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Stanford Medicine

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

Events, Pain, Stanford News

Advances in diagnosing and treating a painful and common jaw disorder

Advances in diagnosing and treating a painful and common jaw disorder

3439490784_46b2cfd9e3_zOn New Years Eve, Australian rapper Iggy Azalea shared with her Twitter followers that she was diagnosed with a temporomandibular joint dysfunction (often referred to as TMD or TMJ). The singer is among the estimated 10 million Americans who suffer from the condition, which is more common in women than men and people ages 20 to 40.

Symptoms of the disorder include a stiffness of jaw muscles, limited movement, clicking or locking of the jaw and radiating facial pain. It was previously believed that problems with how the teeth fit together or the structure of the jaw caused the condition. But in talking to Michele Jehenson, DDS, a clinical assistant professor at the Pain Management Center at Stanford, I was told, “There is still a lot we do not know about what causes [temporomandibular joint dysfunction] but one thing we do know is that they are not caused by upper and lower teeth misalignment or improper jaw position. We now believe that TMD susceptibility is, at least, partly genetic.”

Since the causes of the TMD are not clear, diagnosing the condition can be challenging. Currently, there is no standardize test for providers to use to diagnose patients, so physicians continue to rely on the clinical evaluation, including palpation, range of motion and auscultation. But imaging technologies are starting to play a more important role. Jehenson noted, “We now have more accurate imaging such as cone beam CT scans or MRIs. Some dentists use joint vibration analysis or EMG, but these electronic sensors have been shown to be unreliable and lead to over diagnosis.”

Over the past two decades, there as been a significant amount of research on the outcomes of TMD treatments. As Jehenson told me:

Evidence is very clear that aggressive and non-reversible treatments for TMD (braces, jaw surgery, crowns, full time wear of appliance, jaw repositioning) are rarely indicated. The best treatments should be conservative. Depending on the case, treatments are usually a mix of medication (oral or topical), nighttime appliance wear, injections, physical therapies, behavior modification and counseling, sleep and stress management.

To learn more about the diagnosis and treatment of TMD, join Jehenson for a Stanford Health Library talk on Thursday at 7 PM Pacific Time. During the event, she’ll l further discuss evidence based versus non-evidence based treatments. Those unable to attend in person can watch the talk online.

Photo by Eric Allix Rogers

Chronic Disease, Medicine and Society, Mental Health

Boldly Me: Bay Area non-profit helps build self esteem in those who feel different

Alanna headshot

Alanna Powell

Boldly Me is the dream-come-true of founder Alanna Powell, who was diagnosed with Alopecia Universalis as a toddler and consequently spent the majority of her life completely bald. Powell has built upon her own experience with shaky self-confidence and self-doubt to support and inspire those who “feel different.”

I recently had the chance to talk with Powell, who founded the Fremont, CA-based organization in 2009. Boldly Me programming, which aims to improve the psychological health and self-esteem of both kids and adults, takes place around the Bay Area: The Fremont Unified School District has widely adopted it, and Powell reports that Stanford physician Joyce Teng, PhD, MD, is advocating for it to reach Palo Alto schools.

Boldly Me offers a variety of classes and assembly presentations teaching self-compassion and communication, starting with one called “Me and my thoughts.” Programming also includes activities like hula dancing, baton twirling, and arts and crafts, and community events showcase the kids’ talents and celebrate individuality. The company bases its approach on cognitive and dialectical behavioral therapy, and it has volunteer psychologists and doctors on its advisory board.

image

Kids dance hula at a Boldly Me event

While the core of the program is creating personal compassion and self esteem to enable internal resistance to external reactions, it also approaches the problem from the outside by educating peers and parents. However, Powell says that programming directed at parents is often met with defensiveness, so Boldly Me starts with the kids by teaching them how to communicate problems to parents. Once the parents receive this information, they are receptive to suggestions.

Powell’s personal story was initially a big part of the programming; participants found it inspiring. When I spoke with her, she shared how her parents, with the best of intentions, were overprotective and encouraged her to always wear a wig in company. Her self-consciousness limited her in school, and as a young woman she was afraid to get married and have kids because she worried that a bald woman was unlovable. Her now-husband inspired her by saying that if she was afraid of her wig falling off, she should just “go bald!” She began to do things she never thought she would, such as river rafting and roller coasters. But the process of self-confidence is gradual – she wore her wig during labor, nervous to meet her new baby. Now her kids – ages 13, 11, and 9 – talk about their “cool bald mom!”

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Scope Announcements

Scope will return tomorrow

Scope will return tomorrow

MLK statue2

Our office is closed today in observance of Martin Luther King, Jr. Day. Scope will resume publishing tomorrow.

Photo by Zach Frailey

Nutrition, Public Health

Eating for good blood: Tips for boosting iron levels and hemoglobin

Eating for good blood: Tips for boosting iron levels and hemoglobin

eggs and chard

Have you ever gone to donate blood only to be deferred for low iron count? Also referred to as low blood count, low iron, or low hemoglobin, approximately 10 percent of donors are deferred for this reason. When a donor is deferred, that means they’re unable to donate blood that day. You’ve probably wondered why this happens and if there’s anything you can do about it. Hopefully, the following information will shed some light on the subject.

