Published by
Stanford Medicine

Cancer, Health Policy, NIH, Public Health

Draining the cancer swamp

Draining the cancer swamp

4011473415_46405053bd_zThere’s an old adage that applies to many difficult situations that we face in life: When you’re up to your armpits in alligators, it’s difficult to remind yourself that you should have drained the swamp.

I’ve come to view cancer as a vicious predator lurking in dark waters, eager to attack one out of two of us in our lifetimes. Cancer is the second most common cause of death in the United States.

Looking at the current national funding model for cancer research, I wonder if society has lost track of a vital goal: preventing cancer, not just treating it. Wouldn’t it be better if we prevented cancer in the first place? Cancer prevention would reduce the devastating physical, psychological, emotional, social and economic burden placed on patients, their families and their friends.

As he stepped down from the role of Director of the National Cancer Institute, Harold Varmus, MD, spoke about the deep complexity of cancer and the tremendous amount of basic research that needs to be done. While recognizing the need for clinical testing, he also called for more pioneering discoveries into who gets cancer, where and why.

The financial constraints facing scientific research force us to make difficult choices. Right now, our current health-care model prioritizes “identifiable individuals” over “statistical individuals.” Identifiable individuals are those real persons in distress who have been diagnosed with cancer. They need treatment, and we are highly motivated to help cure them. The cost of doing so, however, is high: The average monthly cost of cancer treatment has more than doubled to $10,000 over the last decade. Of course, we are willing to pay the costs – these victims are our mothers, our fathers, our sons and our daughters.

Statistical individuals are those who may be at risk, but they may not know it. They may never know that scientific research “rescued” them from a devastating disease. Through prevention measures enacted by individuals themselves (e.g., getting more exercise, avoiding tobacco use) or by society (e.g., limiting chemical exposures in the environment, banning the use of tanning beds for minors), these individuals may be able to escape the scourge of cancer.

When making choices about where to invest limited dollars, it is so much easier to say “no” to statistical people rather than real people.

I don’t advocate taking money away from cancer treatment, but I do advocate a greater investment of federal dollars in research that leads to reducing the incidence of cancer in the healthy population. By tracking and analyzing patterns and trends of cancer, we can identify potential risk factors and inform individuals and communities about positive changes they can make toward living cancer-free lives.

It is estimated that over 50 percent of the 585,720 cancer deaths in the U.S. in 2014 were related to preventable causes. As such, federal dollars directed toward statistical individuals will save both money and lives.

We need to drain the swamp. Our ultimate societal goal shouldn’t be to treat cancer more effectively, but to prevent it altogether. We need to intervene as early as possible in the trajectory of cancer. By doing so, we will greatly reduce the extent and depth of human suffering.

Donna Randall, PhD, is chief executive officer of the Cancer Prevention Institute of California.

Photo by William Warby

Genetics, Research, Stanford News

Genetic study supports single migratory origin for aboriginal Americans

Genetic study supports single migratory origin for aboriginal Americans

In a long list of hypotheses going back decades, researchers have tried to explain the peopling of North and South America as a series of separate waves of immigration by ancient people from Siberia. For decades, in fact, researchers have been arguing about how many distinct peoples walked over the massive, 600,000-square-mile land bridge that once connected Siberia and Alaska and, also, how many thousands of years ago each of those migrations occurred.

In the last few years, some researchers have begun to suspect that a single group of Siberians may have walked onto that land bridge and became marooned there for several thousand years before traveling the rest of the way into the Americas. But others have been holding out for a two-wave hypothesis, with a first wave of Asians from as far away as India and a later wave of people from farther north.

Today, in Science, an international team of geneticists, evolutionary biologists, and statisticians concluded that all Native Americans descended from a single immigration event out of Siberia. The team looked at the DNA from 110 modern Native Americans and 23 who died 200 to 6,000 years ago and compared their genomes to those of more than 3,000 individuals from around the world.

