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Addiction, Ask Stanford Med, Health Policy, Public Health, Stanford News

Is a proposed ban on smoking in public housing fair?

Is a proposed ban on smoking in public housing fair?

smoking ban sign - 560

Cigarette smoking kills nearly half a million Americans each year, making it the leading preventable cause of death in the United States.

So the Department of Housing and Urban Development thinks it’s time to ban cigarette smoking from some 1.2 million subsidized households across the nation.

HUD Secretary Julián Castro unveiled a proposal last week intended to protect residents from secondhand smoke in their homes, common areas and administrative offices on public housing property.

“We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke, especially the elderly and children who suffer from asthma and other respiratory diseases,” Castro said, adding the proposed rule would help public housing agencies save $153 million every year in health-care, repairs and preventable fires.

Stanford Law School professor Michelle Mello, PhD, JD, who is a core faculty member with Stanford Health Policy, has researched and written about this issue extensively, including in a 2010 article in The New England Journal of Medicine.

In a piece published yesterday, I asked Mello about her views on the federal smoking ban proposal. A sampling of the Q&A:

What would be the greatest benefit to banning smoking in public housing?

There are lots of benefits, but to me the greatest benefit is to the 760,000 children living in public housing. Although everyone knows that secondhand smoke exposure is extremely toxic, not everyone knows how much children in multiunit housing are exposed — even when no one in their household smokes. Research shows that smoke travels along ducts, hallways, elevator shafts, and other passages, undercutting parents’ efforts to maintain smoke-free homes. Also, chemicals from cigarette smoke linger in carpets and curtains, creating hazardous “third-hand smoke” exposure that especially affects babies and small children.

Beth Duff-Brown is communications manager for Stanford Health Policy.

Photo by Getty Images iStock

Research, Stanford News, Surgery

Immune cell linked to surgery recovery time, Stanford scientists find

Immune cell linked to surgery recovery time, Stanford scientists find

surgery shotWe don’t think about doctors getting sick, or about them feeling just as lousy and miserable as the rest of us when they’re recovering. But it happens.

“In medical school I had a chest surgery and had a horrible recovery — in the hospital 10 days, and exhausted for about two months,” recalled Dan Sessler, MD, professor and chair of the Department of Outcomes Research at the Cleveland Clinic, when I spoke with him recently. “I was so tired I couldn’t pick up a remote and turn on the television.”

Sessler did recover — his was a successful surgery — but going into the operation neither he nor his doctor had any inkling that Sessler wouldn’t experience the normal two-week recovery.

Now, research published online in the journal Anesthesiology could lead to an “immune stress test” where blood taken from a patient prior to surgery could help predict when the patients would be back on their feet. The investigators, including co-senior authors/Stanford physicians Garry Nolan, PhD, and Martin Angst, MD, collected blood from 25 hip replacement patients and exposed the blood to chemicals to mimic how the immune system would respond to a traumatic event like surgery. They found the behavior of a white blood cell called a monocyte was related to how quickly patients recovered.

The researchers are working to replicate the findings in a larger study of 80 patients, and they plan to adapt their findings into a test that can run on standard hospital lab machines. As I wrote in our press release about the practical benefits of such a test:

Knowing the likely recuperation times will help patients plan better for their return to work and other post-surgery commitments. For patients at risk for longer recovery times, doctors could schedule additional physical therapy or special care, or the surgery could be postponed while exercise, dietary changes and stress-release techniques are implemented.

As for Sessler, who was not involved in this study, he said he sees great value in adapting the paper’s results into a test. Predicting a patient’s recovery is “clinically important, and we don’t do a good job” of it, he said.

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

Previously: Discovery may help predict how many days it will take for individual surgery patients to bounce back, New device identifies immune cells at an unprecedented level of detail, inside and out and The importance of human connection as part of the patient experience
Photo by ChaNaWiT

Humor, Medical Education, Stanford News, Videos

“Dear Future Doctor, here’s a few things you’ll need to know”: Med students release parody video

"Dear Future Doctor, here's a few things you'll need to know": Med students release parody video

Ready for the first-ever musical parody produced by Stanford medical students? Filmed on campus last month and released this afternoon, Dear Future Doctor features a group of mostly first-years singing and dancing to the tune of one of Meghan Trainor’s recent hits. Featuring characters like the Late Doctor, the Greedy Doctor and the Celebrity Doctor, the song also – in the words of producer/writer/editor/first-year student Gun Ho Lee – aims to teach a lesson “on what the future doctor is NOT to do.”

