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Global Health, Health Disparities, Health Policy, Stanford News

Rosenkranz Prize winners devoted to innovative health care in developing countries

Rosenkranz Prize winners devoted to innovative health care in developing countries

African girls studyingMarcella Alsan, MD, PhD, knows that the division of labor among men and women starts at a young age in the developing world.

“Anecdotally, girls must sacrifice their education to help out with domestic tasks, including taking care of children, a job that becomes more onerous if their younger siblings are ill,” Alsan, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) within the Freeman Spogli Institute of International Studies, recently told me.

More than 100 million girls worldwide fail to complete secondary school, despite research that shows a mother’s literacy is the most robust predictor of child survival. So Alsan is analyzing whether medical interventions in children under 5 tend to lead their older sisters back to school. She’ll compile data from more than 100 Demographic and Health Surveys covering nearly 4 million children living in low- and middle-income countries. The surveys ask about episodes of diarrhea, pneumonia and fever in children under 5 and record data on literacy and school enrollment for every child in the household.

“My proposed work lays the foundation for a more comprehensive understanding of how illness in households and early child health interventions impact a critical determinant of human development: an older girl’s education,” Alsan, the only infectious-disease trained economist in the United States, said.

Alsan is one of two winners of this year’s Rosenkranz Prize for Health Care Research in Developing Countries, awarded by CHP/PCOR. Her Department of Medicine colleague, Jason Andrews, MD, is the other recipient of the $100,000 prize, which is given to young Stanford researchers to investigate ways to improve access to health care in developing countries.

In the current scientific climate, most National Institutes of Health grants go to established researchers. The Rosenkranz Prize aims to stimulate the work of Stanford’s bright young stars – researchers who have the desire to improve health care in the developing world, but lack the resources.

While Alsan is researching how older girls in poorer countries are impacted by the health of their younger siblings, Andrews is focusing his attention on cheap, effective diagnostic tools for infectious diseases.

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FDA, Health and Fitness, In the News, Nutrition, Public Health

“They might be slightly healthier, but they’ll still be junk foods”: Expert comments on trans-fat ban

"They might be slightly healthier, but they'll still be junk foods": Expert comments on trans-fat ban

4345026096_35defbf6b0_zAs you’ve probably heard, the FDA ruled last week to ban trans-fats and phase them out of all food products over the next three years. This news has been widely covered, both heralded for its health implications and critiqued for being too long in coming. Yet either way, it is not a panacea, as Stanford Medicine professor Christopher Gardner, PhD, explained when he shared his opinion with me over the weekend:

The true impact of the FDA ban on trans-fats will not be known until we find out what substitutes the food industry finds, and what that does to the sale of junk food and the health of Americans in response to the switch. It could be beneficial. But it isn’t as if trans-fats will be gone and everyone will eat an extra two servings of vegetables in their place.

Gardner, who has spent the past 20 years researching the health benefits of various nutrition components, pointed out that “a lot of good people and excellent scientists worked on this for a long time” and “it took a great deal of effort to assemble the science to demonstrate that this is something so harmful in the American diet that it should be removed with an FDA ban.” He also offered more specifics on what food companies might do following the ban:

The companies making those products are unlikely to remove those junk food products entirely from the shelves of grocery stores across America. Instead, it is most likely that they will look for an alternate form of fat that will serve as closely as possible the same role that trans-fats served. Trans-fats act like saturated fats in terms of being solid rather than liquid at room temperature. This can help the icing on a cupcake stay solid, and it can give a “mouth feel” of solid fat that people like to taste in their food. The goal of the food industry will be to replace the trans-fat with another fat that is solid at room temperature, which likely means the replacement could very well be as bad as the trans fats themselves.

For example, palm oil or esterified stearic acid are likely to be options. For the palm oil, this will mean destruction of rain forests and biological diversity. For esterified stearic acid, this will mean another reason to grow more monocultures of soybeans from which to extract the oil. Both of these will likely have a negative environmental impact. There are likely other choices to consider.

