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Humor, Medicine and Literature, Research, Science

Can science journals have beautiful prose?

Can science journals have beautiful prose?

5331998702_2e6ab9e5e8_zScientific journals are not known for being scintillating or inspiring reading. But could they be? A recent article in Nature elaborated on an online discussion started by Stephen Heard, an ecologist at the University of New Brunswick.

In a guest post on the Tree of Life science blog, Heard argued that snappier, livelier writing could attract and retain more readers. “Style and beauty are not incompatible with scientific writing,” he wrote. Papers could appeal to undergraduates, science writers, politicians, and the public.

But is a journal really an appropriate outlet for such writing? Blogs and commentaries might be better mediums for creativity and literary flair, as research articles often must adhere to a more rigid format and provide detailed descriptions of materials, methods and results. Participants in the online discussion have pointed out that clarity and order have a beauty in themselves, the inexorable logic on display in the progression from hypothesis to data to results. Others worried that stylishness would make science research less accessible to non-native speakers of English. Some mentioned (and critiqued) the conventional idea that whimsy and humor cover up flawed science and detract from clarity. And many others praised the idea of incorporating pleasure along with function.

In the original piece, Heard suggested three reasons scientists don’t write beautifully more often:

It could be that writing beautifully in scientific papers is a bad idea, and we know it. Perhaps readers don’t respect scientists who resist the conventional turgidity of our writing form. I don’t think this is true, although I’m aware of no formal analysis.

Or it could be that beauty is a good idea, but well-meaning reviewers and editors squash it. In my paper I argue that beauty (like humour) can recruit readers to a paper and retain them as they read; but that reviewers and editors tend to resist its use. But again, there’s no formal analysis, so I was forced to make both halves of that argument via anecdote.

Or it could be we just don’t have a culture of appreciating, and working to produce, beauty in our writing. I think this is most of the explanation: it’s not that we are opposed to beauty as much as it doesn’t occur to us that scientific writing could aspire to it.

He sees three ways this could change: scientists can add some whimsy to their own writing, leave it in others’ writing when editing, and praise it when they see it. He exclaims:

Wouldn’t it be great if there was an award for the best scientific writing of the year? I don’t mean the best science – we have plenty of awards for that – but the best writing to appear in our primary literature. Such awards exist for lay science writing; if one existed for technical writing I’d be thrilled to make nominations and I’d volunteer to judge.

Heard keeps his own science blog, Scientist Sees Squirrel.

Photo by Ashley Campbell

Cancer, Health Disparities, Patient Care, Research, Stanford News

Study shows evidence-based care eliminates racial disparity in colon-cancer survival rates

Study shows evidence-based care eliminates racial disparity in colon-cancer survival rates

For the past two decades, the National Cancer Institute has documented that African-American patients have consistently had lower survival rates in colon cancer when compared with white patients. In a study published today in the Journal of Clinical Oncology, lead author Kim Rhoads, MD, PhD, and colleagues from Stanford show that receiving high quality, evidence-based treatment can eliminate this racial disparity. As Rhoads explains in our press release:

Historically, we’ve taken less than a critical eye on our own health-care system in terms of how we can take the lead in addressing disparities. The big take away in this paper is that it’s treatment, not necessarily patient factors, but following evidence-based guidelines that gives all patients the best chance for survival. Our work also suggests a real opportunity to equalize these racial differences.

The evidence-based guidelines were created by the National Comprehension Cancer Network, which used clinical trials and medical research to create step-by-step, evidence-based treatments for most cancers. However, adherence to those guidelines depends on the facility and research shows that minority patients tend to receive care from hospitals that have low adherence rates.

The study found that integrated health-care organizations, which provide all of a patient’s health-care services, hospital care and insurance, delivered evidence-based care for colon cancer at a higher rate than non-integrated health-care organizations. In these facilities, all patients had higher survival rates and racial disparity for colon cancer survival disappeared.