The song “is meant to be a satire of the 21st century American medical system,” director/writer/ second-year student Joshua Wortzel elaborates. “In her song, Meghan Trainor pokes fun at some of the unfortunate aspects of modern courtship and gender norms” – and Dear Future Doctor, in turn, pokes fun at some of the things that “we medical students learn about becoming doctors.”


Ethics, Research, Science, Stanford News

Clues could help identify fraudulent research before publication

Clues could help identify fraudulent research before publication

4443921690_d3b8c60e91_zLiars leave behind evidence, researchers have found, whether they’re bluffing at poker or fabricating financial reports. Now, a study published in the Journal of Language and Social Psychology has identified clues left by researchers who falsify their work.

The study’s authors examined 253 primarily biomedical papers that were retracted from journals for fraud and compared them to papers from the same journals, time periods and publication topics. They developed a “obfuscation index,” which included abstract language, jargon, positive emotional terms, casual language and a reading difficulty score. Fraudulent papers had higher scores than accurate papers, the team found.

A Stanford Report article explains:

“We believe the underlying idea behind obfuscation is to muddle the truth,” said graduate student David Markowitz, the lead author on the paper. “Scientists faking data know that they are committing a misconduct and do not want to get caught. Therefore, one strategy to evade this may be to obscure parts of the paper. We suggest that language can be one of many variables to differentiate between fraudulent and genuine science.”

The results showed that fraudulent retracted papers scored significantly higher on the obfuscation index than papers retracted for other reasons. For example, fraudulent papers contained approximately 1.5 percent more jargon than unretracted papers.

“Fradulent papers had about 60 more jargon-like words per paper compared to unretracted papers,” Markowitz said in the article. “This is a non-trivial amount.”

Previously: New Stanford Medicine magazine explores bioethics, Using social media in clinical research: Case studies address ethical gray areas and “U.S. effect” leads to publication of biased research, says Stanford’s John Ioannidis
Photo by Alan Cleaver

Big data, Medical Apps, Patient Care, Precision health, Research, Stanford News, Technology

Precision health in practice: Using HealthKit to monitor patients’ blood-sugar levels

Precision health in practice: Using HealthKit to monitor patients' blood-sugar levels

Rajiv Kumar and patient - 560

Imagine having to keep track of your diabetic son’s constantly changing blood sugar levels by typing each individual reading into an email. Then, once in the doctor’s office, having to spend a chunk of your precious time with your clinician waiting for her to download that data.

That was the plight of Lori Atkins, whose son has Type 1 diabetes, until this March, when the Atkins joined a pilot project involving Apple’s HealthKit. Pediatric endocrinologist Rajiv Kumar, MD, is using HealthKit – a new technology that can securely share health data with third-party applications – to more easily monitor the blood-sugar levels of 10 patients.

A recent Inside Stanford Medicine article describes the project:

Patients like Blake wear a continuous glucose monitor that sends 288 blood-sugar readings a day to an Apple mobile device through Bluetooth. The data is securely transmitted via HealthKit into the patient’s electronic medical record at Stanford Children’s Health through the MyChart app.

The system also improves clinical outcomes, Kumar said: “Our endocrinologists are now able to easily assess large volumes of blood-sugar data between clinic visits — and quickly identify trends that could benefit from insulin dosing regimen changes.”

Kumar is planning to expand the use of the app to more of his patients.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health, Harnessing mobile health technologies to transform human health and A picture is worth a thousand words: Researchers use photos to see how Type 1 diabetes affects kids
Photo by Norbert von der Groeben

Ethics, In the News, Parenting, Patient Care, Pediatrics, Stanford News

Parents now help doctors decide what care is right for the sickest babies

Parents now help doctors decide what care is right for the sickest babies

Today, NPR’s Morning Edition featured an in-depth story on the evolution of decision-making in neonatal intensive care units – hospital nurseries for the sickest infants. Parents now have much more say in their babies’ care than in the past, and Stanford experts who were on the front lines of the change, including William Benitz, MD, chief of neonatology at Lucile Packard Children’s Hospital Stanford, explained how it happened.

As medical care for premature and other at-risk babies advanced in the 1970s and early 1980s, doctors gained the ability to save many infants who would once have died soon after birth. But some children in the new category of survivors had lifelong disabilities, with lasting implications for them and their families.

At first, doctors did not realize that this change would affect parents’ desire to participate in planning medical decisions for fragile infants:

“It never occurred to anyone that that might be a reasonable conversation to have,” Benitz says. “We were in unexplored territory.”

As technology improved and doctors tried to save sicker babies, and some born even earlier in gestation, there were new decisions to make: Should the health team put the tiny child on a ventilator? Attempt heart surgery? Those interventions helped many infants survive. Others did not fare as well.

