Month: December 2017

New course highlights how surgeons can serve their communities

Photo courtesy of Jecca Steinberg

Stanford medical students Jecca Steinberg and Paloma Marin-Nevarez want to spread the word that service-minded medical students can care for underserved communities by specializing in surgery. With the help of their mentor James Lau, MD, they have created an upcoming seminar series for medical students called “Service Through Surgery,” which showcases how surgeons can address health inequities.

Beginning in January, the new 10-week course will expose Stanford medical students to a diverse group of surgical leaders who are passionate about improving health equity through surgery. I connected with Steinberg, shown on the left in the photo, and Marin-Nevarez to learn more.

What inspired you to create the Service through Surgery seminar course?

Marin-Nevarez: “I emigrated from Mexico when I was 10 and settled in a low-income community in south Los Angeles. I never really considered myself disadvantaged until I went to college and experienced firsthand the shortcomings of my education system. Ever since, I knew I would make my life’s work to serve the underserved in communities like my own.

In my second year of medical school, I fell in love with surgery. However, when I thought about being a ‘community physician,’ I didn’t see how surgery would fit into that picture. The speakers in this course will show students with the same internal struggle as mine that they don’t need to compromise their values in order to pursue their dreams.”

What role can diversity play in overcoming health inequities?

Steinberg: “Low-income, minority communities continue to receive inadequate surgical services and bear unconscionable health burdens. Research has demonstrated that increasing diversity among physicians improves healthcare access and outcomes for traditionally disenfranchised communities, but surgery continues to trail behind other medical specialties in racial, socioeconomic and gender diversity. So the surgical workforce represents an underutilized resource for decreasing health inequities and improving the health of our communities.”

Marin-Nevarez: “A more diverse workforce leads to better outcomes for the underserved because minority patients are more likely to seek care from and be more comfortable with physicians from diverse backgrounds. And physicians from diverse backgrounds are more likely to treat patients of color in underserved communities.”

What causes surgery to be less diverse than other medical specialties?

Marin-Nevarez: “Because of unequal opportunities — especially for communities of color — surgeons are not as diverse as they should be. Because of this lack of diversity, there is a lack of mentorship that then perpetuates the cycle.

Mentorship can make a huge difference in recruiting people into a field. For example, James Lau, MD, is an amazing mentor — he was the first person to make me believe that being the first surgeon in my family may be an attainable goal. Those who ‘make it’ without mentorship most likely had access to extra resources or had to work much harder than their counterparts, or both.”

How will your seminar course inspire change?

Steinberg: “Our seminar course will create an opportunity for Stanford medical students to meet and form relationships with accomplished physicians who have combined their passions for diminishing inequities and surgery. It will show the incredible impact surgeons can make on their community. For example, Matias Bruzoni, MD, will talk about a Spanish clinic he created from scratch to improve the surgical experiences and outcomes of Spanish speaking patients. And Sherry Wren, MD, will provide her perspective on serving veterans domestically and populations around the world, exploring the adversity she faced in dedicating her career to social service.

When students connect with role models like these with a similar background and passions, they are more likely to follow in the trajectory of that role model and consider careers that might have previously seemed unattainable. We hope this seminar will provide that initial connection.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Nicotine patches and medications aren’t enough to quit smoking, a study finds

Photo by HansMartinPaul

I’ve watched family members and friends struggle to quit smoking, using nicotine patches and prescription medications. For many, it continues to be an ongoing battle.

This struggle is common, according to a new study from the University of California, San Diego that shows using smoking cessation drugs alone may not improve your chances of successfully quitting. The researchers studied two patient groups — comparing patients who used medication aids to ones that did not — to evaluate the effectiveness of three frontline smoking cessation drugs. To learn more, I spoke with the lead author Eric Leas, PhD, who conducted the research as a graduate student at UC San Diego and is now a postdoc at Stanford School of Medicine.

What inspired you to study the effectiveness of smoking cessation drugs?

“There is a major public health need for smoking cessation aids. Tobacco use remains the primary cause of cancer and cancer mortality in the United States and quitting smoking is so difficult for many smokers. I have several close family members and friends who have had debilitating disease caused by smoking and who struggled for many years to quit.

Several randomized trials have shown that some pharmaceutical smoking cessation aids can double quit rates. However, in the early 2000s, post-market surveillance studies of these cessation aids suggested that the population effectiveness did not match the randomized trial results. This was a major surprise to the medical field and met with some opposition. A criticism of these surveillance studies was that the same individual factors that make quitting difficult are also related to self-selected use of pharmaceutical aids when trying to quit. For instance, heavier smokers are more likely to use a cessation aid and also less likely to successfully quit. In social science and medicine this bias is known as ‘confounding.’”

Why did you study two “matched” patient groups?