“In integrated systems, there’s already a big push to thinking about following evidence-based guidelines, so everyone within that system is in the same mindset,” said co-author Manali Patel, MD, MPH. “It’s easier to do the right thing when you have the system-level support to do so.”

Integrated health-care systems are well suited for coordinating care among several specialists, which is another advantage for colon-cancer patients, because the treatment of colon cancer requires different types of treatments and different types of specialists, the study pointed out.

The results support the development of integrated health care models as envisioned by Affordable Care Act.

“With health-care reform, millions more patients are coming into the system, and we’re going to need to become more integrated in order to meet the demand. We’re going to need to work more closely together, decrease variations in care and standardize what we do,” Rhoads told me. “In this paper, we have a model that shows that when you do this, you get better colon cancer outcomes for everyone.”

Previously: Stanford researchers examine disparities in use of quality cancer centers, Uncommon hero: A young oncologist fights for more humane cancer care and Report shows continuing health disparities for racial and ethnic minorities

Complementary Medicine, In the News, Mental Health, Pediatrics, Research, Stanford News

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

Stanford researchers to study effectiveness of yoga-based wellness program at local schools

kids_yogaManaging stress and making healthy choices is a daily struggle for many of us. But what if way back in elementary school we had learned resiliency skills and mind-body practices to cope with anxiety, reduce incidents of bulling and violence, and boost our cognitive ability? Would this training have helped us keep our flight-or-fight response in check and live healthier lives?

A four-year study conducted by researchers at Stanford aims to answer these questions. The project will evaluate a yoga-based health and wellness program involving 3,400 students at the Ravenswood City School District. The program, which has been funded for three years by the Sonima Foundation, includes exercise-based on yoga, basic fitness regimes, relaxation techniques, mindfulness practices and nutrition. As the San Jose Mercury News reports:

The plan is to employ a multi-method approach that involves biology, physiology and psychology — a complete bio-psychosocial assessment — to measure [students’] emotions and behavior, academic and cognitive strengths and weaknesses, brain activity and structure, stress-related hormone levels, and sleep patterns.

“We’re really looking forward to a year from now — when I tell you this is effective — for you not to only take it on my word, but for you to also have data,” said Dr. Victor Carrion, a professor of psychiatry and behavioral sciences at [Stanford].

Carrion is also the director of the Stanford Early Life Stress and Pediatric Anxiety Program at Lucile Packard Children’s Hospital.

In 2012, he launched a mindfulness program in the Ravenswood City School District to treat post-traumatic stress disorder in teens that was featured on a PBS NewsHour segment. Jones and his wife happened to catch the broadcast, and because Carrion has done pro bono work with students and parents in the community for years, the partnership between the district, Stanford and the Sonima Foundation was forged.

The four-year study is also in partnership with the Center for Education Policy and Law at the University of San Diego.

“This is something that for years has been a gap in our educational system,” Carrion said. “There’s nothing… that teaches children to socialize and to be in touch with their emotions and to take care of their inner health.”

Previously: Stanford researchers use yoga to help underserved youth manage stress and gain focus, Yoga classes may boost high-school students’ mental well-being and Study shows meditation may lower teens’ risk of developing heart disease
Photo by Nicole Mark

Patient Care, Pediatrics, Public Health, Research, Stanford News

Study finds gaps in referring California’s tiniest babies to follow-up care

Study finds gaps in referring California's tiniest babies to follow-up care

preemie feet2When very fragile babies go home from the hospital after birth, they often require special follow-up care. But a new Stanford study has found that some high-risk infants aren’t receiving referrals to the follow-up care they need.

The study, which appears in the February issue of The Journal of Pediatrics, analyzed statewide data on more than 10,000 California babies born in 2010 and 2011 who were considered high risk because they had very low birth weights. Of those who survived to hospital discharge, 20 percent did not receive referrals to the state’s high-risk follow-up program.