What is iron and what does it have to do with blood donation?

Iron is a nutrient that is found in the foods we eat, which then combines with certain proteins to become hemoglobin in your red blood cells. The red blood cells are important because they carry oxygen from the lungs to other parts of the body. When the body experiences low iron and hemoglobin, this essentially means you do not have enough red blood cells in your body to donate blood. Low iron levels may cause you to feel tired, and extremely low iron levels may cause damage to organs. There are several reasons one may have a low blood count – including not eating enough iron-rich foods, donating blood too frequently, chronic illness, or other invisible causes.

Testing your blood

In order to keep our donors safe and healthy, our collections staff must ensure that each donor we see has sufficient levels of iron and hemoglobin before they donate. Therefore, when you visit a center to donate, the collections staff will do a finger prick to test a small amount of blood to assess hemoglobin levels. If your levels are low, we will not be able to collect your blood that day but do encourage you to try some simple measures to raise your levels in order that you can come back to donate again in the future.

What can I do to improve my hemoglobin levels prior to donation?

One way to try to boost your iron levels is through your diet. By eating iron-rich foods, you can promote blood regeneration and increase the amount of iron in your body. Typically, iron-rich foods are colorful and deeply pigmented. Some examples of good sources of iron include:

  • Chard
  • Dates
  • Eggs
  • Lean beef and pork
  • Raisins
  • Shrimp
  • Spinach
  • Whole grain breads

For a more detailed list of foods and their iron content, the USDA provides a nutrient database for reference.

Kristin Stankus is the digital community & social media specialist at Stanford Blood Center. This blog entry originally appeared on the blood center’s blog.

Photo by Patent and the Pantry

Events, In the News, Public Safety, Stanford News

Stanford biomedical community shows support for those affected by police violence

Stanford biomedical community shows support for those affected by police violence

group on ground - 560

Scores of biomedical students, researchers, faculty and staff  staged a “die-in” yesterday to protest excessive police violence against people of color.

Clad in black “BlackLivesMatter” t-shirts, demonstrators lay down on the medical school’s Discovery Walk while listening to Martin Luther King, Jr.’s “I Have a Dream” speech. The demonstration was organized by the Biomedical Association for the Interest of Minority Students (BioAIMS.)

The demonstration also featured two large posters that prompted viewers to complete the statement “I am privileged because…” or “I have a dream…”

Organizers said they were motivated to stage the demonstration because they felt there wasn’t enough conversation about the issue on the Stanford campus.

The Stanford community is comprised of people with a variety of backgrounds, who come from all sorts of communities, organizer and graduate student Jesus Madrid said. “Do we want to forget what it’s like outside?”

The demonstrators pointed out that violence against minorities is very relevant to biomedical researchers and doctors. “People getting killed is absolutely medically relevant,” said graduate student and organizer Tawaun Lucas.

In addition, it takes widespread societal awareness that extends beyond racial groups to promote change, the organizers said.

BioAIMS president Julie Huang said the group was pleased with the turnout, which topped 150 people.

A few voices from the demonstration:

“On a campus like this, we do need to focus on issues that are globally important.”
Sheri Krams, PhD, associate professor of surgery

“I’m new here, and I wanted to inform myself. In Austria, we absolutely have police violence against minorities.”
—Alex Woglar, PhD, postdoctoral research fellow in developmental biology

“It could have been any of us.”
—Tawaun Lucas, graduate student and member of BioAIMS

BioAIMS intends to keep the dialogue ongoing by hosting a series of upcoming events, including “Transitions into Privilege,” a forum scheduled for Thursday, Jan. 22 from 12-1 PM in the fourth floor reading room at the Li Ka Shing Center for Learning and Knowledge.

Previously: Community violence can increase risk of heart disease, What happens when people witness violence and death? and Gun safety addressed by editorials in three JAMA journals
Photo by David Purger

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

Medicine and Society, Mental Health, Stanford News

Helping those in academic medicine to both “work and live well”

Helping those in academic medicine to both "work and live well"

stethoscope with blue backgroundOne of the perks of working for a university is that I get, like a regular ol’ student, a nice long winter break. I was off work for more than two weeks in late December and early January, and I used the time wisely (if I do say so myself) – by working out a lot, playing lots of games and doing lots of crafts with my young daughters, cleaning out my ridiculously packed garage, and even settling down with a 278-page book I had found the time to check out from my local library. The title (a rather ironic one given that I felt, during those glorious days off, as if I had all the time in the world)? Overwhelmed: Work, Love, and Play When No One Has the Time.

The book was penned by journalist Brigid Schulte and published last March, and I quite enjoyed reading Schulte’s take on, and the science behind, the work-life demands of hard-working professionals (especially ones with kids) and “our addiction to the daily grind.” And while many of her stories – like how she once stopped doing housework in favor of eating soup and watching the rain with her kids – resonated with me personally (ah, the importance of slowing down and savoring life’s little pleasures!), I was also happy to see a shout-out to my place of work.

