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Aging, Medicine and Society, Podcasts

A conversation about the end of life

A conversation about the end of life

My sister, Cathleen, recently passed away. She had been in a coma for nearly a year from an accidental fall while visiting her daughter in New York. She lay on a sidewalk after apparently tumbling down the stairs and bled out for nearly 20 minutes until an ambulance arrived. She never regained consciousness.

Many, many times over the past year I wondered what she would have wanted if she had known of her cruel predicament. It was hard to imagine that a woman whose credo was ‘live, live, live’ would have wanted to waste away in a nursing home unconscious with little chance of recovery. Yet she was a fighter. Would she have wanted to grasp for every final bit of air before she breathed her last? Or at some point would she have wanted to just die peacefully?

I never had a conversation with my sister about end-of-life matters. Thankfully I also never had to make any fateful decisions since I wasn’t her legal guardian. Her husband and two daughters were ultimate authorities. But the question still gnaws at me even today, several weeks after her death. What would she have wanted? And in that time, I’ve thought a lot about what I would want if I were in that situation.

Ellen Goodman, the Pulitzer Prize winning columnist from the Boston Globe, never had a conversation with her mother about the end of life either. In the last years of her mother’s life, Goodman found herself swirling in a fog of decisions. They were basic decisions about care, treatment and survival – decisions that her mother was incapable of making:

In the last year of my mom’s life, she was no longer able to decide what she wanted for dinner, let alone what she wanted for medical treatment. So the decisions fell to me. Another bone marrow biopsy? A spinal tap? Pain treatment? Antibiotics? I was faced with cascading decisions for which I was wholly unprepared. After all the years I had written about these issues, I was still blindsided by the inevitable.

After her mother’s death, having keenly observed numerous great social movements throughout her years of reporting, Goodman wanted to create another movement. And so The Conversation Project – an initiative “dedicated to helping people talk about their wishes for end-of-life care” – was born.

I spoke with Goodman for a 1:2:1 podcast when she was out west to evangelize her project and to meet with VJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training. As a great journalist Goodman knows how to communicate, and she articulately laid out why The Conversation Project is landing at the right moment to launch another historical social movement.

Previously: Talking about a loved one’s end-of-life wishes, The importance of patient-doctor end-of-life discussions, KQED health program focuses on end-of-life care and Facing mortality

Cancer, Dermatology, NIH, Podcasts, Research, Stanford News, Women's Health

New findings on aspirin and melanoma: Another outcome of the Women’s Health Initiative

New findings on aspirin and melanoma: Another outcome of the Women's Health Initiative

There has been a lot of interest in the Stanford study suggesting that aspirin reduces the risk of melanoma in women; dermatologist Jean Tang, MD, PhD, spent much of her day today discussing the findings with reporters from NPR and the three networks’ evening news programs. Earlier, in a 1:2:1 podcast, Tang talked about her work and described the importance of the Women’s Health Initiative (WHI), from which she and her co-investigators pulled their data:

The Women’s Health Initiative was funded by the National Institutes of Health and American taxpayers’ dollars…  This was a huge investment of taxpayers’ dollars, and it has incredibly paid off, [producing] many published papers and, more importantly, many important messages and conclusions about the health of American women.

Women were enrolled [in the WHI] to reflect the multi-ethnic population of the U.S. So American Indians are represented, Mexican-American women are represented, black women are represented. You are never going to get the richness and diversity of the women represented in this database anywhere else in the world.

Previously: New research shows aspirin may cut melanoma risk

Podcasts, Science

Alan Alda on communicating science. Yes, M*A*S*H’s Hawkeye Pierce

Alan Alda, best known to television audiences for his iconic portrayal of Hawkeye Pierce, MD, on the television series M *A *S * H, has thought a lot about communicating science. You probably would know that if you were a fan of the PBS series Scientific American Frontiers, which he hosted for 12 years and where he interviewed more than 700 scientists. In a recent conversation I had with him for a  1:2:1 podcast, Alda told me that he went into the majority of those interviews completely blank and would ask the most basic questions. Some scientists, he said, could give a good “elevator speech” and in 20 seconds distill the essence of their work. And for others, it was a struggle. But he learned early on how to draw information from even the most reluctant: “I learned my ignorance was an asset, as long as I had curiosity. I was so curious that I barraged them with questions, and if I didn’t get it, I said, ‘No, go back over that. I don’t get it.’ It was a very personal interaction.”

Alda has taken his passion for communicating science to the academy, where he co-founded the Center for Communicating Science at Stony Brook University on New York’s Long Island. There, he teaches science students the art of improvisation.

We started our conversation with a basic question: Why is understanding science so important today? “The things that we do in our daily lives,” he told me, “and the decisions that are made that affect our economy and the way we live are all based in science. Yet, most of us are divorced from science, we don’t speak the language, we often don’t understand the concepts.”