From our press release on the research:

Babies who weigh less than 3.3 pounds at birth, nearly all of whom are born prematurely, are at risk for a variety of neurologic and developmental problems in childhood. In California, all babies with a very low birth weight who received care in a California Children’s Services-approved neonatal intensive care unit qualify for a state-supported, follow-up program that provides diagnostic assessments and services until they turn 3.

“If we cannot succeed in that first step of getting these babies referred to follow-up, we’re at a critical disconnect for what we can offer them as they grow and develop,” said Susan Hintz, MD, professor of neonatal and developmental medicine and lead author of the study.

The study analyzed which very-low-birth-weight babies were receiving referrals. Neonatal intensive care units that treated more of these babies referred a higher proportion of such patients to follow-up care, and babies with several types of medical problems were more likely than others to receive referrals. Babies whose birth weights were on the higher end of the low-weight category were less likely to get referrals, as were those of African-American and Hispanic descent.

The good news, however, is that the data was collected just after California revamped its high-risk follow-up program. Hospitals with low referral rates are already receiving feedback to help them improve, and those with high referral rates are being studied to see how their successes can be transferred to other settings. More from our release:

“We’ve already made substantial improvements in site-specific online tools and resources available to hospitals for nearly real-time feedback, and referral rates now appear to be higher than they were during 2010 and 2011,” Hintz said.

California is ahead of other states in having a comprehensive, statewide program to help high-risk infants, [she] added. “The expectation that all our high-risk infants will be referred is enormously innovative in this country,” she said.

Previously: Preemies face increased risk of death in early adulthood, Stanford study finds, NICU trauma intervention shown to benefit mothers of preemies and How Stanford researchers are working to understand the complexities of preterm birth
Photo by Jenny

Aging, Cancer, Research, Stanford News

Stanford researchers deliver double punch to blood cancer

Stanford researchers deliver double punch to blood cancer

Acute myeloid leukemia is an aggressive and deadly cancer affecting cells that turn into our blood. Now, a study published in Nature Medicine shows that a drug known to cause cell death might be effective for a particular subtype of this lethal disease.

To get an idea of just how aggressive and deadly acute myeloid leukemia is, consider the survival rates for the 13-14,000 American adults who are sickened each year. The overall survival rate is 30-40 percent, according to Stanford cancer researcher Ravindra Majeti, MD, PhD, but if patients are over 65 years old, the survival rate dips to just 5 percent. The majority of acute myeloid leukemia patients are elderly.

Apoptosis, or cell death, of tumors is the goal in cancer treatments. There are multiple pathways leading to cell death, and identifying ways to nudge cancer cells towards dying is the focus of much cancer research.

But sometimes the path to cell death is nonlinear and hard to find.

In this work, a team of Stanford cancer researchers led by Majeti and Steven Chan, MD, identified a two-pronged attack for acute myeloid leukemia cancer cells. The researchers first focused on mutated proteins called isocitrate dehydrogenase 1 and 2 (known as IDH1/2 for short). Cancer cells containing mutated IDH1/2 proteins often survive traditional chemotherapy treatments, contributing to relapse, and they exist in 15 percent of acute myeloid leukemia patients. The second focus of the Stanford researchers was the BCL-2 gene, which is known to enable cancerous growth by putting the brakes on cell death in acute myeloid leukemia and other cancer cells. Simply stopping BCL-2 activity in acute myeloid leukemia patients is not very effective, as indicated by low survival rates for the disease.

The Stanford scientists found that giving a drug that inhibits BCL-2 successfully lifted the blockade on cell death, but only in cells with mutated IDH1/2 proteins. Majeti said the drug that promotes cancer cell death by inhibiting BCL-2 is now in clinical trials.

Kimberlee D’Ardenne is a writing intern in the medical school’s Office of Communication and Public Affairs.

