Stanford programs offer students opportunities to research and practice medicine in Africa

A recent Stanford Report story highlights Stanford’s Center for African Studies and its rapidly-growing research programs and courses in Africa, which have exploded in popularity among students lately. In the story, biology major Laura Hunter shares her experience of working in a medical clinic in Ghana:

Laura Hunter was 35,000 feet above Africa, watching the sunrise over the place she would call home for the next several weeks. The Stanford junior was about to touch down in Ghana to start a fellowship at a medical clinic treating some of the country’s poorest people.

Raised in Seattle and planning to pursue a medical career, the biology major was traveling alone outside the United States for the first time.

Within a few days, Hunter was filling prescriptions, taking measurements of blood pressure, dressing and cleaning sores. Then she started working on a case that has had the biggest impact on her so far – the rehabilitation of a woman who fell from a tree and needs physical therapy to, hopefully, walk again.

“At first, connecting with Assibi was tough … but over time we have been able to make a connection,” Hunter, an African Service Fellow, said in an email from Tamale, Ghana. “Forming that one-on-one bond with a patient and watching her improve has been very rewarding.”

Previously: Stanford residents share stories from volunteering abroad
Photo by Laura Hunter

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Stanford bioethicist Christopher Scott weighs in on today’s human embryonic stem cell ruling

A U.S. appeals court has affirmed (.pdf) the ruling last year by district court judge Royce Lamberth that federal funding of human embryonic stem cell research is legal. Although the decision effectively puts to rest opponents’ arguments that such funding violates the Dickey-Wicker amendment, at least one judge asked Congress for clarification about the power of the federal government to regulate such research.

Bioethicist Christopher Scott, who directs Stanford’s Program on Stem Cells in Society, has this to say about today’s ruling:

This is a major victory for stem cell researchers. It affirms that the National Institutes of Health’s interpretation of the 1996 Dickey-Wicker amendment is reasonable. Importantly, it removes a barrier of uncertainty for stem cell scientists and the patients who stand to benefit from their discoveries. The Obama administration should be congratulated for its assiduous work to guarantee that the president’s policy makes the difference when the rubber meets the road: funding research that could lead to the next generation of treatments and cures.

Scott has previously published research showing that limiting human embryonic stem cell research is likely to also slow research on induced pluripotent stem cells–an alternate way to create stem cells that does not require the destruction of human embryos–because the two fields are so closely intertwined.

Science writer Maggie Fox, writing for NBC news, has posted a nice summary of the issues leading up to today’s decision. But I found reading the actual text (.pdf) of the ruling to be very enlightening. In particular, Judge Janice Rogers Brown (one of three judges who ruled on the case) commented about the Dickey-Wicker amendment:

The challenging—and constantly evolving—issues presented by bioethics are critical and complex. Striking the right balance is not easy and not, in the first instance, a task for judges. What must be defended is “the integrity of science, the legitimacy of government, and the continuing vitality” of concepts like human dignity. Given the weighty interests at stake in this encounter between science and ethics, relying on an increasingly Delphic, decade-old single paragraph rider on an appropriations bill hardly seems adequate.

Previously After the lawsuit, what’s next for stem cell research, Judge Lamberth dismisses stem cell lawsuit and Embryonic stem cell regulation will affect iPS cell research

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NIH releases mobile app to help women identify health risks, maintain a healthy lifestyle

The National Institutes of Health has launched a new mobile application offering women guidance on maintaining a healthy lifestyle and tips for identifying health risks for themselves, as well as their families.

The app is based on the Office of Research on Women’s Health publication A Primer for Women’s Health: Learn about Your Body in 52 Weeks. Available for free in the Apple App Store or via Google Play, the app provides a year’s worth of research-based health information highlighted week-by-week. According to an NIH release:

Questions to ask health care providers, a glossary of health terms, and health screening information and links to additional information from NIH institutes and centers expand the mobile app’s offerings.

Key features of the app are:

  • a personal health section for recording medications, medical conditions, and disabilities
  • a journal feature
  • a personal goal-setting section for health and lifestyle details

A variety of different skins can be applied to personalize the app, and it can be password-protected to help ensure health information remains confidential.

The NIH plans to launch a similar app for men’s health in the near future.

