very disabling infection.

What can people do to protect themselves?

Reduce standing water such as in bird baths and wear protective clothing with long sleeves, long pants and socks covering your pants. Use insect repellents containing DEET - not low-potency insecticides. If possible, avoid being out during the times of day mosquitoes are active such as early in the morning and at sunset. It’s all about prevention.

Why isn’t there a vaccine for West Nile?

The chances of any one person getting West Nile are pretty remote. There’s no market, honestly. There’s a much bigger demand in the veterinary market for a vaccine like this. There is a vaccine for horses – West Nile can be fatal in horses. It also affects dogs and cats. There are some experimental treatments – last year at Stanford we gave a patient an experimental treatment and he awoke from a coma.

Do you expect the virus to continue spreading?

It’s hard to predict from year to year what communities will be affected. It all depends on what happens in the environment. The best information is available at the CDC.

Becky Bach is a former park ranger who now spends her time writing about science or practicing yoga. She is a science-writing intern in the Office of Communications and Public Affairs.

Previously: Should local residents be worried about West Nile virus?, Image of the Week: West Nile virus and Close encounters: How we’re rubbing up against pathogen-packing pests
Photo by: CulexNil

Ebola, Events, Global Health, Health Policy, In the News, Infectious Disease, Public Health

Interdisciplinary campus panel to examine Ebola outbreak from all angles

Interdisciplinary campus panel to examine Ebola outbreak from all angles

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Scientists have estimated that the West Africa Ebola epidemic will take another 12-18 months to control and will infect hundreds of thousands of more people during that time. In an opinion piece published last week in the Los Angeles Times, Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health, discussed how the outbreak got so out of control and explains why the “world needs a new approach to solving massive international health crises and preventing future ones.”

Tomorrow on the Stanford campus, Barry will participate in an interdisciplinary forum focusing on the health, governance, security and ethical dimensions of the epidemic. Additional speakers include Doug Owens, MD, a general internist and director of the Center for Health Policy/Primary Care Outcomes Research; microbiologist David Relman, MD, a fellow at the Center for International Security and Cooperation; Stephen Stedman, deputy director at the Center on Democracy, Development and the Rule of Law; and Paul Wise, MD, MPH, a child health specialist and core faculty member of the Center for Health Policy/Primary Care Outcomes Research. Drawing on their diverse backgrounds, the panelists will offer unique perspectives from their respective fields on the latest developments in addressing the outbreak.

The event will be held at 4 PM local time at the Bechtel Conference Center in Encina Hall and is free and open to the public. Conference organizers will also be live tweeting the panel; you can follow the coverage on the @FSIStanford Twitter feed, or by using the hashtag #EbolaForum.

Previously: Expert panel discusses challenges of controlling Ebola in West AfricaShould we worry? Stanford’s global health chief weighs in on Ebola, Biosecurity experts discuss Ebola and related public health concerns and policy implications and Stanford global health chief launches campaign to help contain Ebola outbreak in Liberia
Photo by European Commission DG ECHO

Aging, Health and Fitness, Public Health, Research

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

Twenty-four percent of middle-aged and older Americans meet muscle-strengthening guidelines

free_weightsPast research has shown that strength training can benefit older adults’ health in numerous ways including arthritis relief, alleviating back pain, increasing bone density, improving sleep and boosting mental health. But despite these findings, a new study from Centers for Disease Control and Prevention (CDC) has found that few U.S. adults age 45 and older adhere to the Department of Health and Human Services’ muscle-strengthening recommendations.

The guidelines advise middle-aged and older adults to do moderate or high intensity muscle-strengthening activities that involve all major muscle group two or more days a week. Training can involve hand weights or weight machines, basic exercises such as sit-ups and push-ups or yoga and similar fitness practices.

In the latest study, researchers examined data from a telephone health survey conducted in 2011 by the CDC known as the U.S. Behavioral Risk Factor Surveillance System. For the survey, respondents provided information about the types of physical activities they engage in and frequency, as well as answered questions about if they specifically did exercises to strengthen their muscles. HealthDay reports:

Of all those who answered the questions on muscle strengthening, about 24 percent said they met the government’s recommendations.