After all this, will those junk foods now be health foods? Absolutely not. They might be slightly healthier junk foods, but still junk foods.

Previously: Want to curb junk food cravings? Get more sleep, Talking to kids about junk food ads, and Trans-fat still lurks in packaged foods
Photo by Kevin

Chronic Disease, Pediatrics, Research

Earlier puberty linked with wide range of health conditions in study

Earlier puberty linked with wide range of health conditions in study

children-516340_1280Given that I have an eight-and-a-half-year-old who looks and often acts much older than her age, puberty has been on my mind a lot lately. (So much so, in fact, that I just got the highly regarded book The New Puberty: How to navigate early development in today’s girls – y’know, just in case). I was interested, then, to come across results of a recent U.K. study that examined the effect of the timing of puberty onset on later physical health.

A Medical Research Council press release nicely summarizes the work, which is the largest of its kind to date:

The study, published in Scientific Reports, confirms previous findings that early puberty in women is a risk factor for heart disease and type 2 diabetes, and showed, for the first time, that early puberty in men also influences these same conditions.

In addition, new links were found between the timing of puberty and a wider range of health conditions, including irritable bowel syndrome, arthritis, glaucoma, psoriasis and depression in men and women, and also early menopause in women.

Researchers tested data from nearly half a million people in UK Biobank, a national study for health research funded primarily by the [Medical Research Council Epidemiology Unit at the University of Cambridge] and the Wellcome Trust. Participants were asked to recall puberty-timing by remembering the age of their first monthly period for women and age at voice-breaking for men.

Those in the earliest or latest 20 percent to go through puberty had higher risks for late-life disease when compared to those in the middle 20 percent, including around 50 percent higher relative risks for type 2 diabetes, heart disease and poor overall health. Furthermore, these disease links were not simply explained by nutritional status or obesity.

It’s important to note that the study relied on self reports versus medical records on puberty timing – which the authors call the main limitation of their work. In addition, as is emphasized in the release, the findings don’t show cause and effect but instead demonstrate “a causal link between puberty and certain diseases.” Still, the results are interesting and appear important enough for more scientific digging; as the authors conclude in the paper, “further work is needed to understand the possible… mechanisms that link puberty timing to later life health outcomes.”

Previously: Study shows former foster kids face higher risk of future health problems“The child is father of the man”: Exploring developmental origins of health and disease and Research shows kids’ health good predictor of parents’ future health
Photo by EME

Cancer, Medical Education, Medicine and Society, Patient Care

Cancer Ninja fights patient misinformation, one cartoon at a time

Screen Shot 2015-06-15 at 1.16.14 PMThere seems to be a trend towards using cartoons for health education: In just the past few months, we’ve posted on children’s books, depression blogs, global-health videos, and art-based clinical skills, all using non-realist art to convey information and qualitative experience. A new blog by Andrew Howard, MD, radiation oncologist at the University of Chicago and the University of Illinois at Chicago, fits right in with this innovative bunch. His blog, Cancer Ninja, aims to use cartoons to convey both how cancer works and what it’s like to be diagnosed and treated for it. Howard started it just one month ago, so his project was fresh from the creative oven when I spoke with him on the phone last week.

What motivated you to start Cancer Ninja?

I’d been frustrated for a while with how little my patients know about cancer. They come in with all these confusions; they don’t understand the difference between chemotherapy and radiation (and from a doctor’s perspective, there’s a huge difference). They don’t understand our rationale for choosing one treatment or another or a combination. One patient was convinced that hot sauce caused cancer and was really upset that she had gotten cancer because she had gone out of her way to avoid hot sauce all of her life. I realized there is a lot of misinformation out there, and that was the purpose for starting this blog.

My wife and I have two little girls, and in the evenings sometimes they say, ‘Draw dinosaurs with me, Daddy!’ So I started drawing with them, and I enjoyed it so much that I would sometimes stay up at night after they had gone to bed, still working on my dinosaur. My wife saw me enjoying that a lot, and thought maybe I could combine this with educating people about cancer.

