Earlier today I wrote about the 50-cent paper microscope developed by Stanford bioengineering professor Manu Prakash, PhD. You can now watch a video of him building and demonstrating the microscope on TED.com. This TED “Talk of Week” has already been viewed almost 300,000 times.

Prakash, who grew up in the mega-cities of India without a refrigerator, is a leader in the frugal design movement. His lab is currently developing a number of global health solutions, leveraging the cost savings of emerging manufacturing techniques such as 3D printers, laser cutters and conductive ink printing.

Previously: Stanford bioengineer develops a 50-cent paper microscope, Stanford bioengineer developing an “Electric Band-Aid Worm Test and Stanford bioengineers create an ultra-low-cost oral cancer screening tool

I have a few friends who can tell pretty quickly when they’ve eaten a food that contains milk or lactose, the sugar found in milk. The signs are unpleasant — mostly gas and diarrhea (yuck!). So they were interested when I told them that a nutrition researcher at Stanford was conducting a clinical trial to test the validity of claims that people who are lactose-intolerant can digest raw milk more easily than pasteurized milk.

Unfortunately for them, the claims don’t hold up.

In my news release about the study, which was published today in the Annals of Family Medicine, professor of medicine Christopher Gardner, PhD, found no difference in digestibility between the two.

Although the study was small — just 16 participants who were lactose-intolerant — the results were highly consistent among all the participants. As Gardner notes in the press release, “It’s not that there was a trend toward a benefit from raw milk and our study wasn’t big enough to capture it; it’s that there was no hint of any benefit.”

One thing that surprised Gardner was how many people believe they are lactose-intolerant because of the symptoms they experience, yet don’t meet the clinical standard for the condition. In fact, Gardner originally recruited 63 potential study participants, but only 43 percent of them actually met the standard.

So, what’s causing the discomfort that this group of people feel when they consume milk products? And would raw milk — which hasn’t been pasteurized and which proponents say contains “good” bacteria that may aid digestion — help folks who don’t meet the clinical definition of being lactose-intolerant? Gardner says he hopes other researchers will try to answer those questions.

Previously: Stanford pediatrician and others urge people to shun raw milk and products
Photograph by chrisdat

With a change of job or marital status, or by provisions of the Affordable Care Act, you switch health-insurance carriers. You move. Your doctor goes out of network, is booked right now, goes on vacation, or retires altogether. You find a new primary care provider. Again.

So how much patient history, and patient-doctor relationship history, gets lost in transition? Scientists from the University of Bristol in the U.K. aimed to answer that question and found that patients are more likely to bring up a health concern with a doctor they’ve built a relationship with over time than with a new doctor.

The researchers’ findings were presented last week at the South West Society for Academic Primary Care (SW SAPC) meeting. From a release:

…researchers collected data from 22 practices in the Bristol area, recording consultations between 190 patients and 30 GPs.

Researchers then looked at whether consultation length and the number of problems and issues raised were affected by patient-doctor continuity.

Analysis showed that almost a third of patients had a ‘deep’ relationship with their GP, which in turn encouraged them to raise 0.5 more problems (a topic requiring a GP to make a decision or diagnosis) and 0.9 more issues (the number of topics raised within each problem, such as symptoms) during each consultation.

This may mean many more problems and issues are addressed over the course of several visits.

Study author Matthew Ridd, PhD, said, “This research study is the first of its kind to show how seeing the same doctor can positively affect consultations.”

Previously: Managing primary care patients’ risky drinking, Future doctors have a lot at stake, even if they don’t know it: A student’s take on the Affordable Care Act, Matching into family medicine and My parents don’t think I’m smart enough for family medicine: One medical student’s story
Photo by Stanford EdTech

E-cigarettes are about to get zapped. To date, across the globe, they’ve been largely unregulated – and their growth since they first came on the scene in 2007 has been exponential. Now, in the first big regulatory action that is sure to spur similar responses across the pond, the European Parliament approved rules last week to ban e-cigarette advertising in the 28 EU member nations beginning in mid-2016.  The strong action also requires the products to carry graphic health warnings, be childproof and contain no more than 20 milligrams of nicotine per milliliter. It’s expected that the U.S. Food and Drug Administration will soon follow suit and the days of great independence for e-cigarettes will come to a crashing halt. A few U.S. cities, Los Angeles most recently, have banned e-cigarettes in public spaces.

Until recently, I was completely ignorant about the whole phenomenon of e-cigarettes. What is the delivery system? Where are they manufactured? Are they a safe alternative to smoking? And how are they being marketed and to whom? Well here’s an eye opener: According to the Centers for Disease Control and Prevention, e-cigarette usage more than doubled among middle and high school students users from 2011 to 2012. Altogether, nearly 1.8 million middle and high school students nationwide use e-cigarettes.

Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, has long studied the effects of tobacco advertising, marketing, and promotion through his center, SRITA (Stanford Research Into the Impact of Tobacco Advertising). After years of detailing how tobacco use became ubiquitous in the U.S. he’s now tracking the marketing of e-cigarettes, and what he’s found probably won’t surprise you. The same sales techniques that brought about the explosive growth of tobacco use are being deployed again to make e-cigarettes look sexy, cool and defiant.

While there are claims by the e-cigarette industry that e-cigarettes are important tools to help people kick the tobacco habit, there’s little evidence to date to back up that claim. And Jackler isn’t completely sold on the notion that e-cigarettes will bring about a great cessation of tobacco smoking; he sees them more as a continuity product. He told me:

What the industry would like to see you do is when you go to a place that you can’t smoke, that you pick up your e‑cigarette and you vape, and you get your nicotine dose in the airport when waiting, or when you’re in your workplace, or when you’re even in school, and that way, when you leave school or the workplace, you go back to the combustible tobacco products.

Sorry if I’m a bit cynical, but as an ex-smoker I find it hard to believe that Big Tobacco – which is increasingly getting into the e-cigarette business – doesn’t also see vaping as a way to continue to keep smokers smoking. Bubble gum flavors and packaging designed to resemble lipstick containers! Who’s really being targeted here?

After my 1:2:1 podcast (above) with Jackler, I’m convinced we’ve been down this road before and it wasn’t pretty health-wise. More than 16 million Americans suffer from a disease caused by smoking. Listen to the podcast and you be the  judge about the true intentions of those promoting e-cigarettes.

Previously: Stanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labels, What’s being done about the way tobacco companies market and manufacture products and Image of the Week: Vintage Christmas cigarette advertisement
Photo by lindsay-fox

When Manu Prakash, PhD, wants to impress lab visitors with the durability of his Origami-based paper microscope, he throws it off a three-story balcony, stomps on it with his foot and dunks it into a water-filled beaker. Miraculously, it still works.

Even more amazing is that this microscope — a bookmark-sized piece of layered cardstock with a micro-lens — only costs about 50 cents in materials to make.

In the video posted above, you can see his “Foldscope” being built in just a few minutes, then used to project giant images of plant tissue on the wall of a dark room.

Prakash’s dream is that this ultra-low-cost microscope will someday be distributed widely to detect dangerous blood-borne diseases like malaria, African sleeping sickness, schistosomiasis and Chagas.

“I wanted to make the best possible disease-detection instrument that we could almost distribute for free,” said Prakash. “What came out of this project is what we call use-and-throw microscopy.”

The Foldscope can be assembled in minutes, includes no mechanical moving parts, packs in a flat configuration, is extremely rugged and can be incinerated after use to safely dispose of infectious biological samples. With minor design modifications, it can be used for bright-field, multi-fluorescence or projection microscopy.

One of the unique design features of the microscope is the use of inexpensive spherical lenses rather than the precision-ground curved glass lenses used in traditional microscopes. These poppy-seed-sized lenses where originally mass produced in various sizes as an abrasive grit that was thrown into industrial tumblers to knock the rough edges off metal parts. In the simplest configuration of the Foldscope, one 17-cent lens is press-fit into a small hole in the center of the slide-mounting platform. Some of his more sophisticated versions use multiple lenses and filters.

To use a Foldscope, a sample is mounted on a microscope slide and wedged between the paper layers of the microscope. With a thumb and forefinger grasping each end of the layered paper strip, a user holds the micro-lens close enough to one eye that eyebrows touch the paper. Focusing and locating a target object are achieved by flexing and sliding the paper platform with the thumb and fingers.

Because of the unique optical physics of a spherical lens held close to the eye, samples can be magnified up to 2,000 times. (To the right are two disease-causing microbes, Giardia lamblia and Leishmania donovani, photographed through a Foldscope.)

The Foldscope can be customized for the detection of specific organisms by adding various combinations of colored LED lights powered by a watch battery, sample stains and fluorescent filters. It can also be configured to project images on the wall of a dark room.

In addition, Prakash is passionate about mass-producing the Foldscope for educational purposes, to inspire children — our future scientists — to explore and learn from the microscopic world.

In a recent Stanford bioengineering course, Prakash used the Foldscope to teach students about the physics of microscopy. He had the entire class build their own Foldscope. Then teams wrote reports on microscopic observations or designed Foldscope accessories, such a smartphone camera attachment.