Among those less likely than others to meet these guidelines were women, widows, those age 85 or older, people who were obese, and Hispanics. Participants who didn’t graduate from high school were also less likely to meet U.S. strength-training recommendations.

Jesse Vezina, of Arizona State University, and his fellow researchers concluded that interventions designed to encourage people to participate in strength training should target these high-risk groups.

Previously: Moderate exercise program for older adults reduces mobility disability, study shows, Help from a virtual friend goes a long way in boosting older adults’ physical activity and Do muscles retain memory of their former fitness?
Photo by Positively Fit

Health Costs, Health Policy, In the News, NIH, Public Health, Science Policy

Research investment needed now, say top scientists

Top scientists made the case for continued investment in basic science and engineering earlier this week by unveiling a new report, “Restoring the Foundation: The Vital Role of Research in Preserving the American Dream” by the American Academy of Arts and Sciences.

Here’s why this is important: Federal investment is needed to power innovation engines like Stanford’s School of Medicine, and if that money gets funneled to roads, the military, Medicare, or any of a variety of other uses, fewer jobs, and fewer discoveries, could result. From the report:

Unless basic research becomes a higher government priority than it has been in recent decades, the potential for fundamental scientific breakthroughs and future technological advances will be severely constrained.

Compounding this problem, few mechanisms currently exist at the federal level to enable policy-makers and the research community to set long-term priorities in science and engi­neering research, bring about necessary reforms of policies that impede progress, or facilitate stronger cooperation among the many funders and performers of research…

Stanford President John Hennessy, PhD; biochemist Peter S. Kim, PhD; and physicist (and former U.S. Secretary of Energy) Steven Chu, PhD, are among the scientific rock-stars who co-authored the report.

For an excellent piece on the political debate surrounding the report’s release, check out the coverage in Science here. NPR also recently aired a series that colorfully illustrates the effects of research cutbacks, including a piece on a patient suffering from ALS, and a profile of several underemployed scientists.

Becky Bach is a former park ranger who now spends her time writing or practicing yoga. She’s a science writing intern in the Office of Communications and Public Affairs. 

Previously: More attention, funding needed for headache care, “Bold and game-changing” federal report calls for $4.5 billion in brain-research funding, Federal investments in research and higher education key to U.S. maintaining innovation edge

Chronic Disease, Pediatrics, Public Health, Stanford News

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes self-management program helps at-risk teens and their families make healthier choices

Diabetes_coaches_classThe prevalence of Type 2 diabetes among Americans ages 12 to 19 has grown from nine percent to 23 percent in less than a decade. In an effort to reduce U.S. adolescents’ diabetes risk, researchers at Stanford developed a school-based program where medical residents train healthy at-risk teens to be self-management coaches for family members diagnosed with Type 2 diabetes.

Researchers tested the initiative, called the Stanford Youth Diabetes Coaches Program, over the course of a year at three Bay Area high-schools serving primarily ethnic minority youth of low socioeconomic status. The study involved 97 adolescents – 49 student coaches and 48 non-participant students. Student coaches participated in an eight-week training course that was taught by family medicine residents and modeled after the Stanford University Diabetes Self-Management Program for adults. All participants completed pre- and post-study questionnaires and a select group of student coaches and family members gave in-depth interviews.

The program emphasized communication skills, problem solving and setting achievable goals using action plans. Beyond providing basic diabetes knowledge, the program also included guidance on nutrition, healthy meal planning, physical activity, weight management and stress management and on developing relationships with health-care providers. Student-coaches engaged with their family members during weekly 30-minute sessions where they shared information about topics they learned in class, discussed their relatives’ experiences and goals and helped them make an action plan for the week. In discussing their findings, study authors’ wrote:

The results of the study indicate that the Stanford Youth Diabetes Coaches Program increases knowledge and psychosocial assets of participant youth … Youth participants also reported positive changes in their own lives as the coached family members, and family members emphasized the importance of student coaches’ role in encouraging healthy behaviors. Additionally youth participants reported high program satisfaction.