Your website is targeted to be generally informative about cancer; why did you start with breast cancer? 

Breast cancer is really common in this country, unfortunately, and it’s also very well studied, so we understand a lot about it, which makes it a nice model. There’s a pretty clear algorithm for the proper way to treat a patient with such and such stage breast cancer, so it makes it easy to follow along.

How many characters or episodes are you hoping to do? So far, there’s just “Jane.” 

Screen Shot 2015-06-16 at 1.36.59 PMI’m kind of experimenting. I envision that I’m going to follow Jane though her diagnosis and treatment, but my wife told me that Jane can’t die; she really likes Jane. But 40 percent of people with cancer will ultimately die of their disease, so I want to draw and write about what it’s like to be confronting one’s death, at least as I have witnessed it. What can medicine offer those people, and what can’t it? So I want to introduce a character who dies. I feel like there’s so much that’s already happened in Jane’s story, and I could go back and fill in the details. The mutation steps that turn a cell into a cancer cell, that’s actually a really complicated transformation that I could explore in greater depth.

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Neuroscience, Research, Stanford News

Brain connections last as long as the memories they store, Stanford study shows

Brain connections last as long as the memories they store, Stanford study shows

6732863457_4175ebea30_zIf you find yourself forgetting information you have only your synapses to blame. These connections between neurons are what hold on to memories. When they break, there in a flash goes the name of that new coworker.

That’s been the theory for some time now, but Mark Schnitzer, PhD, who is a professor of biology and applied physics, has now shown it to be true. He was able to watch connections form and break in a region of the brain called the hippocampus, where memories are stored for about 30 days in the mice they worked with.

He and his collaborators found that the average synapse also lasts about 30 days in that region, suggesting that the synapse and the memory are related.

For a story I wrote about the work, Schnitzer told me, “Just because the community has had a longstanding idea, that doesn’t make it right.”

He said that his findings, which were published today in Nature, open up the field to investigating other aspects of memory including in stress or disease models.

Previously: Fly-snatching robot speeds biomedical research, Federal BRAIN Initiative funds go to create better sensors for recording the brain’s activityThe rechargeable brain: Blood plasma from young mice improves old mice’s memory and learning and Individuals’ extraordinary talent to never forget could offer insights into memory
Image by Flood G

Medical Education, Patient Care, Stanford News, Surgery, Videos

Why become a doctor? A personal story from a Stanford plastic surgeon

Why become a doctor? A personal story from a Stanford plastic surgeon

Recent graduates: Never fear if you haven’t picked a career yet; it’s never too late to figure out what you want to do when you grow up. I’m on my third career, and Rahim Nazerali, MD, now an assistant professor of surgery at Stanford, is on his second.

He explains in this recent Stanford Health Care video:

I had a career in international health and I felt like I wasn’t interacting with enough people, I was doing a lot of behind the desk work and I never really interacted with the people I was affecting. I entered medicine for that reason.

And when he entered medical school at Brown University, Nazerali thought he would pursue emergency medicine or orthopedics. But he was wrong again. In the video, he describes a surgery — which he watched on his first day on a plastic surgery rotation — that convinced him that this field was the one for him. Plastic surgeons converted a gaping post-tumor chest hole into a natural looking chest: “You could hardly even tell that anyone was there,” Nazerali said. “At that point, I thought, ‘I want to do that.'”

Now, he’s on the front lines of patient care, where he hopes to stay.

“Many patients come back in after they have their confidence back, after they have their life back, after they have their time with their family back,” Nazerali said. “That’s what makes it really rewarding.”

Previously: Why become a doctor? A personal story from a Stanford oncologist, Students draw inspiration from Jimmy Kimmel Live! to up the cool factor of research careers and Stanford’s senior associate dean of medical education talks admission, career paths

NIH, Pregnancy, Research, Technology, Women's Health

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

Scientists create a placenta-on-a-chip to safely study process and pitfalls of pregnancy

2798127284_487b56b9cf_zThese days it seems that just about anything can be recreated on a microchip. But still, I did a double-take when I read about the new way that scientists are using technology to study pregnancy: They’ve created a “placenta-on-a-chip.”