Previously: The latest on stem-cell therapies for leukemia, Blood cancers shown to arise from mutations that accumulate in stem cells and Leukemia prognosis and cancer stem cells

Global Health, Haiti, Research, Stanford News

Health care in Haiti: “At risk of regressing”

Health care in Haiti: "At risk of regressing"

streets of Haiti - smallAs an undergraduate at Duke University, Maxwell Kligerman stumbled into an amazing scientific opportunity. He spent the summer of 2009 collecting data on the availability of health-care facilities in Leogane, Haiti, a coastal city with a population of about 50,000 to support the work of Family Health Ministries, a non-profit founded by Duke reproductive endocrinologist David Walmer, MD.

With a guide, Kligerman walked every street in Leogane, tabulating the location and characteristics of even the most modest doctors’ offices.

His tally was important for local residents and some global health scholars, but certainly not anything with worldwide relevance.

We still need to keep Haiti on our radar. It’s been five years since the earthquake, but now is really the tipping point.

Then, on Jan. 12, 2010, the magnitude 7.0 Haitian earthquake struck, its epicenter just five miles from Leogane. Kligerman had unique, pre-earthquake data that could show the effects of the quake on local health-care opportunities. He could see what happened when the city experienced an influx of foreign aid and how the quake affected the trajectory of its development.

Taking advantage of his rare opportunity, Kligerman returned to Leogane in both 2011 and 2013, collecting information about the availability of health-care facilities.

Now, Kligerman is a third-year medical student at Stanford and recently published his findings in The American Journal of Tropical Medicine and Hygiene, in collaboration with Walmer and Stanford’s Michele Barry, MD, senior associate dean for global health, and Eran Bendavid, MD, assistant professor of medicine.

He has a critical message for those interested in global health: “We still need to keep Leogane and Haiti on our radar. It’s been five years since the earthquake, but now is really the tipping point.”

Before the earthquake, Leogane had 25 health-care facilities, ranging from a small doctors’ offices to large hospitals. Eleven of those buildings collapsed during the earthquake.

But soon, the international community swooped in, upping the number to 28. By 2013, Leogane had 34 healthcare facilities, many offering free care. Yet although the numbers look rosy, change is on the horizon.

Doctors without Borders, which operates the only full-service hospital, has announced plans to close the facility in 2015. That alone will dramatically reduce the availability of health care to Leogane residents, Kligerman said.

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Clinical Trials, Patient Care, Public Health, Research, Stanford News

Screening for diseases doesn’t necessarily save lives, study shows

Screening for diseases doesn't necessarily save lives, study shows

6143531948_a9bdfe6fb5_zIt seems like it should work: If everyone was tested for every disease, lives would be saved, right? These conditions would be spotted quickly, treated and voilà – the deadly disorder would go away.

Not necessarily, according to a new study from a team led by Stanford epidemiologist John Ioannidis, MD, DSc, published this week in the International Journal of  Epidemiology. Here’s Ioannidis:

Screening for diseases that can lead to death typically does not prolong life substantially; a few screening tests may avert some deaths caused by the disease being screened, but even then it is difficult to document an improvement in overall survival.

Ioannidis and his team examined whether screening prevents death in 19 diseases with 39 screening tests, looking at evidence from randomized controlled trials and from meta-analyses combining the results of the trials. Patients were asymptomatic when tested.

In their meta-analysis, the researchers found that mortality from the disease dropped in these cases: ultrasound for abdominal aortic aneurysm in men, mammographyfor breast cancer, and fecal occult blood test and flexible sigmoidoscopy for colorectal cancer. But no other tests reduced the number of deaths caused by the disease in meta-analyses.

What gives?

The test might not be able to detect accurately enough early stages of the disease, or there might not be life-saving treatments available, Ioannidis and colleagues write.

Ioannidis acknowledges that screening might ward off other ill-effects of disease aside from death. But in general, few screening tests among the many new ones being proposed are subjected to a randomized controlled trial before they are introduced, Ioannidis said.

“This is unfortunate. All screening tests should be evaluated with rigorous randomized controlled trials. I see no alternative to prove that they are worth being adopted in large populations,” he told me.