One of the lead authors is María Ávila-Arcos, PhD, a postdoctoral researcher in the lab of Stanford professor of genetics Carlos Bustamante, PhD. Ávila-Arcos led many of the statistical analyses for the paper, including comparison of whole human genomes from diverse Native American populations—both modern and ancient. Bustamante is also a co-author, along with Stanford professor of structural biology and of microbiology and immunology, Peter Parham, PhD, five other Stanford researchers, and dozens of researchers from around the world.

“For a long time,” Bustamante told me, “we’ve sought to understand the genetic history of the first people to populate the Americas and how they relate to modern day populations. This project brought together a large interdisciplinary team and amassed the largest data set to date on this problem. We found strong evidence for a single major wave and subsequent divergence of the founding population.”

The new genetic analysis suggests that the first immigrants to America left Siberia no more than 23,000 years ago, and then lived in isolation on the grassy plains of the Beringia land bridge for no more than 8,000 years. Those plains disappeared beneath rising seas 10,000 years ago.

Once in the Americas, ancient Native Americans split into two major lineages about 13,000 years ago. One lineage populated both North and South America and one stayed in North America.

Previously: Kennewick Man’s origins revealed by genetic studyUsing genetics to answer fundamental questions in biology, medicine and anthropology and Melting pot or mosaic? International collaboration studies genomic diversity in Mexico
Video by National Climatic Data Center/NOAA via DarthMaximolonus

Imaging, Immunology, Mental Health, Neuroscience, Research, Stanford News

Are iron, and the scavenger cells that eat it, critical links to Alzheimer’s?

Are iron, and the scavenger cells that eat it, critical links to Alzheimer's?

iron linkIf you’ve been riding the Alzheimer’s-research roller-coaster, brace yourself for a new twist on that wrenching disease of old age.

In a study published in Neurobiology of Aging, Stanford radiologists Mike Zeineh, MD, PhD,  and Brian Rutt, PhD, and their colleagues used a ultra-powerful magnetic-resonance-imaging (MRI) system to closely scrutinize postmortem tissue from the brains of people with and without Alzheimer’s disease. In four out of five of the Alzheimer’s brains they looked at, but in none of the five non-Alzheimer’s brains, they found what appear to be iron-containing microglia – specialized scavenger cells in the brain that can sometimes become inflammatory – in a particular part of the hippocampus, a key brain structure that’s absolutely crucial to memory formation as well as spatial orientation and navigation.

Zeineh and Rutt told me they don’t know how the iron gets into brain tissue, or why it accumulates where it does. But iron, which in certain chemical forms can be highly reactive and inflammation-inducing, is ubiquitous throughout the body. Every red blood cell that courses through our microvasculature is filled with it. So one possibility – not yet demonstrated – is that iron deposits in the hippocampus could result from micro-injury to small cerebral blood vessels there.

As surprising as the iron-laden, inflamed microglia Zeineh, Rutt and their associates saw in Alzheimer’s but not normal brains was what they didn’t see. Surprisingly, in the brain region of interest there was no consistent overlap of either iron or microglia with the notorious amyloid plaques that have been long held by many neuroscientists and pharmaceutical companies to be the main cause of the disorder. These plaques are extracellular aggregations of a small protein called beta-amyloid that are prominent in Alheimer’s patients’ brains, as well as in mouse models of the disease.

Because they weren’t able to visualize small, soluble beta-amyloid clusters (now believed to to be the truly toxic form of the protein), Rutt and Zeineh don’t rule out a major role for beta-amyloid in the early developmental stages of pathology in Alzheimer’s.

Continue Reading »

Health Disparities, Mental Health, Pediatrics, Public Health

Stanford study of mental illness in incarcerated teens raises policy questions

Stanford study of mental illness in incarcerated teens raises policy questions

depressionMental illness is an even bigger problem for jailed teenagers than experts previously realized.

That’s the take-away message from a Stanford study, publishing today in the Journal of Adolescent Health, which compared 15 years’ worth of hospital stays for adolescents in California’s juvenile justice system with hospitalizations of other California kids and teens. Experts already knew that juvenile inmates are more likely than other young people to have mental health problems, but the new study gives fresh perspective on the scope of the issue.