A functioning placenta is critical for a healthy pregnancy because it regulates the flow of nutrients, oxygen and waste products between the mother and fetus. It also controls the fetus’ exposure to bacteria, viruses and other harmful substances. Researchers would like to learn more about how the placenta acts as a “crossing guard” and how it can regulate the body’s traffic so well. Yet, studying the placenta is hard to do because it’s highly variable, and tinkering with the placenta is risky for the fetus.

To overcome these challenges, an interdisciplinary team led by a University of Pennsylvania researcher created a two-chambered microchip that mimics the structure and function of the human placenta. The study was published online in the Journal of Maternal-Fetal and Neonatal Medicine and is reported on in this National Institutes of Health press release:

The device consists of a semi-permeable membrane between two tiny chambers, one filled with maternal cells derived from a delivered placenta and the other filled with fetal cells derived from an umbilical cord.

After designing the structure of the model, the researchers tested its function by evaluating the transfer of glucose (a substance made by the body when converting carbohydrates to energy) from the maternal compartment to the fetal compartment. The successful transfer of glucose in the device mirrored what occurs in the body.

As Roberto Romero, MD, chief of the perinatology research branch at the NIH’s National Institute of Child Health and Human Development, explains in the press release, this new technology could help researchers explore how the placenta works, and what happens when it fails, in ways that couldn’t be safely done before. This, the researchers say, could lead to more successful pregnancies.

Previously: NIH puts focus on the placenta, the “fascinating” and “least understood” organPlacenta: the video game, The placenta sacrifices itself to keep baby healthy in case of starvation, research showsThe placenta sacrifices itself to keep baby healthy in case of starvation, research shows and Program focuses on the treatment of placental disorders
Photo by Jack Fussell

Bioengineering, Neuroscience, Stanford News, Technology

From brains to computers: How do we reverse-engineer the most mysterious organ?

From brains to computers: How do we reverse-engineer the most mysterious organ?

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So let’s say you want to make a piece of electronics that works just like the brain. Where would you start?

That’s the question neuroscientist Bill Newsome, PhD, director of the Stanford Neurosciences Institute, posed in a recent talk to a Worldview Stanford class on decision-making.

I thought the idea was so intriguing I wrote a series of stories about what it would take to reverse engineer the brain, and how close we are to succeeding at each. We’re still a ways from computers that mimic our own agile noggins, but a number of people are making progress in everything from figuring out where the brain’s wiring goes to creating computers that can learn.

These are the steps Newsome outlined to take us from our own grey goo to electronics with human-like capacities:

  1. Map the connections: Neuroscientists Karl Deisseroth, MD, PhD, and Brian Wandell, PhD, are mapping where the brain’s 100 billion neurons go.
  2. Monitor the signals: Biologist Mark Schnitzer, PhD, and bioengineer Michael Lin, MD, PhD, have created ways of watching signals in real time as they fire throughout the brain
  3. Manipulate the system: Neuroscientists Karl Deisseroth, MD, PhD, and Amit Etkin, MD, PhD, are working on techniques to manipulate the way the brain works and watch what happens.
  4. Develop a theory: Not only do we not know how the brain works, we don’t even really have a theory. Applied physicist Surya Ganguli, PhD, is working to change that.
  5. Digitize the circuits: If you want to turn the brain into electronics you need some wiring that mimics the brain. Bioengineer Kwabena Boahen has made just such a chip.
  6. Teach electronics to interact: Engineer Fei-Fei Li, PhD, has taught a computer to recognize images with almost human-like precision. This kind of ability will be needed by electronics of the future like self-driving cars or smarter robots.