Previously: Diagnosing ear infections using your iPhone? Not so far-fetched, Stanford medical residents launch iPhone app to help physicians keep current on research and School of Medicine alumni association partners with Doximity to test first-of-its-kind smartphone app
Photo by Jeffrey Pott

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Sully Sullenberger talks about patient safety

Who could forget the live pictures on CNN? A US Airways passenger plane floating majestically on the Hudson. It looked like some giant bird, wings spread, just effortlessly ambling along. But it was far from that. Nearly four minutes after take-off as the aircraft climbed to 3,000 feet, Captain Chesley “Sully” Sullenberger had radioed the LaGuardia tower announcing that he had hit a flock of birds, “lost thrust on both engines” and was heading back to the airport. We all know what happened next. Sullenberger, unable to make it back to field, ditched the Airbus 320 into the Hudson. Miraculously, all 150 passengers aboard survived. Leer más “Sully Sullenberger talks about patient safety”

Should local residents be worried about West Nile virus?

Those of you near Stanford may have heard the local news that Santa Clara County is spraying pesticide to control an unusually large hatch of summer salt marsh mosquitoes in and around the Palo Alto Baylands park. This saltwater marsh at the south end of the San Francisco Bay is providing an unusually good hatching ground for the mosquitoes because of a breach in a tide wall that normally controls marsh water levels, as a press release from the county’s Vector Control District explains:

A breached tide wall in the Palo Alto baylands has created ideal conditions for the breeding of the mosquitoes by allowing water levels in the basin to rise and fall. SCCVCD has been closely monitoring the development of mosquito larvae, and current field conditions are producing continued egg-hatch. Recent adult “fly-offs” have created considerable discomfort for residents and businesses in nearby areas.

Of course, news about hungry mosquitoes prompts worries about West Nile virus, especially in light of media coverage such as today’s New York Times piece about the West Nile outbreaks in Texas.

To clarify whether local salt marsh mosquitoes pose a health risk, I called Russ Parman, a spokesman for the county Vector Control District. West Nile isn’t a big issue with the salt marsh mosquitoes, a species called Aedes dorsalis, Parman said, because mammals are their target meal. In contrast, the Culex mosquitoes that transmit West Nile bite both birds and humans, carrying the virus from its natural reservoir in birds to human hosts. (There are many other mosquito species, too – California has about 50 different types of mosquito.)

Instead, the problem with Aedes is that they’re big and vicious. “They’ll bite you right through your blue jeans,” Parman said. Leer más “Should local residents be worried about West Nile virus?”

Pediatric social worker discusses the emotional side of heart transplants

Speaking of heart transplants, Mary Burge, a pediatric heart transplant social worker at Lucile Packard Children’s Hospital, was on Talk of the Nation yesterday. In case you missed the segment, Burge discussed her work helping parents process the news that their child will need a new heart and providing support for families before and after the procedure.

She also commented on how getting a new heart can be a particularly emotional experience – more so than other types of transplant procedures -because of how the organ is viewed culturally: Leer más “Pediatric social worker discusses the emotional side of heart transplants”

One family – and five children with same serious heart disease

It’s difficult to imagine having a seriously ill child – let alone five of them. But for a couple in Oregon, this is their reality: Each of their five children suffers from dilated cardiomyopathy or symptoms that can lead to the condition.

NBC got word of the story this summer and is now following the family as 8-year-old Lindsey Bingham awaits a heart transplant at Lucile Packard Children’s Hospital. (The eldest Bingham child, Sierra, had a successful transplant here six years ago.) Reporter Sandy Cummins recently blogged about the family and had this to say of her initial visit with them:

The Binghams are an impressive family. As we dined in the hospital cafeteria, I was struck by Stacy Bingham’s patience with her other kids, her sense of calm, and by Jason’s laser focus on helping his children. Megan, 11, asked lots of great questions about the production process. They’re not attention-seekers and agreed to be interviewed for two reasons:  In the hope that it will help their children and that it will inspire people to become organ donors. Leer más “One family – and five children with same serious heart disease”

Grieving on Facebook: A personal story

Last week, I experienced my first Facebook-era death. It had been several years – long before the ubiquity of social media – that I had last lost a relative, and I quickly discovered that experiencing loss and grieving online comes with a unique set of pros and cons.