For more on Foldscope optics, a materials list and construction details, read Prakash’s technical paper.

Previously: Stanford bioengineer developing an “Electric Band-Aid Worm Test, Stanford bioengineers create an ultra-low-cost oral cancer screening tool,
Related: Prakash wins Gates grant for paper microscope development
Photo in featured entry box by Norbert von der Groben

The five most-read stories this week on Scope were:

A closer look at the autoimmune disease vasculitis: In this entry, Cornelia Weyand, MD, PhD, professor and chief of immunology and rheumatology, answers questions about vasculitis. The condition, which involves inflammation in the blood vessels, was in the news last week following the death of writer/actor/director Harold Ramis.

8 reasons medical school debt won’t control my life: In this week’s SMS Unplugged post, Jennifer DeCoste-Lopez outlines steps she’s using to manage debt while completing med school.

Elastic for floppy nerves: Stanford Bio-X scientists have found the secret to how nerves withstand the wear and tear of bending joints and moving tissues: an elastic-like protein matrix that keeps them resilient.

Simultaneous treatment for several food allergies passes safety hurdle, Stanford team shows: A team led by Kari Nadeau, MD, PhD, found that an experimental treatment already being widely tested for single food allergies, called oral immunotherapy, could be modified so that patients can be desensitized to multiple food allergens at the same time.

The ultramarathoner’s heart: An article in the recent issue of Stanford Medicine magazine describes visionary Silicon Valley product designer Mike Nuttall‘s experiences with hereditary heart disease and ultramarathon running.

And still going strong – the most popular post from the past:

The mystery surrounding lung-transplant survival rates: A 2012 article in the San Francisco Chronicle offered a look at the challenges facing lung transplant patients and explored why a significant number don’t live beyond the five-year mark, despite improvements in survival rates.

When astronauts travel into space, their heart muscles don’t have to work as hard to circulate blood because of the lack of gravity. Past research has shown that half of astronauts on missions lasting two weeks or less and nearly all of those who spend four to six months in space suffer from hypotension, or abnormally low blood pressure.

To improve astronaut safety, Stanford researchers have developed a simple device that provides high-fidelity measurements of astronauts’ cardiovascular performance. As reported in a Stanford Report story, the project involved re-engineering a digital bathroom scale so that it is capable of determining cardiac output even in microgravity. Bjorn Carey writes:

After more than a dozen publications on the technology and its performance in human tests, the researchers found that the ballistocardiograph measured by their modified scale could measure cardiovascular activity in equal or better resolution than other clinical mechanical monitoring devices.

In a single 10-second measurement, the scale can glean enough data from a patient to assess his or her cardiovascular risks. [Richard Wiard, a bioengineering doctoral candidate] said that the scale does this with greater accuracy than the standard assessment used today, and also provides a clearer picture of a patient’s (or space-faring astronaut’s) near-term risk.

The above video shows footage from researchers’ ride on what astronauts have affectionately dubbed the “vomit comet,” a fixed-wing airplane that dips and climbs through the air to simulate the feeling of weightlessness.

Previously: Students design special stethoscope for use in space, noisy places, Space: A new frontier for doctors and patients and Fruit flies in space! Researchers hope to learn more about the heart through space-station experiment

This probably won’t grab as many headlines as the news of a smartphone that wakes you up with the sizzle and smell of bacon, but it should!

A team of Stanford scientists is using 3D printing to create inexpensive adapters that make it easy to use a smartphone and an ordinary examination lens to capture high-quality images of the front and back of the eye. And – what seems to me as just as important – providing a nearly effortless way to share those images.

“Think Instagram for the eyes,” said one of the developers, assistant professor of ophthalmology Robert Chang, MD.

This is a big deal because most primary-care doctors have no good way to see into patients’ eyes, and no easy way to share the images. The usual eye-imaging instruments are expensive and hard to use, and even ophthalmologists who have the equipment and know-how find capturing and sharing the images slow going.

As one of Chang’s fellow developers, Stanford ophthalmology resident Dave Myung, MD, PhD, told me when I interviewed him for an article in Inside Stanford Medicine:

“A picture is truly worth a thousand words… Imagine a car accident victim arriving in the emergency department with an eye injury resulting in a hyphema – blood inside the front of her eye. Normally the physician would have to describe this finding in her electronic record with words alone. Smartphones today not only have the camera resolution to supplement those words with a high-resolution photo, but also the data-transfer capability to upload that photo securely to the medical record in a matter of seconds.”