Previously: Neuroscientists dream big, come up with ideas for prosthetics, mental health, stroke and more
Image, based on two Shutterstock images, by Eric Cheng

Stanford News

Stanford Medicine magazine earns national awards

Stanford Medicine magazine earns national awards

heart in SM magPlease join me in a round of applause for Stanford Medicine magazine for recently winning six awards in a national competition, including top prize in the category of “best articles of the year.”

The publication earned a platinum, three golds, a silver and a bronze in the 2015 Circle of Excellence Awards Program, a contest held by the Council for the Advancement and Support of Education, or CASE. The magazine is produced by the School of Medicine’s Office of Communication & Public Affairs and edited by Rosanne Spector.

As my colleague Susan Ipaktchian writes in a news story detailing the magazine’s awards, the judges were “particularly blown away by the depth of the reporting and the degree of access the reporters had to their sources.” More from the piece:

Writer Tracie White earned the sole platinum award in the best-articles category for “Almost without hope,” a look at the heartbreakingly scarce medical resources on an Indian reservation in South Dakota. The judges wrote that they “admired the author’s handling of a subject ripe with standard conventions and hackneyed writing. The author never fell into this trap, capturing the story and delivering it creatively. With a strong fact/narrative balance, the author got this one right. Job well done.”

The magazine earned a gold award for periodical design for its spring 2014 issue, whose theme was mysteries of the heart. The judges said the theme “was carried through the entire magazine in an exceptional way, and we especially loved the variety of interpretations of the theme seen in the illustrations, each of which was compelling, a wonder to look at and a strong partner to the editorial in terms of conveying the subject.” The magazine’s art direction is provided by David Armario Design.

The illustration for “Fresh starts for hearts,” a story in the spring 2014 issue, earned a silver award. The artist who created the image is Jason Holley. “The illustration for this article was beautiful in an artistic way, yet told a story that complemented the article completely,” the judges wrote.

Look for the release of the latest issue of Stanford Medicine in coming days.

Previously: Stem cell medicine for hearts? Yes, please, says one amazing familyKudos for Stanford Medicine magazineBroken promises: The state of health care on Native American reservations and Stanford Medicine magazine writers score two awards
Illustration, from the article “Fresh starts for hearts” in the spring 2014 magazine issue, by Jason Holley

Applied Biotechnology, In the News, Research, Stem Cells, Transplants

“Supplying each cell with a scuba tank”: New advances in tissue engineering

"Supplying each cell with a scuba tank": New advances in tissue engineering

membrane-article.jpgResearchers in the U.K. have found a way to make growing synthetic tissue more sustainable. At present, the size of engineered tissues is limited because the cells die from lack of oxygen when the pieces get too big. By adding an oxygen-carrying protein to the stem cells prior to combining them with tissue scaffolding, the researchers overcame this problem.

The study, led by Adam Perriman, PhD, research fellow at the University of Bristol’s Synthetic Biology Research Centre, and Anthony Hollander, PhD, professor of integrative biology at the University of Liverpool, was published yesterday in Nature Communications. The tissue they were fabricating was cartilage, but the process could potentially be applied to other tissues, as well.

Perriman describes the findings in a press release:

We were surprised and delighted to discover that we could deliver the necessary quantity [of oxygen] to the cells to supplement their oxygen requirements. It’s like supplying each cell with its own scuba tank, which it can use to breathe from when there is not enough oxygen in the local environment.

Hollander also comments on the significance of the research:

We have already shown that stem cells can help create parts of the body that can be successfully transplanted into patients, but we have now found a way of making their success even better. Growing large organs remains a huge challenge but with this technology we have overcome one of the major hurdles.

Creating larger pieces of cartilage gives us a possible way of repairing some of the worst damage to human joint tissue, such as the debilitating changes seen in hip or knee osteoarthritis or the severe injuries caused by major trauma, for example in road traffic accidents or war injuries.

Previously: Building bodies, one organ at a time, How Stanford researchers are engineering materials that mimic those found in our own bodies and A brief look at “caring” for engineered tissue
Photo by Warwick Bromley

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