This work follows another recently published paper, in which Ioannidis and colleagues argue that screening all baby boomers for hepatitis C isn’t necessarily beneficial.

Previously: To screen or not to screen for hepatitis C, Bad news for pill poppers? Little clear evidence for Vitamin D efficiency, says Stanford’s John Ioannidis, John Ioannidis, MD: Research’s researcher and Screening could slash number of breast cancer cases
Photo by david_jones

Aging, Genetics, Immunology, Infectious Disease, Research, Stanford News

In human defenses against disease, environment beats heredity, study of twins shows

In human defenses against disease, environment beats heredity, study of twins shows

Pfc. Lane Higson and Pfc. Casey Higson, identical twins serving in Iraq with the Enhanced Combat Aviation Brigade, 1st Infantry Division. The twins, natives of Myrtle Beach, S.C., joined the Army together and have not separated since.I’m one of those people who’ve paid to have their genomes analyzed for the purpose of getting a handle on susceptibility to this or that disease as time goes by. So it was with great interest that I came across a new study of twins conducted by immunologist Mark Davis, PhD, and fellow Stanford investigators. The study, published in CELL, shows that our environment, more than our heredity, plays the starring role in determining the state of our immune system, the body’s primary defense against disease. This is especially true as we age.

Improving gene-sequencing technologies have focused attention on the role of genes in diseases. But the finding that the environment is an even greater factor in shaping our immune response should give pause to anyone who thinks a whole-genome test is going to predict the course of their health status over a lifetime.

“The idea in some circles has been that if you sequence someone’s genome, you can tell what diseases they’re going to have 50 years later,” Davis told me when I interviewed him for a news release I wrote on the study. But, he noted, the immune system has to be tremendously adaptable in order to cope with unpredictable episodes of infection, injury and tumor formation.

Davis, who heads Stanford’s Institute for Immunity, Transplantation and Infection, is worth taking seriously. He’s made a number of major contributions to the field of immunology over the last 30 years or so.  (Not long ago, I wrote an article about one of those exploits for Stanford Medicine.)

To find out whether the tremendous differences observed between different people’s immune systems reflec tunderlying genetic differences or something else, Davis and his colleagues compared members of twin pairs to one another. Identical twins inherit the same genome, while fraternal twin pairs are no more alike genetically than regular siblings, on average sharing 50 percent of their genes. (Little-known fun factoid: The percentage can vary from 0 to 100, in principle, depending on the roll of the chromosomal dice. But it typically hovers pretty close to 50 percent, just as rolling real dice gives you a preponderance of 6s, 7s, and 8s. Think of a Bell curve.)

Because both types of twins share the same in utero environment and, usually, pretty close to the same childhood environment as well, they make great subjects for contrasting hereditary versus environmental influence. (If members of identical-twin pairs are found to be no more alike than members of fraternal-twin pairs with respect to the presence of some trait, that trait is considered to lack any genetic influence.)

In all, the researchers recruited 78 identical-twin pairs and 27 pairs of fraternal twins and drew blood from both members of each twin pair. That blood was hustled over to Stanford’s Human Monitoring Center, which houses the latest immune-sleuthing technology under a single roof. There, the Stanford team applied sophisticated laboratory methods to the blood samples to measure more than 200 distinct immune-system cell types, substances and activities.

Said Davis: “We found that in most cases – including your reaction to a standard influenza vaccine and other types of immune responsiveness – there is little or no genetic influence at work, and most likely the environment and your exposure to innumerable microbes is the major driver.”

It makes sense. A healthy human immune system has to continually adapt to its encounters with hostile pathogens, friendly gut microbes, nutritional components and more.

“The immune system has to think on its feet,” Davis said.

Previously: Knight in lab: In days of yore, postdoc armed with quaint research tools found immunology’s Holy Grail, Deja vu: Adults’ immune systems “remember” microscopic monsters they’ve never seen before and Immunology escapes from the mouse trap
Photo by DVIDSHUB

Biomed Bites, Cancer, Obesity, Research, Stanford News

Stanford researcher tackles tricky problem: How does a cell become a fat cell?