The research team, led by Arash Anoshiravani, MD, an adolescent medicine specialist at Lucile Packard Children’s Hospital Stanford, looked at 15 years of hospital-stay data for California’s 11- to 18-year-olds. From a total of almost 2 million hospitalizations, about 11,000 were for incarcerated youth.

Of these 11,000 hospital stays, 63 percent were due to mental-health diagnoses. In contrast, just under 20 percent of the hospital stays by adolescents from the general population were prompted by mental illness. Hospital stays were also longer for the incarcerated teens, suggesting more severe illness.

However, the kinds of diagnoses were pretty similar between the two groups, with depression and substance abuse the most common. From our press release about the new study:

The types of diagnoses suggest that many incarcerated teens’ mental health problems developed in response to stressful and traumatic childhood experiences, such as being abused or witnessing violence, Anoshiravani said.

“They’re regular kids who have had really, really horrible childhoods,” he said, adding that he hopes the new data will motivate social change around the problem.

“We are arresting kids who have mental health problems probably related to their experiences as children,” he said. “Is that the way we should be dealing with this, or should we be getting them into treatment earlier, before they start getting caught up in the justice system?”

Previously: Online health records could help high-risk teens, study finds, Lucile Packard Children’s Hospital partners with high schools on student mental health programs and Increasing awareness and advocacy of emotional disorders with mental health first-aid programs
Photo by ryan melaugh

Addiction, Behavioral Science, Genetics, Research

Alcohol-use disorder can be inherited: But why?

Alcohol-use disorder can be inherited: But why?

man-69287_1280Drop into any support group meeting, and you’ll likely find that many of the addicts there had a parent who was also an addict. It’s estimated that alcoholism (now sometimes called alcohol-use disorder) is 50 percent heritable, although researchers have struggled to identify genes specifically associated with the condition.

The hunt continues for alcohol-use disorder related genes, and a new frontier in the field is the study of the epigenome, a term that refers to inherited changes that affect gene expression, rather than the genes themselves. A new review by a team based at the University of Pittsburgh School of Medicine in the journal Alcohol compiles all that is known about the effects of the epigenome on alcohol inheritance.

“Only recently, with improvements in technology to identify epigenetic modifications in germ cells, has it been possible to identify mechanisms by which paternal ethanol (alcohol) exposure alters offspring behavior,” the researchers wrote.

The basic mechanism is that traits can be passed on through modification of the proteins associated with DNA; these proteins control how genes are expressed. Several studies have examined the role of a father’s alcohol use in the time period surrounding conception, finding their children more likely to suffer from some psychiatric disorders; in research on mice, some effects of paternal alcohol use include low birth weight and decreased grooming. These effects are likely attributed to the alteration of the development of sperm, the researchers write.

Many mysteries remain, leaving plenty of opportunities for additional research. Now, the team is starting to examine how paternal exposure affects offspring’s alcohol consumption.

Previously: Alcoholism: Not just a man’s problem, Could better alcohol screening during doctor visits reduce underage drinking? and Are some teens’ brains pre-wired for drug and alcohol experimentation?
Image by geralt

Health and Fitness, Nutrition, Obesity, Research

Can food mentions in newspapers predict national obesity rates?

Can food mentions in newspapers predict national obesity rates?

New_York_TimesFood words trending in today’s newspapers could help predict a country’s obesity rates in three years, according to findings recently published in the journal BMC Public Health. 

In the study, researchers examined whether media mentions of food predate obesity prevalence by analyzing mentions of foods in New York Times and London Times articles over the past 50 years. Using this data, they statistically correlated it with each country’s annual Body Mass Index, or BMI. Brennan Davis, PhD, lead author of the study and an associate professor of marketing at California Polytechnic State University, said in a release that results showed:

The more sweet snacks are mentioned and the fewer fruits and vegetables that are mentioned in your newspaper, the fatter your country’s population is going to be in 3 years, according to trends we found from the past fifty years … But the less often they’re mentioned and the more vegetables are mentioned, the skinnier the public will be.