If you’ve known (and loved) Alan Alda as an actor, there’s another piece of his life that is just as formidable: science communicator extraordinaire. With the Center at Stony Brook, he’s created The Flame Challenge, an international contest that asks scientists to communicate complex science in way that interest and inform an 11 year old. Last year’s challenge was answering: What is Flame? This year’s: What is Time?

Think about it. How would you distill a question that seems so simple into a concept that every 11-year-old could understand?

Previously: Challenging scientists to better communicate their ideas to the public, Want to become a better science communicator? Try explaining science to a child and A conversation about the importance of conveying complex scientific concepts to broad audiences
Photo credit: CBS Television

Neuroscience, Podcasts, Research, Stanford News, Women's Health

Stanford expert talks estrogen therapy and Alzheimer’s

Stanford expert talks estrogen therapy and Alzheimer's

Estrogen-based hormone therapy has been a hotly debated issue for years. In 2002, the Women’s Health Initiative, the largest-ever federally sponsored study of postmenopausal women’s health, halted part of its trial examining hormone therapy. Published data showed that the combination of estrogen and progestin increased the risk for heart attacks, strokes, blood clots and breast cancer among postmenpausal women. It seemed certain to slam shut the door on hormone therapy for many women. Yet, a series of studies has softened that judgment. And now comes another.

As my colleague mentioned just yesterday, a new study from Stanford professor Natalie Rasgon, MD, PhD, and others has found that some women – specifically those who carry a gene that puts them at increased risk for developing Alzheimer’s – may benefit from an estrogen regimen. The word ”may” is a huge caveat here, as the study was small and certainly not definitive.

San Francisco Chronicle writer Erin Allday teased out the research in an article yesterday. And I spoke with Rasgon earlier in the week for a 1:2:1 podcast, as I was curious about yet another possible rebound for estrogen therapy. Rasgon reiterated to me that her study is far too small to be conclusive – “it opens more questions than it answers” - but it’s intriguing nonetheless.

Previously: Hormone therapy halts accelerated aging seen in women with Alzheimer’s genetic risk factor, Hormone therapy soon after menopause onset may reduce Alzheimer’s risk and Common genetic Alzheimer’s risk factor disrupts healthy older women’s brain function, but not men’s

Patient Care, Podcasts, Public Health, Stanford News

Abraham Verghese discusses reconnecting to the patient at the bedside

Abraham Verghese discusses reconnecting to the patient at the bedside

In his latest podcast on the Heart.org radio, Robert Harrington, MD, chair of the Department of Medicine, talks with Stanford physician and best-selling author Abraham Verghese, MD, about the humanistic aspects of health care and the training of medical students and residents in bedside medicine.

During the segment, Verghese discusses developing the Stanford Medicine 25 initiative, a series of hands-on workshops teaching 25 essential techniques for examining patients, and how it’s used to reconnect with the patient. At the opening of the show, Harrington asks Verghese to describe the role of humanism in medical practice. He responds:

There is much more to what we do than simply finding the biology of disease and administering a cure. I think we are dealing with human beings who are not just biological machines but have deep and complex feelings. I think the humanistic aspect of medicine is trying to address just  that; addressing the need for not just a cure but also healing.

We forget that for most patients illness has two aspects. There is always a physical sense of loss but there is also always a sense of spiritual violation, a sense of why me? Why now? I think part of our fiduciary responsibility in medicine, part of our fulfilling the public trust, is to address both the physical los sand sense of violation. I think that is where humanism and medicine comes to play—as a reminder that we are there to administer to more than just the body but also to the soul.

The full podcast is worth listening to. Afterwards, read more about how the Stanford Medicine 25 curriculum was created and why the hands-on diagnostic skills are imperative in examining patients in this 2010 Stanford Medicine article.

Previously: Stanford AIM Lab launches patient exam iPad app, Abraham Verghese discusses the importance of hands-on patient examsExploring the “fading art” of the physical exam and Abraham Verghese at Work: A New York Times profile
Photo by Stanford EdTech

Neuroscience, Pain, Podcasts, Research

Exploring empathy and altruism in the animal world

Back in 2011, a study (subscription required) showing how a group of lab rats repeatedly freed their trapped friends (often even choosing to do so before eating a coveted snack) garnered a fair amount of media buzz. Researchers involved in the study said the findings suggested that empathy, driven by another’s pain, was not limited to humans and animals of higher intelligence but rather was widespread in the animal kingdom.

In the latest NeuroTalk podcast, Forrest Collman, PhD, interviews study co-author Peggy Mason, PhD, a neuroscientist at the University of Chicago, about the experiment. During the talk they discuss what led Mason to investigate empathy and helping behaviors, and whether she would free a friend at the expense of having to share a tasty treat.

Previously: Stanford students launch NeuroTalk podcast series

Neuroscience, Podcasts, Stanford News

Stanford students launch NeuroTalk podcast series

Stanford students launch NeuroTalk podcast series

NeuWrite West, a new student group at Stanford dedicated to improving communication among scientists and between scientists and the public, has launched a podcast series.