“A lot of them ended up with significant impairments,” Benitz recalls. And doctors started to get pushback. “In the mid-80s we began to hear from families that maybe that wasn’t consistent with their goals for their children.”

As a result, neonatologists began having in-depth conversations with parents about the possible outcomes of different treatments for their infants. The practice is now widespread, and it means a lot to parents like Karin and Chris Belluomini, whose daughter, Joy, was born in May 2015 with Down syndrome, several heart defects and fluid around her lungs.

Continue Reading »

Clinical Trials, Ethics, Health Policy, Public Health, Stanford News

Using social media in clinical research: Case studies address ethical gray areas

Using social media in clinical research: Case studies address ethical gray areas


If a public-health researcher is reviewing Facebook profiles of 14-year-old males for firearm references and discovers photos or words referencing a potentially threatening situation, should the researcher intervene? What levels of privacy should these children expect in the online world?

These are the kinds of difficult questions that ethics consultants are faced with as they attempt to provide moral and legal guidance to researchers gathering health-related data from the Internet.

To help researchers with these nascent ethics issues, the Clinical Research Ethics Consultation Collaborative, a group of almost 50 bioethicists who provide free or low-cost ethics consultations across the United States, has begun publishing case studies on its most ethically challenging cases. Thus far they’ve posted 40 case studies in the categories of behavioral/social science research, clinical trials, genetics, pediatrics, research misconduct and surrogate decision making. The site also includes information on how to participate in educational webinars and collaborative case discussions.

This effort is being led by Benjamin Wilfond, MD, at Seattle Children’s Research Institute and University of Washington, and Mildred Cho, PhD, at the Stanford Center for Biomedical Ethics.

“Our bioethics consortium has learned a great deal from the complex ethics consultations that we’ve been providing since 2005,” said Cho. “Now we have a strategy for sharing these best practices with others, to provide moral and legal guidance to researchers across the country and to better inform policymakers on evolving ethical gray areas.”

More information on the collaborative or to request a consult can be found on this website.

Previously: The challenge – and opportunity – of regulating new ideas in science and technologySocial media brings up questions, ethical unknowns for doctorsBuild it (an easy way to join research studies) and the volunteers will come
Photo by NLshop/Shutterstock

Cancer, In the News, Pediatrics, Stanford News

“Earth angel” brings smiles to sick kids in hospital

"Earth angel" brings smiles to sick kids in hospital

6552156879_1cd906fbab_zHere’s a tale that will tug on your heart strings: It begins in a small town in Pennsylvania, in 1926, at the birth of Joe Manfrey, the fifth child in a family that would eventually grow to nine.

Like many his age, Manfrey served in World War II; his ship was part of the battle of Iwo Jima.

But unlike many of his peers, Manfrey, now 89, is still volunteering twice a week in the cancer unit in the Lucile Packard Children’s Hospital Stanford where he spreads good cheer, hope and sock monkeys. Manfrey was featured in a recent story in the San Jose Mercury News:

“Joe embodies the great values of the Greatest Generation,” said Leslie Griffith, a nurse in the Bass Center for Childhood Cancer and Blood Diseases. “He is funny, engaging and soothing to parents, who can be crying or overwhelmed by a surreal sadness. But just when they feel lost, someone kind and upbeat like Joe arrives — an Earth angel, a beautiful spirit.”

But there’s a twist to Manfrey’s story.

His own son, now 47, survived acute lymphoblastic leukemia as a child, at a time when its survival rates were much lower than they are now. He shows patients a photo of his son as a bald, 5-year-old, and then one as a healthy adult.

“By showing them the pictures together, it lets them know that I personally know what they are going through. It also gives them hope because they can see that Rob grew up to be healthy and strong,” Manfrey said in the article.

“This is not about me,” he emphasized in the story. “I do this for the kids and the parents, in order to take their minds off the difficulties they are going through. I try to make them feel a little more comfortable.”

Previously: California collaboration focuses on analyzing pediatric cancers, A look at the dramatic improvement in pediatric cancer survival rates and Children’s hospital volunteers snuggle infants to soothe tiny patients and reassure their parents
Photo by Clyde Robinson

Chronic Disease, Events, Stanford News

A reminder before World Diabetes Day: “We need more people educated about the disease”

A reminder before World Diabetes Day: “We need more people educated about the disease"

Bay Area native Anna Simos had always been the healthy one in her family — never a candy eater, she said — but, at 15, she was diagnosed with what had been the traditional family illness: diabetes. “My grandmother and uncle had Type 1 diabetes and my father Type 2, so with that diagnosis, I knew what it meant,” she said. “It was sobering and I knew there was no easy way out.” She remembers that day quite clearly. “The doctor brought in a syringe with insulin and told me to give myself a shot. I asked him how many times do I do this every day? Probably four to six, he said. I was not happy.”