Researchers say the research could help public health officials better understand the effectiveness of current obesity interventions.

Previously: Adventurous eaters more likely to be healthy, new study shows, Want kids to eat their veggies? Researchers suggest labeling foods with snazzy names, Can edible “stop signs” revive portion control and curb overeating? and Can dish color influence how much you eat?
Photo by Jaysin Trevino

Big data, Cancer, Genetics, Immunology, Research, Science, Stanford News

Linking cancer gene expression with survival rates, Stanford researchers bring “big data” into the clinic

Linking cancer gene expression with survival rates, Stanford researchers bring "big data" into the clinic

Magic 8 ball“What’s my prognosis?” is a question that’s likely on the mind, and lips, of nearly every person newly diagnosed with any form of cancer. But, with a few exceptions, there’s still not a good way for clinicians to answer. Every tumor is highly individual, and it’s difficult to identify anything more than general trends with regard to the type and stage of the tumor.

Now, hematologist and oncologist Ash Alizadeh, MD, PhD; radiologist Sylvia Plevritis, PhD; postdoctoral scholar Aaron Newman, PhD; and senior research scientist Andrew Gentles, PhD, have created a database that links the gene-expression patterns of individual cancers of 39 types with the survival data of the more than 18,000 patients from whom they were isolated. The researchers hope that the resource, which they’ve termed PRECOG, for “prediction of cancer outcomes from genomic profiles” will provide a better understanding of why some cancer patients do well, and some do poorly. Their research was published today in Nature Medicine.

As I describe in our release:

Researchers have tried for years to identify specific patterns of gene expression in cancerous tumors that differ from those in normal tissue. By doing so, it may be possible to learn what has gone wrong in the cancer cells, and give ideas as to how best to block the cells’ destructive growth. But the extreme variability among individual patients and tumors has made the process difficult, even when focused on particular cancer types.

Instead, the researchers pulled back and sought patterns that might become clear only when many types of cancers, and thousands of patients were lumped together for study:

Gentles and Alizadeh first collected publicly available data on gene expression patterns of many types of cancers. They then painstakingly matched the gene expression profiles with clinical information about the patients, including their age, disease status and how long they survived after diagnosis. Together with Newman, they combined the studies into a final database.

“We wanted to be able to connect gene expression data with patient outcome for thousands of people at once,” said Alizadeh. “Then we could ask what we could learn more broadly.”

The researchers found that they were able to identify key molecular pathways that could stratify survival across many cancer types:

In particular, [they] found that high expression of a gene called FOXM1, which is involved in cell growth, was associated with a poor prognosis across multiple cancers, while the expression of the KLRB1 gene, which modulates the body’s immune response to cancer, seemed to confer a protective effect.

Alizadeh and Plevritis are both members of the Stanford Cancer Institute.

Previously: What is big data?Identifying relapse in lymphoma patients with circulating tumor DNA,  Smoking gun or hit-and-run? How oncogenes make good cells go bad and Big data = big finds: Clinical trial for deadly lung cancer launched by Stanford study
Photo by CRASH:candy

Global Health, Health Policy, Stanford News

Stanford India Health Policy Initiative fellows are in Mumbai – come follow along

Stanford India Health Policy Initiative fellows are in Mumbai - come follow along

India Health Policy students

Today, I’m on my way to India to join the 2015 Stanford India Health Policy Initiative fellows. These fellows are part of a program that designs and conducts collaborative student projects focused on generating new, on-the-ground insight into the factors that distinguish health-delivery success and failure. This summer, the four fellows are Mark Walsh, a rising senior who is majoring in economics; Pooja Makhijani, a second-year medical student; and Lina Vadlamani and Hadley Reid, both rising seniors who are majoring in human biology.

The students are spending seven weeks investigating the pharmaceutical networks in urban Mumbai in an effort to understand how informal providers interface with these networks and whether it impacts how providers practice, prescribe and dispense medication. The fellows are traveling house to house to investigate community preferences for medications.