Titled NeuroTalk, the series features conversations with prominent scientist who visit the Stanford Institute for Neuro-Innovation and Translational Neuroscience to share their most recent work with the campus community. Erica Seigneur, a graduate student and co-producer of the podcast, told me, “Our motivation for launching this podcast stems from the NeuWrite mission. In particular, we hope to capture some of the personality and the process behind the science, which we hope will get more people excited about the seminars, especially for topics outside their own field.”

The first podcast in the series was released earlier this week and includes a discussion with Allison Doupe, MD, PhD, a professor of psychiatry and physiology at the W.M. Keck Foundation Center for Integrative Neuroscience at UC San Francisco. During the interview, Doupe discusses her research on the neural basis of vocal learning in songbirds.

Podcasts, Stanford News

Top 10 1:2:1 podcasts for 2012

Top 10 1:2:1 podcasts for 2012

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 for 2012 were:

“Sully” Sullenberger takes on patient safety: Captain Chesley B. “Sully” Sullenberger III is best-known as the pilot who miraculously landed US Airways Flight #1549 in the Hudson River, after a flock of geese struck and disabled the plane’s engines. In this podcast, he talks about a proposal to create an independent agency modeled on the National Transportation Safety Board to investigate and prevent cases of medical harm and why he believes it’s critical for medicine to adapt safety lessons from the aviation industry.

Medical school without lectures: Charles Prober, MD, senior associate dean for medical education, and Chip Heath, PhD, professor at the Graduate School of Business, argued in a recent New England Journal of Medicine piece that it’s time to re-think the traditional medical school lecture. In this podcast, Prober sketches out his vision for a new medical curriculum.

Sex testing for elite female athletes: This year, the International Olympic Committee adopted sex verification policies (.pdf) for women athletes completing in the 2012 London Olympic Games. Stanford medical anthropologist Katrina Karkazis, PhD, and Rebecca Jordan-Young, PhD, a sociomedical scientist at Barnard College, challenged the proposed policies as unfair, unscientific and unethical.

Stanford medical school’s new leader: Lloyd Minor, MD, an otolaryngologist and former provost of Johns Hopkins University, became dean of the School of Medicine on Dec. 1. During this podcast, Minor discusses what he has learned about Stanford since arriving on campus in September, what he values in himself and other people, and where health care is headed as new reforms become reality.

The legacy of Philip Pizzo: On Dec. 1, Philip Pizzo, MD, ended his remarkable 12-year tenure as dean of the Stanford School of Medicine. Shortly before passing on the leadership of the school to Lloyd Minor, MD, he reminisced about past accomplishments and shared what’s next for him.

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Medical Schools, Podcasts, Stanford News

Meet the medical school’s new dean: Lloyd Minor

Meet the medical school's new dean: Lloyd Minor

Lloyd Minor, MD, the former provost of Johns Hopkins University, officially became dean of the Stanford School of Medicine on December 1.

A few days before he assumed his post, I sat down with him for a 1:2:1 podcast. We had a wide-ranging conversation, beginning with his childhood in Arkansas. We talked about his parents – his mother was a kindergarten teacher whose most famous student was Chelsea Clinton, and his father worked for the Internal Revenue System, helping Minor prepare his taxes every year until he passed away. And he described how his world-view changed when he discovered the stark inequities between black and white schools as a young teen bussed to a former all-black junior high school in Little Rock.

We talked about Minor’s values and why he believes collaboration, not hierarchical top management, is the key to success for any leader. When I asked him whether this was the best of times or the worst of times for health care, he replied, “Both.” He believes academic medical institutions can play a significant leadership role in the reshaping of medicine, and he sees Stanford as a place that is uniquely qualified to be at the forefront of that change.

Minor is a physician-scientist whose ground-breaking work on a debilitating inner ear disorder was featured on the popular prime time medical drama “Grey’s Anatomy,” which we talked about, too.

And why did Minor choose to come west to Stanford and leave Baltimore after 19 years at Hopkins? You’ll hear him discuss that in the podcast.

Previously: An introduction to Lloyd Minor, Stanford medical school’s new dean and Lloyd Minor named dean of Stanford’s School of Medicine

Health Policy, HIV/AIDS, Podcasts, Public Health, Sexual Health, Stanford News

Stanford expert discusses recommendation for universal HIV screening

Stanford expert discusses recommendation for universal HIV screening

Yesterday my colleague wrote about a task force’s draft recommendation for universal HIV screening. Today, in a 1:2:1 podcast, task force member Douglas K. Owens, MD, discussed the proposed guidelines and the importance of screening. He believes the recommendation, if implemented, could have a substantial impact on the course of the epidemic in the United States.

Previously: Task force issues draft recommendation for universal HIV screening

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