In a section on workplaces that have been remade to help their employees both “work and live well,” Schulte described how Stanford’s medical school is:

seeking to ‘rewire’ [the beliefs that success in academic medicine only comes from working 24/7] by changing the narrative of success. They have ambitious plans to remake their culture, to provide career counseling and multiple paths to success at various speeds. And they’re starting by showcasing a different kind of role model, in prominent displays along corridors and on the university website, focusing on those who have achieved excellence at work and have a rich life outside of it.

Schulte briefly discussed the work of Hannah Valantine, MD, former senior associate dean for leadership and diversity and now the first chief officer for scientific workforce diversity at NIH, who alongside Stanford colleagues had been working to change the workplace culture in academic medicine. Valantine and pediatrician Christy Sandborg, MD, co-created a pilot program called Academic Biomedical Career Customization (ABCC) in an effort to help faculty achieve balance; the program, which ran from 2012-14 and is described in an excellent 2013 article from the Clayman Institute for Gender Research, encouraged “faculty to address work-life issues by varying their workloads and responsibilities over the course of their careers” and included “a ‘time banking’ system, where faculty earn credits they can cash in for help with certain tasks at work or at home.”

Schulte quoted Valantine as saying, “We decided to include the housework benefits, because when [molecular biologist] Carol Greider got the news that she’d won the Nobel Prize in Medicine, she was doing the laundry.”

While grant funding for the ABCC program ended last year, folks at the Office of Faculty Development and Diversity told me that Stanford is applying the lessons and successes of the program into new work-life and work-flexibility initiatives throughout the School of Medicine.

Previously: Program for residents reflects “massive change” in surgeon mentality, NIH selects Hannah Valantine as first chief officer for scientific workforce diversity, Amplifying the physician-mother voice and Hannah Valantine: Leading the way in diversifying medicine
Photo by Michael Tam

Ebola, Events, Infectious Disease, Stanford News

Physician at forefront of Ebola fight: “Ultimate award” is what you get back from survivors

Physician at forefront of Ebola fight: "Ultimate award" is what you get back from survivors

BauschWhen Lassa fever, a cousin of Ebola, was afflicting hundreds of thousands of people in West Africa in the late 90s, Daniel Bausch, MD, MPH & TM, worked with the federal Centers for Disease Control and Prevention in Guinea to set up a laboratory for study and testing of the rodent-borne disease. Unfortunately, the lab lost its international funding in 2003, as it could have proven useful in preventing the Ebola epidemic, which began in a remote village in Guinea just a few hours away, Bausch told a Stanford audience last week.

“I think back that if we had succeeded in keeping this lab going, how different it would have been if we’d been able to just send a sample down the road,” instead of losing valuable time in shipping the samples to Europe for testing, said Bausch, the keynote speaker at a day-long global health conference.

Today, Bausch, an associate professor at the Tulane School of Public Health and Tropical Medicine, is at the forefront of the Ebola fight, treating patients at an Ebola clinic in Sierra Leone that he helped establish and training and recruiting other clinicians. He is also consulting with the World Health Organization in the development and implementation of treatment guidelines and drug and vaccine testing for the disease.

In 1996, Bausch was working with the CDC in the Democratic Republic of Congo, where dozens of miners were being felled by a strange set of symptoms. The source was identified as Marburg virus, a cousin of Ebola that kills more than 80 percent of victims. While the usual course of spread is from one person to the next, these miners were harboring different variants of the virus, suggesting multiple sources, he said. The disease was traced back to the caves where miners unearthed their gold and where they were exposed to bats — the likely reservoir of the virus, Bausch said. He and colleagues published an article on their Marburg investigation in 2006 in the New England Journal of Medicine.

Because of his rare expertise with hemorrhagic fevers, Bausch was called upon early on to help fight in the latest Ebola outbreak, working alongside West African colleagues in Guinea and Sierra Leone who died of the disease.  He said one bright spot in the epidemic is the speed with which scientists have moved forward in developing new treatments and potential vaccines. “In the last six months, we’ve seen a process that’s unprecedented, with accelerated science and the launch of clinical trials that would normally take years,” he said.

And he said he cherishes the experience of seeing patients who have successfully fought off the disease. He showed a photo of a colleague, draped in white protective gear, alongside a young survivor: a smiling boy in striped pants who had lost his father to Ebola.

“That is the ultimate reward… It means something to you – what you get back from (the survivors),” he said.

The Stanford Global Health Research Convening Day was sponsored by Stanford’s Center for Innovation in Global Health.

Previously: Back home from Liberia, Stanford physician continues to help in fight against EbolaEbola: This outbreak is differentStanford physician shares his story of treating Ebola patients in Liberia and Ebola: A look at what happened and what can be done
Photo, of Daniel Bausch and others in Guinea, courtesy of Bausch

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