The FDA announced today its plans to regulate e-cigarettes. The news comes as little surprise to many, including Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, who studies the effects of tobacco advertising, marketing, and promotion through his center, the Stanford Research Into the Impact of Tobacco Advertising. I asked Jackler this morning what he thought of the FDA’s plan, and he had this to say:
While I welcome the FDA proposal to deem electronic cigarettes as tobacco products under their regulatory authority, I’m disappointed with the narrow scope of their proposal and the snail’s pace of the process. Given its importance, I’m particularly troubled by the FDA’s failure to address the the widespread mixing of nicotine with youth-oriented flavorings (e.g. gummy bears, cotton candy, chocolate, honey, peach schnapps) in electronic cigarettes products. Overwhelming evidence implicates such flavors as a gateway to teen nicotine addiction [which] led the FDA to ban flavors (except for menthol – which is presently under review) for cigarettes in 2009. Give the lethargic pace of adopting new regulations, a generation of American teens is being placed at risk of suffering the ravages of nicotine addiction.
In a podcast last month, Jackler spoke in-depth about the rise of, and problems with, e-cigarettes. If you haven’t yet listened, now is a great time to.
During finals, one of my college roommates would ritualistically sit in silence and knit an entire hat before she could begin studying. The steady, repetitive action calmed her down and cleared her mind. (Before less stressful exams, she baked.)
I thought of her when coming across a recent post on The Checkup that points to evidence, including previous research in seniors with mild cognitive impairment, that the health benefits experienced by people who engage in activities such as knitting and crocheting might be more than anecdotal. More from the piece:
In one study, 38 women hospitalized for anorexia were given a questionnaire about their psychological state after being taught to knit.
After an average of one hour and 20 minutes of knitting a day for an average of three weeks, 74 percent of them reported less fear and preoccupation with their eating disorder, the same percentage reported that knitting had a calming effect, and just over half said knitting gave them a sense of pride, satisfaction and accomplishment.
That might have been why Pee-wee Herman found the unsolved mystery of his stolen bike so unnerving: “It’s like you’re unraveling a big cable-knit sweater that someone keeps knitting and knitting and knitting…” he said in the 1985 film Pee Wee’s Big Adventure.
Rockefeller University neurobiologist Cori Bargmann, PhD, is quoted in today’s New York Times as saying optogenetics is “the most revolutionary thing that has happened in neuroscience in the past couple of decades.” The article is a profile piece of Karl Deisseroth, MD, PhD, the Stanford researcher who helped create the field of optogenetics, and it reveals how a clinical rotation in psychiatry led him to this line of work:
It was eye-opening, he said, “to sit and talk to a person whose reality is different from yours” — to be face to face with the effects of bipolar disorder, “exuberance, charisma, love of life, and yet, how destructive”; of depression, “crushing — it can’t be reasoned with”; of an eating disorder literally killing a young, intelligent person, “as if there’s a conceptual cancer in the brain.”
He saw patient after patient suffering terribly, with no cure in sight. “It was not as if we had the right tools or the right understanding.” But, he said, that such tools were desperately needed made it more interesting to him as a specialty. He stayed with psychiatry, but adjusted his research course, getting in on the ground floor in a new bioengineering department at Stanford. He is now a professor of both bioengineering and psychiatry.
Last week, my colleague reported on a new Stanford study showing that free drug samples lead to more expensive prescriptions. Over the weekend, dermatologist Al Lane, MD, senior author of the study, appeared on PBS NewsHour to discuss the implications of his findings. (He’s also quoted in a New York Timesblog post on the research.) After mentioning that pharmaceutical companies spend more than $6 billion a year on sampling, he told NewsHour’s Hari Sreenivasan “that [this] cost eventually has to be paid by someone.” And he closes on a powerful note:
One of the focuses of our study was for the dermatologists to realize that although they think they’re helping the patients, they’re really being manipulated to write for more expensive medications with no proven benefit of those medications over the generic drugs.
In case you missed it, The Washington Post recently took a look at how the Obamas are bringing flavors of healthy eating and activity into their home. An article describes how a culture of health drives not only President and First Lady Obama, but also influences their family, members of the current administration and nation-wide initiatives.
From the piece:
Earlier this year, there was an intense battle for bragging rights inside the complex as teams of six with names such as “Runnin’ Like Amtrak,” from Vice President Biden’s staff, and “Team Engage (Our Core),” from the Office of Public Engagement, earned a point for every 30 minutes of “moderate-to-vigorous physical activity” performed each day. Each team totaled its points each week.
“The culture here has shifted pretty dramatically, in direct ways and indirect ways, based on their leadership,” said Sam Kass, executive director of first lady Michelle Obama’s Let’s Move initiative and the White House senior policy adviser for nutrition policy. “I think we really live that. I think that’s been a transformation for the kitchen
In Obamaworld, the methods staff members use to reach their diet and fitness goals reflect their faith in the power of technology and data. Council of Economic Advisers Chairman Jason Furman, [PhD,] who got kudos from the president after he lost 50 pounds, surveyed the scientific literature on weight loss, tracked his food consumption and rate of physical behavior electronically and converted it into a spreadsheet to analyze it properly.
Past presidents and presidential candidates have taken different stances on eating and exercise behavior; as the article notes, “the cultural shift has political consequences.”
The texture of a food – whether it’s creamy or crunchy – may influence a person’s overall consumption and his perception on whether the food is calorie-rich or diet-friendly. That’s according to findings recently published in the Journal of Consumer Research.
For the study, researchers conducted five laboratory studies during which individuals were asked to sample hard, soft, rough or smooth foods and then give calorie estimations for each food. During one of the experiments, participants were asked to watch TV ads while eating bit-sized brownies. As the Huffington Post reports:
… half of the participants were asked to estimate how many calories they thought the brownies had, while the other half were not. Within these groups, half of the participants were given brownie bits that were soft, while the others were given ones that were hard.
Among the participants who were not asked to focus on the calorie content of the brownies, they consumed more soft brownie bits than hard brownie bits. However, among the participants who were asked to focus on the calorie content, they consumed more of the hard brownie bits than the soft ones.
The study is part of a growing body of scientific evidence showing that several factors can impact whether we consider foods to be healthy or fattening and how much we eat. Past research has shown that people frequently underestimate the calories they’re eating and that many of us tend to overeat in sit-down restaurants rather than fast-food spots. Additionally, the sequence of foods may affect how we calculate calorie content, and the color of tableware can influence how much we eat.
Cancer. It’s been called “The Big C,” but the more we study it, the more it resembles hundreds of little c’s, each with its own unique molecular makeup. The differentiation exists both among patients with cancers in the same site (the various sub-types of breast cancer, for example) as well as within a single patient. This latter phenomenon is referred to as “intra-patient tumor heterogeneity,” and it has profound implications for the future of cancer treatment, including the viability of so-called “targeted therapies” receiving so much attention and hope.
Many cancer tumors tend to be chaotic mixes of different cell types, some more aggressive – and therefore more dangerous – than others. Chemotherapy and the emerging category of more specific “targeted therapeutics” work by acting on a known characteristic of a particular cancer cell type, like accelerated replication rates or a specific genetic mutation. But in a complex tumor, not all cells will exhibit that specific characteristic, or at least not do so at the same time. Also, it is possible for cancer cells to adapt and become resistant to a particular therapy, in a partially analogous way in which evolution works on a macroscopic scale.
A recent opinion piece published online in the journal The Scientist points out that intra-patient heterogeneity can also involve treatment-relevant difference between the primary tumor and metastases, as well as among metastases. Written by Stanford Cancer Institute Director Beverly Mitchell, MD; David Rubenson, associate director for administration and strategic planning; and Daniel S. Kapp, MD, professor emeritus of radiation oncology at Stanford, the article discusses these matters in detail and lays out many of the significant scientific and clinical questions surrounding the potential for treating cancers with targeted therapies. This fall, the Stanford Cancer Institute will convene an international symposium to discuss these questions and a range of related issues.
Information on the symposium, titled “Intra-patient Tumor Heterogeneity: Implications for Targeted Therapy,” will soon be available on the Stanford Cancer Institute website.
Test day approaching? Get your game face on. A study of a computer program that recognizes and interprets facial expressions has found that identifying students’ level of engagement while learning may predict their performance in the class. Computer scientists at the University of California, San Diego and Emotient, a San Diego-based company that developed the facial-recognition software used in the study, teamed with psychologists at Virginia Commonwealth and Virginia State universities to look at “when and why students get disengaged,” study lead author Jacob Whitehill, PhD, researcher in UC San Diego’s Qualcomm Institute and Emotient co-founder, said in a release.
The authors write in the study, which was published in an early online version in the journal IEEE Transactions on Affective Computing:
In this paper we explore approaches for automatic recognition of engagement from students’ facial expressions. We studied whether human observers can reliably judge engagement from the face; analyzed the signals observers use to make these judgments; and automated the process using machine learning.
“Automatic engagement detection provides an opportunity for educators to adjust their curriculum for higher impact, either in real time or in subsequent lessons,” Whitehill said in the release. ”Automatic engagement detection could be a valuable asset for developing adaptive educational games, improving intelligent tutoring systems and tailoring massive open online courses, or MOOCs.”
Gesamkunstwerk, my favorite German word and a term commonly associated with the operas of Richard Wagner, can be translated as a “total work of art” playing to many of the senses and synthesizing numerous art forms. The word came to mind as I read about a pilot study using theater as an environment for children with autism-spectrum disorders to explore “communication, social interaction, and imagination skills – the ‘triad of impairments’ seen in autism,” a New Scientist piece notes, “engaging all the children’s senses at once.”
Twenty-two children ages 7-12 attended one weekly 45-minute session for 10 weeks involving improvisation exercises led by trained performers in enclosed make-believe environments such as a forest or outer space.
As well as looking at whether behaviours used to diagnose autism changed after the drama sessions, the researchers also assessed emotion recognition, imitation, IQ and theory of mind – the ability to infer what others are thinking and feeling. Subjective ratings were also gathered from parents and teachers and follow-up assessments were conducted up to a year later.
At the early assessments, all children showed some improvement. The most significant change was in the number of facial expressions recognised, a key communication skill. Nine children improved on this. Six children improved on their level of social interaction. The majority of these changes were also seen at the follow-up assessments.
The project’s lead psychologist, David Wilkinson, PhD, at the University of Kent, told New Scientist, ”It’s an opportunity for children to create their own narratives in an unconstrained, unfamiliar environment.” He continued, “They find this empowering, and we know from the psychology literature that individuals who are empowered enjoy increased attention skills and an improved sense of well-being.”
Here’s a scary statistic, included in a recently published Newsweekarticle: “Each year, smoking-related illnesses kill more black Americans than AIDS, car crashes, murders and drug and alcohol abuse combined, according to the Centers for Disease Control and Prevention (CDC).” And then there’s this: “More than four in five black smokers choose menthol cigarettes, a far higher proportion than for other groups… By mitigating the harshness of cigarettes and numbing the throat, menthol makes smoking more palatable, easier to start – and harder to quit.”
The article discusses advocates’ call for a ban on menthol cigarettes (all other flavored cigarettes were banned in 2009) before going on to describe the history of African Americans and menthol-cigarette use, and tobacco companies’ aggressive marketing tactics. (“The tobacco industry… positioned itself as an ally of the very community it was seducing,” writes Abigail Jones.) It also quotes Stanford’s Robert Jackler, MD, founder of Stanford Research into the Impact of Tobacco Advertising, who expresses his concerns with ads that appear in a prominent African-American publication:
…[Jackler] has analyzed Ebony magazines since the 1940s and discovered it ran 59 cigarette ads in 1990, 10 in 2011 and 19 last year.
Ebony published 21 articles about breast cancer and 11 about prostate cancer between 1999 and 2013 but did not publish a single full-length story on lung cancer in that 15-year period. “Tobacco advertising is a huge revenue stream,” says Jackler. “Ebony professes itself to be the so-called ‘heart and soul and voice of the African-American community,’ and it completely neglects smoking.”