These results substantiate current work suggesting that school-based programs benefit adolescents and that children have potential to support the self-management of family members with diabetes. Evidence strongly suggests that school-based programs hold promise to improve the health of at-risk adolescents.

“This study really speaks to the question of: How do you engage teens about their health?,” said first author Liana Gefter, MD, a research associate in Stanford’s Center for Research and Education in Family and Community Medicine. “The effectiveness of the program is rooted in the idea of empowering students to be a leader in a setting where they are traditionally only told what to do. A lot of the students really had a transformation during the eight-week course. Our findings demonstrated that after only eight weeks, compared to non-participants, students had significant increases in self-worth and belonging – assets that have been shown to be necessary precursors for adopting healthy behaviors. In this way, we believe the program could lay the foundation for sustainable health improvement.”

During interviews with researchers, student coaches and diabetes patients said the program inspired them to improve their diet and increase their regular physical activity. Additionally, they noted that the program strengthened their relationships with each other, and students reported their appreciation for having a physician come into their classroom.

In light of the program’s success, Gefter and colleagues Nancy Morioka-Douglas MD, MPH; Eunice Rodriguez, MPH, DrPH, and Lisa Rosas, MPH, PhD, are working to expand the program to underserved schools at other sites in California and around the country. Pilots are currently underway, or will begin, at campuses in Delaware, Georgia, Washington, Ohio and Michigan.

Previously: Sugar intake, diabetes and kids: Q&A with a pediatric obesity expert, Have you voted in the Healthy Living Innovation Awards?, Diabetes prevention program trains youth in chronic disease self-management and Stanford Diabetes Coaches Class selected as 2011 Healthy Living Innovation Awards finalist
Photo by Stanford Youth Diabetes Coaches Program

Big data, Chronic Disease, Clinical Trials, Health and Fitness, Public Health

Stanford to launch Wellness Living Laboratory

Stanford to launch Wellness Living Laboratory

1200px-Female_joggers_on_foggy_Morro_Strand_State_BeachIf you’re the kind of person who wears a heart monitor while jogging, tracks your sleep with an app or meditates to lengthen your lifespan, then a new Stanford project, called WELL, just might be for you.

WELL, which stands for the Wellness Living Laboratory hasn’t started quite yet — it will launch in 2015 — but when it does, it will unleash a variety of cutting-edge tools in an effort to define health.

Health seems like a no-brainer, but it is more than the absence of disease, says John Ioannidis , MD, DSc, the head of the Stanford Prevention Research Center. Ioannidis wants to find out how people can be “more healthy than healthy.”

To do that, he secured $10 million and laid out plans for the project. WELL plans to enroll thousands of volunteers — who Ioannidis calls “citizen scientists” — in two initial locations: Santa Clara County, Calif., and China, with plans to expand to other sites in the future.

Participants may be able to select which health factors to track and to report much of their information remotely and digitally, although some in-person visits may be required. Participants will also have the opportunity to enroll in a variety of clinical trials to test various interventions, such as nutrition counseling or smoking cessation programs.

The program will focus on wellness, rather than diseases, with the hypothesis that promoting wellness thwarts diseases, Ioannidis said.

Volunteers who would rather not provide health information will also have the opportunity to benefit from access to a program-wide social networking effort that will spread news of successful practices, he said. “This outer sphere could reach out to tens of millions of people,” Ioannidis told me.  Stay tuned to learn how to sign up.

The $10 million came as an unrestricted gift to Stanford University from Amway’s Nutrilite Health Institute Wellness Fund.

Previously: Medicine X explores the relationship between mental and physical health, Stanford partnering with Google [x] and Duke to better understand the human body, New Stanford center aims to promote research excellence and Teens these days smoking less but engaging in other risky behaviors
Photo by: Mike Baird

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