I learned of my uncle’s stroke the old-fashioned way: via phone. My parents and I kept in steady contact that way over the next 36 hours, but it was Facebook that filled me in on certain details about my uncle’s status and my relatives’ whereabouts. The social networking site also enabled me to quickly express support, both before and after he passed, for family members scattered across the country. (“My heart goes out to you,” I posted on the wall of one of my cousins.)

I was 1,840 miles away from the hospital where my uncle lay, but the keyboard brought us closer. Being on Facebook helped me feel less isolated and helpless; if nothing else I could “like” someone’s comment on the need for prayers and positive thoughts about my uncle. I could feel like I was doing something.

My uncle had a warm, wonderful smile, but seeing it at that moment felt like a punch in the gut – another reminder that he was gone. As long as I was on Facebook, avoidance wasn’t an option.

But there were definite down-sides to being so connected (and yet so far away). When one relative wrote several hours after the stroke, “Things don’t look good,” it filled me with additional angst and left me with only questions. Did something just happen that I didn’t know about? Had she just received new information from his doctors, or was she merely conveying a general concern? I had no way of knowing; it felt inappropriate to ask in the comments section. Leer más “Grieving on Facebook: A personal story”

Stanford physician discusses rapid growth of palliative medicine and legislation to meet demands

Demand for palliative care has grown (.pdf) tremendously over the past decade. VJ Periyakoil, MD, director of Stanford’s hospice and palliative medicine fellowship program, has experienced firsthand how the burgeoning specialty has exploded, and how the nation’s physician workforce has struggled to keep pace.

“We are at a point in time where the demand for quality palliative care far exceeds the supply of clinicians with required expertise,” Periyakoil told me. “It takes a long time to train doctors and currently we are churning out about 300 fellows annually. Each year, the fellows who graduate from our palliative care fellowship get multiple job offers and most are often recruited to leadership positions.”

A recent American Medical News story offered a detailed look at the rapidly growing need for palliative care services, as well as physicians trained in hospice care:

From 8,000 to 10,000 physician specialists are needed to meet demands in hospice and palliative care programs nationwide, according to the [American Academy of Hospice and Palliative Medicine], a professional organization for hospice and palliative medicine physicians. But only 4,500 doctors specialize in the field, and training programs are expected to produce only an additional 4,600 specialists in the next 20 years, the academy said.

The demand for palliative medicine is driven in large part by advancements in biomedicine and the United States’ graying population. Additionally, a growing body of scientific evidence on the speciality is beginning to show it can improve quality of life for patients diagnosed with serious chronic illnesses and can reduce health costs. As a result, an increasing number of  hospitals are adding or expanding their palliative care programs and more patients seeking services.

In an effort to increase interdisciplinary training in hospice and palliative care, Congress is considering legislation that would allocate nearly $50 million for a range of programs, including training for doctors and fellowships to encourage mid-career physicians to transition to the specialty. The Palliative Care and Hospice Education and Training Act was introduced in July and would also provide awards to support educators in the field.

When I asked Periyakoil how the bill, in enacted into law, would help meet future hospice and palliative care demands, she responded:

If we look at the field of geriatrics, the federal Health Resources and Services Administration funds the Geriatric Academic Career Award (GACA) to increase the number of junior faculty at accredited schools of allopathic and osteopathic medicine. It also promotes the development of their careers as academic geriatricians who emphasize training in clinical geriatrics, including the training of interdisciplinary teams of health professionals. The proposed legislation is a similar effort to promote interdisciplinary palliative care.

The bill could also have important implications for Stanford’s fellowship program. Our fellowship is the oldest interprofessional palliative care fellowships in the country. Funded by the Office of Academic Affiliations, the program trains fellows from the field of medicine, psychology, social work and chaplaincy in palliative care. The fellows learn to train together and work together. Currently, this model is restricted to the fellows serving Veterans Affairs hospitals due to funding reasons. In the future, if the legislature passes, I hope that we will have funding to expand these interprofessional fellowships in academic medical centers.

Previously: Helping caregivers practice palliative care and Examining the generational gap between physicians and patients in hospice and palliative care
Photo by Don LaVange

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The big downside of some life-changing medications

Several years ago, I listened in a state of semi-shock as a doctor gave me a classic bad news-good news combination: The autoimmune system disorder I had was incurable and life-threatening, but researchers had recently discovered that a certain package of medications could put it into remission. I remember that conversation well, but I don’t recall the doctor mentioning much, if anything, about the side effects of those medications.

At age 12, Jena Graves of Napa, Calif. faced the same serious situation. She was diagnosed with the autoimmune system disease lupus, and among her essential medications was the same steroid I was given, prednisone. It’s a go-to medication for millions who suffer from conditions including asthma and diabetes; it’s also on a short list of commonly prescribed “obesogenic” drugs whose effect on the body includes rapid weight gain.

Graves, just 5 feet 2 inches tall, shot up from 120 pounds to 272 pounds and developed Type 2 diabetes and other obesity-related health problems.

A colleague recently shared Graves’ story, which was told again in today’s San Francisco Chronicle. In the piece, Stanford’s John Morton, MD, who performed gastric bypass surgery on Graves this summer, raises a flag on behalf of patients like her:

“All these medications are absolutely wonderful when they work in the right patients,” [said Morton]. “But we’ve got to figure out if it’s appropriate or not to blanket America with prednisone and other obesity-generating drugs that are creating problems.”

Graves isn’t the only patient who has paid the price for being on one prescription too many, he said.

“I can’t tell you how many patients come in to see me who’ve been on medications for years,” he said. He asks: “Why are you on this medication? ‘I don’t know.’ Has someone followed up? ‘No. I just get my prescription refilled.”

Previously: When medications cause severe obesity

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Smoking rates increasing in the developing world

Although smoking rates in the United States have been slowly declining, tobacco use is on the rise in several developing countries.

In a recent Atlantic post, Lindsay Abrams takes a closer look at the pervasive influence of cigarette manufacturers in the developing world and offers data from the latest Global Adult Tobacco Survey (subscription required).

Survey results show that nearly half of men in 14 developing countries are tobacco users and that women are starting to smoke at younger ages. Overall, researchers predict smoking will cause one billion deaths in the 21st century. Despite the grim outlook, Abrams says there’s reason to be optimistic:

Quit rates are noticeably higher in countries with programs in place for discouraging tobacco use and helping with quitting, such as the U.S., the U.K., Brazil, and Uruguay.

As the world looks to countries as models for tobacco use, Uruguay deserves note. It was included in GATS precisely because of its stringent anti-tobacco policies, including mandated graphic labels that take up 80 percent of cigarette packaging, sales tax increases, and bans on tobacco advertising and on indoor smoking in public places. Earlier this month, the International Tobacco Control Policy Evaluation Project (ITC) released a report indicating that the prevalence of tobacco use in Uruguay has decreased by 25 percent over three years.

Among other promising data, 70 percent of Uruguay’s smokers expressed regret for every having taken up smoking, and in the five-year period covered by the survey, over two-thirds of smokers at least attempted to quit. Positive health changes are already being seen, and may in part be attributed to these policies. The ITC found a 22 percent reduction in the rate of hospital admissions for heart attacks and a 90 percent decrease in air contamination in enclosed public spaces in the year after they were enacted.

Previously: A call to stop tobacco marketing, Study suggests genetics may predict success of smoking cessation methods and What’s being done about the way tobacco companies market and manufacture products
Photo by Alex Dram

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School of Medicine opens outdoor workout facility

Members of the School of Medicine community can now do a reps on TRX equipment between meetings, shoot hoops at lunch or participate in fitness classes after work at the medical school’s recently opened outdoor fitness facility.

Last Thursday, a crowd of 200 gathered at the new School of Medicine Sports Complex to test out the equipment and join in the ceremonial cutting of basketball nets. My colleague Margarita Gallardo covered the event and offers more details about the facility in an Inside Stanford Medicine story:

Just a few months ago, the complex was nothing but a dirt lot that served as the staging area for the Lokey Building. Now the area, the first of its kind at the medical school, is equipped with a full basketball court with a Nike Grind surface, Kompan outdoor exercise equipment, a TRX frame, benches and a water fountain. For those who want to play volleyball, the court is lined so that players can bring their own portable net and ball.

Leer más “School of Medicine opens outdoor workout facility”