For those of us who live in climes with no shortage of sunny days, spending hours outdoors is a such given that we may forget - especially in the bliss of summer vacation - that it can be too much of a good thing. But Stanford’s dermatologists, about to host their annual free skin cancer screening on June 2, are quick with facts and figures about the risks of too much unprotected time in the sun.

In the latest issue of Inside Stanford Medicine and in the video above, we tell the story of Kelly Bathgate – a classic example of what doctors are seeing in rising numbers: a young woman with melanoma. In the last 30 years, the rate of melanoma in women under age 40 has risen 150 percent. 

So how can these cancers be prevented? Since sun exposure remains the single most predictive risk factor for development of skin cancer, protective steps aren’t extreme. As Stanford physician Sumaira Aasi, MD, told me:

We’re not asking people to get on a treadmill or not eat their favorite foods. We’re just recommending that people treat sunscreen like brushing their teeth or using deodorant don’t leave the house without it no matter what the weather is like.

Previously: Study shows link between indoor tanning and common skin cancer, Working to prevent melanoma, New law: No more tanning beds for California teens and Intense, rapid sun tanning may increase skin cancer risk

“Medicine is getting so complex that I hope you’re not trying to memorize everything. There is a certain amount of information you must know, but… if you know how to get to [a lot of other information], that’s more important than knowing it off the top of your head.” That was the recent advice given to a group of third-year residents by Stanford emergency medicine physician Graham Walker, MD.

In the Grand Rounds talk above, Walker goes on to discuss how the Internet has accelerated the dissemination of medical information – allowing physicians to share information and test new techniques quicker, potentially improving quality of care, but also making it challenging for doctors to stay current on the latest medical advancements. He explains his approach in using social media to keep up the rapid pace of biomedical news, and he provides tips on how clinicians can use medical-related blogs, apps and other digital tools at the bedside.

Previously: Social media in medicine: Going from “entertaining to life-changing” and A guide to the social web for physicians
Via Cases Blog

Big Gulps, Venti coffees and super-size menu options have skewed Americans’ view of portion size and contributed to the nation’s obesity epidemic.

But adding edible serving size markers that act as subconscious stop signs to snack food items could re-educate Americans’ on portion size and reduce tendencies to overeat, according to two experiments conducted by researchers at Cornell University.

Forbes reports:

In the [first] study, researchers divided 98 students into two groups. The students were given tubes of chips — some divided by red-dyed “stop sign” chips, others not — then settled down to watch movies. Interestingly, the chips were counted differently; in some tubes the marker chips were inserted after every 7 chips; in others after every 14 chips. The researchers, who were part of Cornell’s Food and Brand Lab, then counted the number of chips each student ate.

… [Researchers] found that the students given the tubes with the marked chips ate on average half the number of chips as the students  given the unmarked tubes. The students didn’t receive any explanation of why some of the tubes contained red chips. Even so, the students given the marked chips ate 20 and 24 chips on average (for the seven-chip and 14-chip tubes, respectively), compared with 45 chips in the control group.

During the second study, which has not been published, the food markers were placed after every five or 10 chips. Results showed that participants’ whose tubes had a marker after every five chips ate 14 chips and those with markers placed after every 10 chips ate 16 chips. But volunteers in the control group consumed 35 chips.

The investigators say additional research is needed to better understand how such segmentation cues work, why they work and whether people will compensate for the reduction in food intake by eating more later.

Previously: Stanford nutritionist offers guidelines for eating healthy on the go, Is frequent snacking to blame for Americans’ growing waistlines? and The dark side of “light” snacks: study shows substitutes may contribute to weight gain and “Snack” offerings in restaurants may be on the rise
Photo by Adam Gerard

Scientists at Stanford have invented a way to store, erase and code digital data in the DNA of living cells.

Bioengineers used enzymes from bacteria to flip sequences of DNA one direction, then another. The back and forth represent the ones and zeros of digital information. By coding a section of DNA that determines if the cells fluoresce red or green, the researchers easily visualized the switch (see photo).

The team, led by Drew Endy, PhD, calls the flipping device a “recombinase addressable data” module, or RAD. Endy commented in a release on the method’s potential biomedical applications:

Programmable data storage within the DNA of living cells would seem an incredibly powerful tool for studying cancer, aging, organismal development and even the natural environment.

In developing the system, researchers had to control the precise dynamics of two opposing proteins, integrase and excisionase, within the microbes. The team found it was fairly simple to flip a section of DNA in either direction but needed to repeatedly and reliably flip the sequence back and forth to create a fully reusable binary data register. Getting the balance of protein levels right took researchers three years and 750 tries. As explained further down the release:

[First author Jerome Bonnet, PhD] has now tested RAD modules in single microbes that have doubled more than 100 times and the switch has held. He has likewise switched the latch and watched a cell double 90 times, and set it back. The latch will even store information when the enzymes are not present. In short, RAD works. It is reliable and it is rewritable.

For Endy and the team, the future of computing then becomes not only how fast or how much can be computed, but when and where computations occur and how those computations might impact our understanding of and interaction with life.

“One of the coolest places for computing,” Endy said, “is within biological systems.”

A paper on the device was published today in the Proceedings of the National Academy of Sciences. The team’s next goal is to scale up to a byte – equivalent to eight bits of programmable DNA.

Previously: Drew Endy contemplates new modes of computing in medical research
Photo by Norbert von der Groeben

A new poll from NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health offers an interesting snapshot of Americans’ views on the cost of health services and quality of care.

Roughly 1,500 adults across the country were surveyed for the poll and slightly more than a quarter of respondents had a serious injury or illness or an overnight hospitalization within the past 12 months. Shots reports:

When the results came back, we found that people who have a serious medical condition or who’ve been in the hospital in the past year tended to have more concerns about costs and quality than people who aren’t sick. No big surprise there.

But what was notable: 3 of 4 people who were sick said cost is a very serious problem, and half said quality is a very serious problem.

Nearly half of those with recent serious illness say they felt burdened by what they had to pay out of their own pocket for care.

The recently ill are more likely to say the cost and quality of care have worsened over the past five years, compared to people who weren’t sick.

Among people who’ve recently required a lot of care, significant proportions say their treatment was poorly managed, with nearly a third complaining of poor communication among their caregivers. One in eight believe they got the wrong diagnosis, treatment or test.

The results prompted NPR to put out a call out on Facebook asking users to share their experiences with the health-care system and launch a series called “Sick in America.”

Previously: Personal essays highlight importance of cost-conscious medical decisions, Educating physicians on the cost of care, When it comes to health-care spending, U.S. is “on a different planet” and U.S. health-care costs rising faster than abroad
Photo by Stanford EdTech

In this richly-colored painting, artist and patient-rights activist Regina Holliday depicts central themes of the upcoming Stanford Medicine X conference. On the artist’s blog she explains:

In the foreground, two girls stand within rising water. They are patients in need of rescue from the coming flood.  One girl turns her back to the viewer and holds a smart phone in her hand. The other girl looks out of the frame and a blue twitter bird perches upon her finger. Though they look concerned but they are not panicked, because they have the tools of mobile health and social media to help them.

To the left of this piece, a series of people are pushing their rafts upon the rising water. Our blocks from the tower have become rafts to navigate the deluge. Here we have doctors, techs, academics, venders, designers and patients trying to find common ground. Each uses the pole in their hands to move forward in the water. As the pole crosses before their body each becomes the letter “X.”

We are the X in Medicine X. We are the unknown part of the equation. We are the mysterious other that has not been applied to the solution. We are the files locked in a cabinet and dismissed as other or strange. We are the ever arching story above and beyond the episode of care.

Via Medicine X blog

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

Can yoga help women suffering from fibromyalgia?: A study published in the Journal of Pain Research shows that practicing yoga boosts levels of the stress hormone cortisol and could help ease some symptoms of fibromyalgia such as pain, fatigue, muscle stiffness and depression.

Stanford medical residents launch iPhone app to help physicians keep current on research: To help their colleagues keep current on medical advancements, Stanford medical residents Dave Iberri, MD, and Manuel Lam, MD, introduced a new medical app that features physician-written summaries of landmark clinical trials.

The Beast cut in on my song: Living with coronary microvascular dysfunction: As part of Scope’s partnership with Inspire, Catasauqua, Penn. resident Annette Pompa writes about her experience living with coronary microvascular dysfunction.

Honoring a pioneer in heart-transplant medicine: Sharon Hunt, MD, recently received a lifetime achievement award from the International Society for Heart and Lung Transplantation. A pioneer in the field of post-transplant cardiology, she has cared for more than 1,500 heart transplant patients during her career.

Stanford professors propose re-imagining medical education with “lecture-less” classes: In a perspective piece in the New England Journal of Medicine, Charles Prober, MD, senior associate dean for medical education at the School of Medicine, teamed with Chip Heath, PhD, a professor of organizational behavior at the Stanford Graduate School of Business, to propose a new model for optimizing medical education.

Google’s PageRank algorithm sorts search results by relevance and now researchers are using a similar strategy to sift through thousands of proteins that affect the progression of pancreatic cancer.

German scientists from the Dresden University of Technology ranked cancer biomarkers and found seven proteins that predicted how patients respond to chemotherapy. The study was published in PLoS Computational Biology.

Cancer biomarkers have garnered considerable interest in medical and clinical research. They could be used to predict the outcomes of individuals with cancer and personalize therapy. But so far, few biomarkers have proved clinically useful. For example, controversy surrounds the effectiveness of measuring levels of prostate-specific antigen (PSA) as a way of screening prostate cancer; PSA levels are also high in non-cancerous enlarged prostates. In addition, biomarkers identified in different studies almost never overlap.

The German team worked around this problem by analyzing relationships between biomarkers. An article from e! Science News explains:

This problem has been circumvented using the Google strategy, which takes into account the content of a web page and also how these pages are connected via hyperlinks. With this strategy as the model, the authors made use of the fact that proteins in a cell are connected through a network of physical and regulatory interactions; the ‘protein Facebook’ so to speak.

“Once we added the network information in our analysis, our biomarkers became more reproducible,” said Christof Winter, the paper’s first author. Using this network information and the Google Algorithm, a significant overlap was found with an earlier study from the University of North Carolina. There, a connection was made with a protein which can assess aggressiveness in pancreatic cancer.

The group is currently running a clinical trial to evaluate these new biomarkers.

Previously: Value of disease biomarkers may be overrated

In the this TEDMED talk, Francis Collins, MD, PhD, director of the National Institutes of Health, discusses bridging the gap between basic science and clinical applications in the drug development process. Repurposing existing drugs and testing on fabricated human tissue are two ways that Collins identifies in his talk as potential methods for getting disease treatments to market faster.

Stanford researchers are also working to make translational medicine a reality through the School of Medicine’s SPARK program, which creates partnerships between scientists and entrepreneurs to promote innovative research.

Previously: Re-engineering the drug-development process to speed medical advances, Accelerating the translation of biomedical research into clinical applications and Why drug development is time consuming and expensive (hint: it’s hard)
Via Medgadget

During the most recent National Prescription Drug Take-Back Day, Americans turned in 276 tons of unused medications. But there are likely additional expired or leftover pills still taking up space in medicine cabinets around the country.

Those who still have a surplus of prescription drugs may be interested in findings recently published in Environmental Science and Technology examining the various options for discarding medications and how these disposal methods impact the environment.

In the study (subscription required), researchers compared the financial costs, environmental impact, convenience and compliance of three disposal options: flushing, trashing and incineration. Shots reports:

Their results show that flushing allows the highest levels of drugs to enter the environment by far, and creates more air pollution than trashing.

Drugs collected by take-back programs are incinerated, which means none of the medicines themselves enter the environment. But the programs produce much greater emissions of greenhouse gases and other pollutants than either flushing or trashing. That’s due in large measure to travel: people have to travel to a drop-off point, and then the collected drugs are shipped somewhere for incineration.

[Sherri Cook, a PhD candidate at the University of Michigan,] says one benefit of home disposal is that we already have an infrastructure for collecting household trash. There’s also evidence from Sweden, which has had a drug take-back program for decades, that participation stagnates at around 40 percent of consumers.

At those rates, Cook’s research suggests the drugs getting into the environment would be about the same as if everybody threw them out at home, while producing three times as much pollution.

But Barbara Carreno, a DEA spokeswoman, says collection programs bring in people who otherwise might never have disposed of their old drugs. “People brought medicines to our [April] take-back that had been sitting in drawers, I kid you not, for 40 years,” she says.

For more information on the topic refer to these federal guidelines (.pdf) for safely disposing of drugs at home or this online resource for locating nationwide medical disposal programs.

Previously: Turn in your old pills on April 28
Photo by Cavale Doom

Previous research has shown that women are underrepresented in certain trials, including studies related to cancer and prevention of cardiovascular disease. Today, an editorial in the Los Angeles Times highlights the lack of women in AIDS clinical trials, despite that they account for 25 percent of Americans living with the disease, and researchers’ efforts to reverse this trend.

The editorial board writes:

Why the imbalance? Researchers say it’s due to a combination of factors. The majority of HIV-positive women in the country — more than 60% — are black; 17% are Latina. That means they’re often poorer, with less access to medical treatment at universities doing research, and are therefore less likely to be found when researchers are recruiting. It takes more effort to reach out to public clinics and community case workers to find women of color with HIV or AIDS; that effort can slow the start of a study. There also is a lingering mistrust of medical researchers in the black community, experts say, partly the legacy of exploitative experimentation on minorities. As a result, women and people of color have traditionally been underrepresented in clinical trials on numerous diseases and conditions.

Does it matter if women are included in HIV studies? Yes, because women metabolize or tolerate some drugs differently than men. Side effects, too, can vary depending on gender.

Some researchers are making a greater effort to seek out women and explain their studies carefully. The AIDS Clinical Trials Group has set a floor of 10% participation by women in studies, and it tries for 20%. In addition, it used grant money to hire community health “promoters” at 10 research sites across the country whose job is to make people in minority communities aware of research projects.

Previously: What motivates people to participate in clinical trials? and Women underrepresented in heart studies
Photo by Wellcome Images

As evidence-based medicine takes a greater foothold, medical residents and physicians are tasked with the seemingly constant challenge of staying up to date on the latest treatments and drugs. To help their colleagues keep current on medical advancements, Stanford medical residents Dave Iberri, MD, and Manuel Lam, MD, introduced a new medical app that features physician-written summaries of landmark clinical trials.

Lam, a third-year resident with an undergraduate degree in computer science, and Iberri, a second-year resident and an experienced web developer, carved out time from their busy clinical schedules to develop the recently released Journal Club for iPhone (link to iTunes store).

Below Iberri, a second-year medical resident, discusses the motivation for creating the app and how the Stanford medical center community helped shape the final product.

What spurred the creation of this product?

As medical trainees, we furiously jotted down medical acronyms in our notebooks hoping to read these articles on post-call days. But early on we realize that wading through the sea of medicine journals can be overwhelming, if not downright impossible. In the midst of our resident schedules, how can we digest all this content? Which articles should be at the top of our reading list? Passionate about medical education, Manny and I wanted to solve this problem. We sought to put answers at the clinician’s fingertips, immediately accessible at the point of care. Since smartphones, and the iPhone in particular, are revolutionizing the way medicine in practiced, deciding to design an iPhone app was a no-brainer. Thus the Journal Club. Written by physicians, these article summaries are distilled into bite-size morsels that clinicians can digest quickly. Think of it as CliffsNotes for medical research.

Continue Reading »

Following my colleague Marissa Fessenden’s entry on the difficulty – and importance – of publishing results from duplicate studies that contradict previous findings, there’s some more news on biases in published research. The current issue of the NIH Record newsletter reports on a recent NIH-sponsored talk that John Ioannidis, MD, DSc, gave on the topic. Among his concerns:

Ioannidis said… editors want to publish research that is novel and will have a large impact on the field, which generally means papers that report very large, statistically significant effects.

At the seminar, Ioannidis outlined other instances of bias and made nine recommendations to improve biomedical research by overcoming these. Registering clinical trials, even if the results are never published, is “one of the best ideas ever to appear in clinical research,” Ioannidis said, and it will ensure the important data won’t get “lost.”

The article concludes:

…Under the weight of the great promises they make, investigators often abandon studies whose results seem uninteresting or selectively report only statistically significant portions of their results.

“We need to move away from the requirement to make big promises,” [Ioannidis] said. “Very little of what we do will be so lucky as to break new ground.” He suggested that instead of funding specific research projects, NIH and other funding bodies should support individual researchers with a track record of excellence. “Maybe we should promise instead just to do our best,” he said.

Previously: A critical look at the difficulty of publishing “negative” results, Testing medical ‘truths’ and “Omics” studies need validation, says Stanford’s Ioannidis
Via HealthNewsReview.org

New research based on electronic health record data suggests that patients who undergo genetic testing do not subsequently request costly follow-up tests or additional health-care services.

The findings (subscription required) were published online today in the Genetics in Medicine. The study was completed as part of the Multiplex Initiative and involved 217 healthy adults between the ages of 25 and 40 who volunteered to participate in genetic susceptibility testing offered by their health plan. The testing panel consisted of 15 genetic markers that play roles in common diseases such as Type 2 diabetes, lung cancer and coronary heart disease.

Researchers examined the health-care services used by the participants in the 12 months before and after the genetic testing. Study participants’ behavior was also compared to a group of nearly 400 members of similar insurance plans who elected not to complete genetic testing. According to a National Institutes of Health release:

The study is the first to use electronic health records — rather than self-reported behavior — to measure the impact of genetic testing on the subsequent consumption of health services by commercially insured, healthy adults. Self reports, which can be affected by memory lapses and other problems, tend to be less accurate.

…

The researchers counted the number of physician visits and laboratory tests or procedures the people received, particularly those services associated with four of the eight conditions tested by the multiplex panel. Most of the procedures or screening tests that were counted are not among those currently recommended for people in this age group who don’t have symptoms. The researchers found that participants in genetic testing did not change their overall use of health care services compared with those not tested.

Previously: How genome testing can help guide preventative medicine, What personal DNA testing can reveal about your potential health and future well-being and Could patients’ knowledge of their DNA lead to better outcomes?
Photo by National Institutes of Health

A handful of hospitals in the United Kingdom are partnering with Microsoft Research Cambridge to test the use of Xbox Kinect to view images such as MRI or CT scans in the operating room. Today, a piece in the New Scientist takes a look at how using the video game console during surgery allows physicians to operate more efficiently and maintain their concentration.

MacGregor Campbell writes:

Maintaining a sterile environment in the operating room is paramount, but scrubbing in and out to scroll through scan images mid-operation can be time-consuming and break a surgeon’s concentration or sense of flow. Depending on the type of surgery, a surgeon will stop and consult medical images anywhere from once an hour to every few minutes. To avoid leaving the table, many surgeons rely on assistants to manipulate the computer for them, a distracting and sometimes frustrating process.

“Up until now, I’d been calling out across the room to one of our technical assistants, asking them to manipulate the image, rotate one way, rotate the other, pan up, pan down, zoom in, zoom out,” says Tom Carrell, a consultant vascular surgeon at Guy’s and St Thomas’, who led the operation on 8 May to repair an aneurism in a patient’s aorta. With the Kinect, he says, “I had very intuitive control”.

Carrell used the system to look at a 3D model of a section of the abdominal aorta, captured on a CT scan. This was projected on to a 2D live image-feed of the operation site, taken with a fluoroscopic X-ray camera. So Carrell could see what was happening inside the patient, as well as using the 3D model to help navigate the twists, turns and branches of the aorta. He says he consulted the system four or five times during the 90-minute operation.

Previously: Canadian hospital tests Kinect in the operating room and A look at an iPad in the operating room
Photo by Joint Base Lewis McChord