Over the years, and through a pancreas and two kidney transplants, Simos learned how to balance her diet, lifestyle, medications and essential medical equipment to live a life with Type 1 diabetes. “I had figured it out for myself, but I began meeting others with diabetes and I decided I would do something with this on-the-job training.” She also earned a master’s degree in public health and a master’s degree in the epidemiology of diabetes.

She received so much of her medical care at Stanford Health Care, she began to dream about what she could do to help there, too. Today, Simos, now a certified diabetes educator and diabetes clinical research coordinator at Stanford, will see one of her combined personal and professional goals met: Stanford Health Care’s first Diabetes Prevention and Wellness Health Fair, being held today in recognition of the upcoming World Diabetes Day.

The fair is a free, public event, and Charlie Kimball, a Formula 1 Indy car driver who has diabetes, will be there to talk about how his experience living with diabetes. Among the other features of the event: Fifteen non-profits and vendors, clinicians from Stanford Health Care and Stanford Children’s Health, and other diabetes education experts will offer free risk assessments, updates on diabetes care technology, food demonstrations and nutrition education. “Everyone’s coming together for the first time,” Simos said. “You’re going to learn something if you come, because it’s not just about diabetes — it’s also about prevention.”

Simos is pushed by the numbers: The Centers for Disease Control and Prevention estimates that 387 million adults have a form of diabetes. About 86 million American adults— more than 1 in 3 are pre-diabetic. That condition, defined by blood sugar levels that are above normal but not high enough for a Type 2 diagnosis, increases the risk of heart disease, stroke and Type 2 diabetes. “Diabetes and pre-diabetes are at epidemic levels,” Simos said. She knows how much easier it is to make the dietary and behavior changes than to develop the disease and possibly suffer the worst of its consequences. “We want to help prevent the transplant, the amputation, the blindness — that we can turn around with care,” she said. “We need more people educated about the disease. If we can just get people to start thinking about their risk factors, we can take a different approach to diabetes: prevention.”

Previously: A conversation about the diabetes epidemic and The role of nutrition in diabetes prevention and management
Photo, of Anna Simos meeting with patient Ed Grey earlier this week, by Norbert von der Groeben

Infectious Disease, Medicine and Society, Parenting, Public Health, Research, Stanford News

California’s vaccination exemptions cluster in white, affluent communities

California's vaccination exemptions cluster in white, affluent communities


California’s measles epidemic was no fluke; between 2007 and 2013 the percentage of kindergarteners using a “personal belief” exemption to enroll in school without vaccinations doubled.

In that year, 3 percent of kindergarteners entered school unvaccinated. In some schools, the percentage of vaccinated children was so low that it threatened herd immunity, or the ability for a population to keep a pathogen at bay, according to Stanford health-policy researcher Michelle Mello, PhD, JD.

To understand the rapid increase, Mello worked with a team led by Tony Yang, ScD, with George Mason University. Their research is published today in the American Journal of Public Health.

They found the highest resistance to vaccinations among white, affluent communities. In contrast to previous studies, however, they did not find a correlation between higher levels of education and vaccine exemptions.

“Beliefs about vaccination risk tend to be more entrenched among certain communities of mothers,” Mello said. The study didn’t investigate reasons for seeking exemption, but other studies suggest some mothers in affluent communities may believe they can adequately protect their children through “intensive parenting techniques” such as an organic diet and restricting contact with sick children, Mello said.

Although California eliminated the personal belief exemption this summer in a broad-reaching law that requires all medically eligible school students to be vaccinated, the study speaks to how other states might approach the problem of vaccine exemptions, Mello said.

Similar clusters of vaccine resistance exist elsewhere and the findings could help public health agencies refine outreach methods, she said. For example, by specifically targeting local groups and reaching out to community leaders, officials may have more success providing education about vaccine risks and benefits, Mello said.

The results are particularly striking given the history of vaccination efforts, she said. In the first half of the twentieth century, public health officials struggled to ensure vaccines reached disadvantaged communities. Now, as fear of the targeted diseases has paled, parents may be more fearful of vaccines, leaving the entire population vulnerable.

Previously: Infectious disease expert discusses concerns about undervaccination and California’s measles outbreak, Stanford researchers analyze California’s new vaccine law and The earlier the better: Study makes vaccination recommendations for next flu pandemic
Photo by woodleywonderworks

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