The scientists describe the adapters, currently dubbed the EyeGo, in two articles in the new issue (volume 3, issue 1) of Journal of Mobile Technology in Medicine. And you can read my story to learn more about the development process, including how Myung pieced together the first prototype (with plastic bits he ordered from the Internet and a few Legos), how mechanical engineering graduate student Alex Jais created the first printed model on his own 3D printer, and how residents Lisa He, MD, and Brian Toy, MD, are leading studies to test them out.

Those interested in using an EyeGo adapter for research or beta-testing can e-mail the team at eyegotech@gmail.com.

Previously: Image of the Week: Sigmoid volvulus and Treating common forms of blindness using tissue generated with ink-jet printing technology
Photograph by Dave Myung

“The development of the proposal took over four months, over 500 emails, late nights, early mornings, conference calls, lots of coffee and many meetings,” writes Christopher Buddle, PhD, on his experience as a co-lead author of a large, collaborative research grant proposal. Sound familiar? He notes this is the story of many scientists as well as academics more broadly.

In a post on SciLogs, Buddle describes the emotional highs and lows of the grant-writing process. He writes:

I was waking up at night with thoughts about the grant, and finding that my daily thoughts often drifted towards the grant, and drifted away from whatever else was going on. I would find myself sitting somewhere, looking vacantly into space, with my mind full of ideas about budgets, collaborators and project design. Emails about the grant were always a top priority, were always answered, and I was consistently pushing what I perceived as lower priority to the side. This meant I was not as responsive to my grad students, I was late on review requests, and many other things slipped.

…

Why on earth would I invest so much, given that success is not even guaranteed!

His narrative, and a fun graph illustrating points along the emotional roller-coaster ride, reminded me of twin yoga principles abhyasa, showing up and doing your practice, and vairagya, doing so without attachment to the outcomes.

Participating in the grant-writing process brings its own rewards, even if the proposal is unsuccessful. Buddle explains:

It expands your horizons, and gets you thinking about research problems in new and exciting ways. Writing grant proposal can feed the curiosity, and foster creativity. It hones your writing skills, and makes you think about ways to rephrase, re-write and ‘sell’ the importance of your work. Even unsuccessful grant proposal can be worthwhile because they force you to crystallize your thoughts and package things up neatly…

Previously: How Stanford and Silicon Valley companies are fostering “work-life integration” and Stanford establishes ‘banking system’ to help faculty balance their professional and personal lives

Stand-up comic Tig Notaro brought her unique brand of comedy to Stanford early this week, and she didn’t disappoint the standing-room-only audience of students, faculty, staff and community members gathered on campus.

Notaro, a fairly successful stand-up comic before 2012, exploded on the national scene when she greeted an audience at the Largo in Los Angeles with the words, “Thank you, thank you, I have cancer, thank you, I have cancer, really, thank you.” She then told the audience: “Tragedy plus time equals comedy. But I don’t have the benefit of time. So I’m just going to tell you the tragedy and know that everything is going to be okay.”

In that now legendary comedy set, Notaro went on to share the tragedy of her bi-lateral breast cancer diagnosis, the unexpected early death of her mother, and the ending of a romantic relationship: all within a four-month span. Well-known comedian Louis C.K. was in the audience that night, and he tweeted: “in 27 years doing this, I’ve seen a handful of truly great, masterful standup sets. One was Tig Notaro last night at Largo.”

During her Stanford performance, which was sponsored by the Stanford Storytelling Project, the Stanford Arts Institute and ITALIC, Notaro gave a hilarious impression of a TSA agent trying to pat her down in the front. Notaro chose not to have reconstructive surgery after her bi-lateral mastectomy, so the agent had a hard time deciding if Notaro was a man or a woman. Laughing, Notaro said, “I had small breasts before, and I would joke about them all the time… how small they were.” Pausing for a moment, she grinned and said, “You know, I think my breasts heard me and decided to get revenge.” Notaro’s statement, and the audience’s responding laughter, illustrated what Louis CK has said about her comedy: “It is an amazing example of what comedy can be. A way to visit your worst fears and laugh at them.”

In a Q&A session after her performance, Notaro said using comedy to deal with her cancer was a “godsend. I hadn’t planned to talk about it as part of my act, but it just came out.” And today, she says, she’s glad it did. “I get letters every day from people who have been diagnosed with cancer, or people who have lost a loved one to cancer. If my comedy can help just one person who has to travel the same journey I have traveled, it is worth it.”

Jacqueline Genovese is assistant director of the Arts, Medicine and Humanities Program within the Stanford Center for Biomedical Ethics.

Previously: Saying thank you with art: Stanford undergrad pens one-woman play on cancer
Photo courtesy of Tig Notaro