Stanford researcher tackles tricky problem: How does a cell become a fat cell?

Here’s this week’s Biomed Bites. Check each Thursday to meet more of Stanford’s most innovative biomedical researchers.

Mary Teruel had no intention of becoming a biology professor — after all, she was in a PhD program for aeronautical engineering. But the more she learned about cells, the more fascinated she became.

“I became very interested in the challenging problem of trying to understand the complex network in cells and trying to see if you could apply some of the principles from engineering to understand theses processes and make an insight into human disease,” Teruel says in the video above.

Teruel’s drive to investigate cells led her into her current role as an assistant professor of chemical and systems biology, where she’s striving to unravel a puzzle that underlies the obesity crisis in America: How do cells called pre-adipocytes (or pre-fat cells) become adipocytes (or adipocytes)?

By learning more about cell differentiation, Teruel’s research can also shed light on processes — and potential treatments — involved in cancer.

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Secrets of fat cells discovered, Fed Up: A documentary looks for answers about childhood obesity and How physicians address obesity may affect patients’ success in losing weight

Addiction, Pain, Public Health, Research

Medical marijuana and the risk of painkiller overdose

Medical marijuana and the risk of painkiller overdose

medical marijuanaAfter a study published this fall showed that that opioid overdoses (e.g., with painkillers such as Oxycontin) occur at lower rates in states with legalized medical marijuana, many people interpreted the results as proof that using medical marijuana lowers an individual’s risk of overdose. For example, some speculated that marijuana allows people in pain to forgo using opioids or at least use them in lower doses. Other suggested that medical marijuana reduces users’ consumption of alcohol and anti-anxiety medications, both of which make opioid use more likely to lead to overdose. Still others hypothesized that medical marijuana improves mental health, reducing the risk of intentional opioid overdose (i.e., suicide attempts),

However, all of this speculation was premature. Many things that are associated when geographic areas are compared are not associated in the lives of the individuals who reside in those areas. For example, geographic areas with higher rates of cigarette smoking and higher radon exposure have lower cancer rates, even though individuals who smoke and/or get exposed to radon have higher rather than lower risk of cancer.

The only way to understand the influence of medical marijuana on individuals’ risk of opioid overdose is to actually research individuals, and that is what an Australian team has done. In a recently published study of more than 1,500 people who were on prescribed opioids for pain, they examined experiences with medical marijuana.

Seeking pain relief from medical marijuana was common in the sample, with 1 in 6 participants doing so and 1 in 4 saying they would do so if they had ready access to it. The results did not support the idea that medical marijuana users are at relatively low risk of opioid overdose. Indeed, on every dimension they appeared to be at higher risk than those individuals who did not use medical marijuana for pain.

Specifically, relative to individuals who only used opioids for pain, the medical marijuana users were on higher doses of opioids, were more likely to take opioids in ways not recommended by their doctor, were over twice as likely to have an alcohol use disorder and four times as likely to have a heroin use disorder. Medical marijuana users were also over 50 percent more likely to be taking anti-anxiety medications (benzodiazepines), which when combined with opioids are particularly likely to cause an overdose.

Neither did the medical marijuana users have better mental health. Almost two-thirds were depressed and about 30 percent had an anxiety disorder.   These rates were half again as high as those for non-medical marijuana users.

Medical marijuana thus appears to be commonly sought for pain relief among people who are taking prescribed opioids for pain. But in this population, it’s a marker for much higher rather than lower risk for opioid overdose.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He has served in the past as a senior advisor in the Office of National Drug Control Policy in Washington, DC. He can be followed on Twitter at @KeithNHumphreys.

Previously: Assessing the opioid overdose epidemicTo reduce use, educate teens on the risks of marijuana and prescription drugs and Study shows prescribing higher doses of pain meds may increase risk of overdose
Photo by David Trawin

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