We’ll be updating this Storify page with stories on their time there, and we’ll be tweeting from @StanfordHP (and using the hashtag#StanfordHealthIndia) over the next few weeks. I hope you’ll follow along.

Beth Duff-Brown is communications manager for the Center for Health Policy and Center for Primary and Outcomes Research (CHP/PCOR).

Photo, of Walsh, Makhijani and Vadlamani, courtesy of CHP/PCOR

Dermatology, Public Health, Stanford News

It’s never too early to protect your skin from sun damage

It's never too early to protect your skin from sun damage

I’m not ashamed to admit that I dork out for Disneyland. I was there a few weeks ago, wearing a Minnie Mouse T-shirt and sprinting from one thrill ride to the next. But this trip was different in one respect: I made sure to apply a broad-spectrum sunscreen to my face and limbs before heading into the Magic Kingdom and then brought along the tube so that I could reapply it throughout the day.

Growing up, I was happy that my skin picked up a tan easily, with only occasional sunburn. As an adult, I watched the evidence pile up about the hazards of sun exposure and tried to remember to use sunscreen in the summer months when I was outside for long periods of time. But after speaking with several Stanford dermatologists for a story about skin protection for the recent issue of Stanford Medicine magazine, I resolved to be more vigilant year-round.

As my story notes, one in five Americans will develop skin cancer in their lifetime. One good way of warding off that threat is to use a broad-spectrum sunscreen, many of which are now much lighter and less greasy that the sunscreens of old.

“Your sunscreen should be considered your facial lotion,” dermatology professor Susan Swetter, MD, told me. “It works to moisturize the skin as well as to prevent photoaging and skin cancer.”

The story also includes tips for protecting your skin and for encouraging children to develop good skin-protection habits at an early age. Parents seem to be taking the message to heart: As I made my way through the crowded streets of Disneyland, one scent stood out among all of the others. The unmistakable smell of sunscreen.

Previously: This summer’s Stanford Medicine magazine shows some skinBeat the heat – and protect your skin from the sunWorking to protect athletes from sun dangers and The importance of sunscreen in preventing skin cancer
Illustration by Aleksandar Velasevic

In the News, Pediatrics, Public Health, Stanford News, Technology

Water-conscious hospital will debut in 2017 with expansion of Lucile Packard Children’s Hospital

Water-conscious hospital will debut in 2017 with expansion of Lucile Packard Children’s Hospital

hospital-expansion-exterior-stanford-childrensPlaces where people live and work tend to use a lot of water, and hospitals are no exception. According to the U.S. Environmental Protection Agency’s 2012 report on water use in public buildings, hospitals rank third in water use just behind senior care facilities and hotels.

Now, the Lucile Packard Children’s Hospital Stanford is working to buck this trend with a new expansion that will use the latest water and energy-saving techniques and tools. This 521,000 square foot addition, which will open in 2017, is predicted to use about 38 percent less water than a comparable hospital.

This sustainable approach to building design began long before the current drought situation in California made water conservation a top priority. “In 2008, when we started planning, we knew there was not enough rainfall to sustain even the most efficient hospital’s needs,” said Robin Guenther, lead designer of the expansion project, in a recent post on the Healthier, Happy Lives blog.

In the piece, Guenther and her team discuss some of the expansion’s energy saving features, including shade structures that reduce the building’s heat gain from the sun and moving the hospital’s data center to the roof where it can be cooled by a wind-powered ventilation system instead of by air conditioning. According to Guenther, these modifications will make the building’s thermal energy consumption about 60 percent less than the average hospital in Northern California.

“Sustainability is a guiding principle in everything we do,” Christopher G. Dawes, president and chief executive officer of the hospital, commented. “Everyone on our team shares in this commitment. It’s part of being a good neighbor and a member of the larger community, and ensuring we’re doing the best thing possible when it comes to preserving all of our environmental resources.”

Previously: Green roofs are not just good for the environment, they boost productivity, study shows and From the Stanford Medicine archives: A Q&A with actor Matt Damon on water and health
Image courtesy of Lucile Packard Children’s Hospital Stanford

Stanford Medicine Resources: