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Genetics, Podcasts, Stanford News

Whole genome sequencing: The known knowns and the unknown unknowns

Whole genome sequencing: The known knowns and the unknown unknowns

A few years ago, when I spoke with Euan Ashley, MD, associate professor of medicine and of genetics, about the promise of genomics for diagnosing and treating diseases he agreed that the field was in the wild, wild west. Now, in my latest 1:2:1 podcast with him, I asked how would he describe this moment in time, when so much has changed so quickly in whole genome sequencing (WGS). First, he said, the costs of sequencing the genome have plummeted. “At the point we spoke we were just coming off the $20,000 genome,” he told me. “Which seems remarkable, because we’d just been at… $200,000, and before that at the $2 million genome. In looking around in science… in medicine, I have not seen a technology that has changed that much.”

Euan AshleyAshley recently published a paper that my colleague, Krista Conger, has written about; in it, Ashley and his fellow researchers, Michael Snyder, PhD, professor and chair of genetics, and Thomas Quertermous, MD, professor of medicine, analyzed the whole genomes of 12 healthy people and took note of the degree of sequencing accuracy necessary to make clinical decisions in individuals, the time it took to manually analyze each person’s results and the projected costs of recommended follow-up. Quite clearly, Ashley says, the study shows “there are still some challenges, not that these are non-solvable problems.”

Ashley often cites an infamous quote that Donald Rumsfeld, former Secretary of Defense, said when he was asked about the lack of evidence of Iraqi weapons of mass destruction, as he thinks the questions that Rumsfeld raised about WMDs are analogous to the field of genetics today. Ashley told me:

There are really a number of things that we really know that we know, because they’re genetic variants we’ve seen many times. Also, there are a number of known unknowns… which are genes that we know are a problem but maybe variants we haven’t seen before, so they look pretty suspicious… There [are] the complete unknowns, the unknown unknowns… Many genes about which we really do not know very much at this point in time.

Who would have thought Rumsfeld was laying out the future of WGS and not just WMD’s?

Previously: Assessing the challenges and opportunities when bringing whole-genome sequencing to the bedside, Coming soon: A genome test that costs less than a new pair of shoes, Stanford researchers work to translate genetic discoveries into widespread personalized medicine, New recommendations for genetic disclosure released, Ask Stanford Med: Genetics chair answers your questions on genomics and personalized medicine and You say you want a revolution
Photo of Euan Ashley by Mark Tuschman

Medical Education, Podcasts, Stanford News

Becoming Doctors: Stanford med students reflect and share experiences through podcasts

Becoming Doctors: Stanford med students reflect and share experiences through podcasts

podcast finalInspired by NPR’s “This American Life,” as a Stanford med student Danica Lomeli, MD, started a podcast series to document and share the intense clinical experiences of her classmates. Through digital storytelling, she captured the growth and distress she saw among third-years and provided a space for her peers to reflect on profound personal experiences. Lomeli, MD, now in her first year of post-graduate work in family medicine at UCLA, hosted and produced five podcasts before collaborating on one installment with and then passing on her project on to med student Emily Lines, who uses the platform to share stories of pre-clerkship students. Lomeli and Lines have produced their podcasts under the guidance and support of Stanford’s Medical Scholars Research Program.

Below, Lines answers questions on her podcast series, Becoming Doctors: Stories From in Between.

Can you describe some of the stressors a medical student undergoes, or which challenges med school presents to a student’s sense of humanism and developing identity as a physician?

There is a growing body of work cataloguing the experiences of clerks, interns, and residents through their transformation into physicians, but little has been recorded about the lives of medical students prior to the clerkship years. These years, however, are a period of rapid growth and transition for pre-clerkship students, filled with experiences worthy of documentation. Pre-clerkship students live at the bottom of an extensive hierarchy and may tend to minimize their emotions or the intensity of their experiences when they compare themselves with all they have heard from clerkship students or residents. By giving voice to these trainees early in their careers, I hope to spark an early interest in reflective practice and empower students to see the intrigue in their daily experiences.

We all have a story of our first patient, the first death we see, the first big mistake we make, and the ways that our personal lives are forced to change to make space for dedication to medicine.

How do you decide on topics to cover, and your approach to a given subject?

I just keep my ears open all the time for stories my friends are telling. Sometimes I’ll approach folks and ask them to tell specific stories I’ve heard them tell before.  Other times, I host storytelling parties, which are just informal get-togethers at my house where people can come and share stories in a group setting. We set a microphone out and pass it around as we talk about whatever happens to come up. Most recently, I hosted a themed storytelling party where a group got together to talk about primary care – experiences, passions, motivations, anything! In short, it’s pretty free-form and I take a varied approach to getting stories – whatever method fits the style of the storyteller and his or her story.

Any dream interview subjects?

A lot of people my age don’t see themselves as having a story to tell, but I think that everyone has a great story to share. They are my dream subjects! I hope for my classmates to see the uniqueness of their experiences and to come share them with me.

What are your plans for after graduation? Will you continue to be involved in telling stories?

I’m a pretty gregarious person and I think I’ll always keep telling stories (recorded or not!) I see podcasting as just one way that people can tell their stories – we can write, share in the moment with our friends, take photos, or made podcasts. I am a longtime college radio music DJ and, for me, podcasting was an obvious arena where I could blend my life in medical school with my life at the radio station. I’ve also brought music into the podcast, tapping into the musicians in my class and their recordings, so it’s been great to continue working with music as I develop my storytelling and hosting skills.

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Addiction, FDA, Health Policy, Podcasts, Public Health

E-Cigarettes: The explosion of vaping is about to be regulated

E-Cigarettes: The explosion of vaping is about to be regulated

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.

e-cigUntil 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 labelsWhat’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

Cardiovascular Medicine, Podcasts

Dick Cheney on his heart transplant: “It’s the gift of life itself”

Dick Cheney on his heart transplant: "It's the gift of life itself"

Cheney2Dick Cheney has lived with chronic heart disease for virtually all of his adult life. At 37, as a young man running for the U.S. Congress in Wyoming, he had his first heart attack. His last – a fifth – occurred in 2010 and by then having taken advantage of everything medicine and technology had to offer, Cheney knew he was at the end of the road. And, remarkably, as the former vice president told me in this 1:2:1 podcast, he didn’t fear death:

I concluded that sooner or later, I was going to run out of technology, run out of new innovations and developments in the area of heart medicine… I  thought about it, I guess, I was at peace. It was not painful. It wasn’t surprising or frightening. I had come to that point where I fully expected that I had lived a wonderful and remarkable life. I had a tremendous family. I had everything a man could ask for.

Facing end stage heart failure, in the summer of 2010 he received a left ventricular assist device commonly known as an LVAD. But he knew the device wouldn’t be enough. A transplant was the only option that would set aside decades of heart ailments and give him something he had thought was impossible: longevity. Twenty months later, at 71 years old, a late night phone call informed him a donor had been found. Life for Dick Cheney would begin anew.

Now, nearly two years after his transplant, Cheney and his cardiologist, Jonathan Reiner, MD, have written a book about his history of heart ailments, Heart: An American Medical Odyssey. As we were putting together the current issue of Stanford Medicine – a special on cardiology – it made sense to include an interview with Cheney, and so I pursued one.

Cheney launched the book last fall with a number of high-profile media interviews starting with Sanjay Gupta’s on CBS’ 60 Minutes. We spoke a few days before Thanksgiving when family matters were in the press. I decided not to repeat the buzz questions that had already consumed the press at the time – the Homeland scenario or whether his years of service in the White House afforded him special access to health care unavailable to everyone else. I pursued a different line.

This wasn’t the taciturn Cheney that I had feared as an interviewer. He was pensive, reflective and clearly extremely grateful that he was able to have this extension on life. His co-author Reiner told him that a heart transplant is a spiritual experience so I asked Cheney what’s been his? He told me:

It’s the gift of life itself… After you’ve been through all of the procedures and so forth and then anticipating death and finding your life has been extended that it’s miraculous… You have a sense that after you’ve been through all of  that, everything else is small. You don’t sweat the small stuff… A friend of mine asked me when I told him it was a spiritual experience: “Does that mean now, that you’re a Democrat?” I told him, “Well, not that spiritual.”

I closed the interview with a final question. What if he learned he had the heart of a liberal Democrat? Well, you’ll have to listen to the podcast or read the Q&A to find out his response.

Previously: Mysteries of the heart: Stanford Medicine magazine answers cardiovascular questions
Illustration, which originally appeared in Stanford Medicine magazine, by Tina Berning

Medicine and Literature, Mental Health, Podcasts

A conversation with Scott Stossel, author of My Age of Anxiety

A conversation with Scott Stossel, author of My Age of Anxiety

Stossel bookScott Stossel has written a tome on anxiety. The editor of The Atlantic magazine opens his best-selling memoir with a frightening yet comical scene at his wedding. He’s standing at the altar in a Vermont church, and his angst has ripped open his innards reducing him to a puddle of sweat and embarrassment. Anyone who’s suffered from severe anxiety can fully appreciate the yin and the yang of his moment:

The minister is droning on; I have no idea what he is saying… I am praying for him to hurry up so I can escape this torment… Seeing me – the sheen of flop sweat, the panic in my eyes – he is alarmed. “Are you okay?” he mouths silently. Helplessly, I nod that I am… As the minister resumes his sermon, here are three things I am actively fighting: the shaking of my limbs; the urge to vomit; and unconsciousness.

Anxiety disorders have a terrifying grip on nearly 44 million Americans. In the book, psychologist David Barlow, PhD, said of the affliction, “Anxiety kills relatively few people, but many more would welcome death as an alternative to the paralysis and suffering resulting from anxiety in its severe forms.”

I first came across Stossel’s work as a cover story in The Atlantic. Then, I discovered there was buzz about the book, as friends around the country were talking about it. For a few weeks, Stossel was everywhere – Fresh Air with Terry Gross, The Colbert Report, London’s Sunday Times, personal appearances around the U.S., and in laudatory book reviews in the nation’s top papers. I believed his exploration of  “fear, hope, dread, and the search for peace of mind” was something all anxiety sufferers seek, and I knew I wanted to snag him for a 1:2:1 podcast.

When we spoke, I thought I would open with a question I was very curious about. “You’re in the middle of a book tour,” I said to him. “It’s a New York Times best seller. You’re speaking in public. Flying around the county. Doing things that you really hate. So has the book been good for your anxiety, as your doctor posed it might be?”

Well, as you’ll hear, there have been ups and there have been downs. Unfortunately, there’s no Hollywood ending at this particular moment to his psychological puzzle. Yet Stossel does congratulate himself for finishing the book, a task at times he was doubtful he could or would achieve.

When I asked Stossel to read from the book, he said it was my choice what he read. So I chose a passage that was hopeful. It talks about how his anxiety, though often intolerable and miserable, could have an upside. “But it is also, maybe a gift – or at least the other side of a coin I ought to think twice about before trading in,” he writes.

In the end, I’m struck by the tremendous courage that it took for Stossel to lay himself bare – to expose some of his most idiosyncratic fears that have crippled him since childhood. He’s a brave man. It’s for that reason I think My Age of Anxiety has meaning well beyond the words on the page. It will help de-stigmatize this little dark corner of mental disorders. Through peeling back his own layers of psychic skin almost to the quick, I think he’ll change attitudes and  perceptions.

I especially liked what Elizabeth Gilbert, author of Eat, Pray, Love, said about the book:

It could not have been easy for Stossel to dissect his own anxiety so honestly in this memoir. But he was brave as hell to write it, and I’m glad he did, for he brings to this story depth, intelligence, and perspective that could enlighten untold fellow readers for years to come.

Amen!

Previously: Reframing reactions could reduce symptoms of social anxiety disorder, Stanford study shows and Does more authority translate into a reduction in stress and anxiety?
Image from Random House

otolaryngology, Podcasts, Research, Stanford News

Listening to elephants, communicating science, and inspiring the next generation of researchers

Listening to elephants, communicating science, and inspiring the next generation of researchers

Caitlin O’Connell-Rodwell, PhD, is an instructor in Stanford’s Department of Otolaryngology and a scientist who studies, among other things, how elephants hear. In this just-published Neurotalk podcast, Rodwell discusses her studies from the field, including how elephants use foot stomping and low-frequency vocalizations to communicate. “If you think of the earth as a trampoline and you have this 10-ton animal on the earth running, you’re going to create a huge wave,” she said of the seismic vibrations they create. Elephants can also use their big ears, and comparatively large malleus middle-ear bone, to hear, and draw still to listen, she noted.

The podcast details O’Connell-Rodwell’s contributions to science as a writer and instructor of science communications at Stanford and for the New York Times, as well as her mission to encourage girls to pursue the hard sciences. She said:

As a woman in science, especially doing a little bit of physics, if you don’t have a role model it’s very difficult to try to imagine yourself [there]. So I got interested to get girls interested in the hard sciences because there’s no reason why they shouldn’t be there.

You have to get kids excited about science… One of the things that got me interested in entymology to begin with was that childlike enthusiasm for the miniature and the unknown.

She added, “In our minds it’s a story, but it’s not obvious to everyone else.”

Previously: Elephants chat a bit before departing water hole, new Stanford research shows and Researcher dishes on African elephant soap opera
Photo in featured entry box by Caitlin O’Connell-Rodwell and Timothy Rodwell

Podcasts, Science, Stanford News

Goggles Optional: Stanford podcast aims to “influence the culture of how science is viewed”

Goggles Optional: Stanford podcast aims to “influence the culture of how science is viewed"

BiggishGogglesCommunicating science to a non-specialist audience is an art. Or is it a science? David Zhang, PhD, a postdoctoral research fellow in immunology and rheumatology, and colleagues bring some of each to Goggles Optional, a lively podcast series produced by Stanford scientists to capture’s the public’s interest in research.

Since November 2013, Zhang and the rest of the Goggles Optional team, made up of postdocs and grad students, have recorded a weekly audio program featuring news, research headlines, expert guest speakers, game-show antics and songs, all exploring the latest, most significant and/or weirdest happenings in the field. (You can check out the full list of free podcasts on their website here or download them from iTunes.)

The 13 episodes so far have covered science news from stem cells to staph infections and explored civilian-interest questions such as why we sleep. With more than 7,000 downloads so far, Goggles Optional will expand to include conversations with industry leaders in science. Zhang notes that when spotlighting research, Goggles Optional interviews the first author of a paper to give listeners the perspective from “inside the trenches” and provide grad students and postdocs an opportunity to talk about their work.

Thirteen members strong, the Goggles Optional team includes writers, hosts, a social media specialist and a webmaster. (For a good read, scroll through their bios.) All those involved volunteer their time.

How can these full-time scientists also be broadcast journalists? I wondered that, too.

Collaboration is key. “I give all the credit to the team,” Zhang says, emphasizing that the high volume of work required to produce the series wouldn’t get done without each member’s contributions. Their process, which begins by digging through Nature, PNAS and the like, is streamlined using a shared Google Doc for gathering content ideas. Then, on Monday night, the group meets for a two-hour writing session followed by two hours of audio recording at Stanford’s KZSU studio. The scientists write in pairs or larger groups to decide for each segment, “Is it true?” and “Is it funny?”

The team wants to make science news a table topic in the average educated household. Zhang notes, “I think we have a responsibility as scientists to not just focus on our work, but really to share science with the broader community.” He said the sequester‘s devastating cuts to NIH funding was a key example of the need for this kind of outreach. “I don’t know if we have a right to complain as scientists if we’re not putting the effort to share with the public why science is so important,” Zhang says. That’s why he’s driven to clock non-lab hours in the recording studio – as part of a long-term goal “to influence the culture of how science is viewed in our country.”

Previously: You are what you read: The academic diet of the 21st-century medical studentHawkeye Pierce (i.e. Alan Alda) teaches scientists how to better communicate about their workHelping the public make sense of scientific research and Alan Alda on communicating science. Yes, M*A*S*H’s Hawkeye Pierce
Photo courtesy of David Zhang

Podcasts

Top 5 1:2:1 podcasts of 2013

Top 5 1:2:1 podcasts of 2013

Every few weeks, Paul Costello, chief communications officer for the medical school, talks with innovators in modern medicine and health policy for our 1:2:1 podcast series. The most popular podcasts in 2013 were:

The whats, whys and hows of sleep: According to Stanford sleep specialist Rafael Pelayo, MD, the most common sleep disorder in America is insufficient sleep. Here, Pelayo discussed the ever-popular and mystifying topic of sleep and the latest research and treatment options coming out of the Stanford Center for Sleep Sciences and Medicine.

Laura Roberts on building a career in academic medicine: In addition to her expertise in her field, Laura Roberts, MD, chairman of the Department of Psychiatry and Behavioral Sciences at Stanford, is recognized for her success as a mentor and teacher. In this podcast she discussed her latest book, which is aimed at young physicians, clinicians and scientists and serves as a guide for building more creative, effective and inspiring careers.

Kimberly Allison on seeing cancer from both sides: In 2008, breast-cancer pathologist Kimberly Allison, MD, received the shocking news that she had stage-3 breast cancer. She chronicles her personal experience in the book Red Sunshine and shared in this interview what it’s like to experience cancer as a patient and as a doctor.

Alan Alda on communicating science effectively: The Emmy Award-winning actor Alan Alda is a visiting professor in journalism at Stony Brook University in New York and a co-founder of the school’s Center for Communicating Science. Here, he discussed his passion for science and why communicating science effectively is critical.

Lochlann Jain on the confusion surrounding cancer: An expert in medical and legal anthropology, the research of Lochlann Jain, PhD, focuses on the ways in which stories about injuries and illness get told. Jain was 36 when she was diagnosed with cancer, and her new book, Malignant: How Cancer Becomes Us, sets out to change the conversation about the disease and its effects on all aspects of society.

And still going strong - the most popular podcast from the past:

Marius Wernig on the future of stem cell therapy: In 2010, scientists here succeeded in the ultimate switch: transforming mouse skin cells in a laboratory dish directly into functional nerve cells with the application of just three genes. The research was led by Marius Wernig, MD, assistant professor of pathology, who discussed his findings, and their implications, during this interview.

Cancer, Podcasts, Stanford News

“How cancer becomes us”: A conversation with author and anthropologist Lochlann Jain

"How cancer becomes us": A conversation with author and anthropologist Lochlann Jain

Associate Professor of Anthropology S. Lochlann Jain's new book weaves her research with memoir and aims to start a new conversation about cancer as a cultural, not just medical, phenomenon.I asked Stanford anthropologist Lochlann Jain, PhD, author of “Malignant: How Cancer Become Us,” why, when there are thousands of books on the market about cancer, we needed another one. She agreed there are many. There are superb histories, interesting and excellent memoirs, and penetrating looks at the environmental causes of cancer out there, but, she said, “what we’re missing is an analysis of how cancer is such a large part of America’s political, social and economic life.”

When we first met over coffee to talk about the book, I asked Jain how she  would define cancer, having been a member of its club. “It complicated,” she replied. “I didn’t expect to write about cancer. I just thought I’d get this treatment over with and go back to my work. But then I realized, the whole experience was just so full of paradox, I couldn’t just let it go.”

And paradoxes she does write about: We fight it, yet we produce it. Science, medicine, economics and policy are often at odds with each other. As she told me:

Each of America’s iconic industries – agriculture, oil and gas, cosmetics, plastics, pesticides, tobacco, medicine, construction, military – has undoubtedly led to tens of millions of cancer deaths. The unique way in which cancer presents, decades after exposure, makes it central to the growth of both the industries and the illness, in short to the existence of the United States, as we know it.

She also talked to me about the blame and shame game that accompanies a diagnosis of cancer. She brings clarity to the issue of why victims of cancer are dropped into a torturous inner debate of shoulds and coulds and woulds.

I was completely riveted by our conversation. ”Malignant” is an extraordinarily original piece of writing that takes a microscopic lens to the complex and confounding world of cancer. I hope you’ll find my 1:2:1 podcast with her of value. In my mind, Jain adds a truly unique voice to the literature of cancer.

Previously: Stanford professor dispels “too young for cancer” myth
Photo by L.A. Cicero/Stanford News Service

Ethics, Patient Care, Podcasts

What happened inside New Orleans’ Memorial Hospital? A conversation with Pulitzer Prize-winning author Sheri Fink

What happened inside New Orleans' Memorial Hospital? A conversation with Pulitzer Prize-winning author Sheri Fink

Memorial Medical Center is seen Monday, Sept. 12, 2005, in New Orleans, after more than 40 bodies were recovered Sunday at the 317-bed hospital. Hospital assistant administrator David Goodson said patients died while waiting to be evacuated over the four days after the hurricane hit, as temperatures inside the hospital reached 106 degrees.  (AP Photo/Rick Bowmer)What happened at Memorial Hospital in New Orleans after Hurricane Katrina struck and paralyzed the city? Pulitzer Prize winner Sheri Fink details the hospital’s struggles for survival in her new book, Five Days at Memorial. It’s a harrowing tale of colossal failures within Memorial and also outside as the federal, state and local governments bungled their response. I find myself still outraged eight years later, wondering how a tragedy of this magnitude could happen to an American city.

In addition to the horror of a hospital in chaos due to a storm of historic proportions, the story of Memorial is filled with ethical conundrums about what constitutes humane health care. Did health care workers choose life for some patients and death for others? Three health care workers were arrested and faced criminal allegations that they deliberately injected a number of patients with drugs to hasten their deaths. In the end, a New Orleans grand jury declined to indict even though the State Attorney General maintained to the end that a number of the dead were victims of homicide.

In her finely detailed investigative work, Fink brings the reader into Memorial for a minute by minute harrowing recounting of what happens when things fall apart in a hospital. Five Days at Memorial is a stunning read, and I was pleased to be able to talk with Fink at length for my latest 1:2:1 podcast. As I wrote in an earlier blog entry:

Put yourself [in place of the health care workers]. What would you have done? Are the ethical lines clear to you? Is what happened inside Memorial black and white? Or is it gray?

Fink holds an MD and PhD from Stanford’s School of Medicine.

Previously: Pulitzer Prize-winner Sheri Fink: the final hours at New Orleans Memorial, New York Times wins three Pulitzers for health stories and Murky waters: A look at Memorial Medical Center after Hurricane Katrina
Photo by ASSOCIATED PRESS

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