“In our analysis, we attempted to address confounding variables using a method known as ‘matching.’ The goal of matching is to make study comparison groups similar with respect to potential confounders. In addition to cigarette consumption, we matched sociodemographics such as age, sex, race-ethnicity and education; smoking characteristics such as previous quit history and nicotine dependence; self-efficacy in quitting and having a smoke-free home.”

What did your study find?

“Even after matching, we found no evidence that the pharmaceutical aids improved the likelihood of successful quitting. While understandable, this finding is disappointing considering the need for successful cessation aids.

One possible explanation is that in many of the cessation randomized trials, smokers received the drugs in combination with intensive behavioral support. This support is not typically provided in the population. Prescribing behavioral support along with these drugs may be needed — as our results suggest that administering the drugs on their own is not working.”

What are you working on now?

“In collaboration with other professors at the School of Medicine and Stanford Business School, I am currently extending this work by studying how different groups of smokers respond to smoking cessation treatments, with the goal of developing tailored treatment plans.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Kidney stones most likely affect residents of warm, wet regions

Photo by harryson

If you’ve ever had a kidney or bladder stone, you know how excruciating and debilitating it can be. The pain — typically felt in the abdomen, groin or back — is often severe enough to cause nausea and vomiting.

These stones are solid clumps of minerals and salts that form in the kidney or bladder when the urine becomes very concentrated, which allows minerals to crystalize and stick together. Factors that are known to increase the disease risk include genetic predisposition, dehydration, a high-salt diets and obesity.

A landmark study published in 1994 determined that where you live also affects your risk for stone disease. U.S. residents in the south and east have more stones than those in the west and north. What causes this geographic distribution? The answer is still unknown: weird, right?

One theory is that higher temperature is a risk factor, but Stanford urology resident Kai Dallas, MD, told me that temperature doesn’t fully explain the phenomena.

“If higher temperature alone was the primary driving factor, then the American Southwest should have an equally high prevalence rate to the Southeast. The fact that it does not suggests that there are additional factors at play,” explained Dallas.

So his research team explored a correlation between weather patterns and urinary stone prevalence in regions throughout California, by analyzing data on urinary stone operations from the California Office of Statewide Health Planning and Development and climate data from the National Oceanic and Atmospheric Administration.

Their study found that more urinary stone surgeries occurred in regions with more rain and higher temperatures. These results intrigued Dallas because they “explained an unanswered trend in the larger national trend.”

Further studies are needed to explore why exactly this association exists, but Dallas said the and his colleagues have a theory: “We hypothesize that the increased rate of stone burden in hot climates with higher precipitation could be related to the increased inefficiency of human body thermoregulation in wet heat verses dry heat. In other words sweating is less efficient in very humid hot conditions, causing further sweating and fluid loss. And dehydration has been shown to cause kidney stones.”

Dallas hopes their study results will lead to a greater understanding of the causes of stone disease and better appropriation of resources to areas where the population faces a higher risk. He also explained that their findings are particularly important in light of climate change:

“The Environmental Protection Agency predicts that global warming will increase global precipitation. In fact, in the contiguous 48 states, total annual precipitation has steadily increased 0.17 inches per decade since 1901. This means the whole United States climate will become hotter and wetter, which is exactly the climate patterns we found that places patients most at risk for kidney stone disease.”

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Few California pharmacists prescribe birth control, a study finds

Photo by Anqa

It takes time and money to visit the doctor’s office to get birth control. This is particularly an issue for low-income women, those who live in rural areas and teenagers who feel uncomfortable seeing their family doctor.

So four states — California, Oregon, Colorado and New Mexico — are trying to make contraception cheaper and more readily available by allowing trained pharmacists to prescribe and dispense birth control pills, patches, injections and vaginal rings. However, pharmacists aren’t required to participate and few do, according to a new study.

University of California, Berkeley researchers investigated the availability and cost of pharmacist-prescribed contraception in California using a telephone audit survey of approximately 1000 community-based, retail pharmacies. Although randomly selected, most of the pharmacies were in urban areas and affiliated with retail chains, like CVS.

Posing as patients, they called the pharmacies and said, “I heard that you can get birth control from a pharmacy without a prescription from your doctor. Can I do that at your pharmacy?” If the answer was yes, then the researcher asked follow-up questions to identify the types of birth control available and the service fee.

The study found that pharmacy-prescribed birth control was available in only 11 percent of the surveyed pharmacies, with no availability differences between the rural or urban stores. They also determined that most participating pharmacies charged a service fee between $40 and $45.

“Our findings strongly suggest that more pharmacies need to offer this service to live up to the promise of widespread, easier access to birth control,” said lead author Anu Manchikanti Gómez, PhD, an assistant professor of social welfare at UC Berkeley, in a recent news release.

The authors noted that the current service fees may make birth control too expensive for some low-income women. They are hopeful this will improve once California’s Medicaid program starts reimbursing pharmacists for these services, which is required by July 2021.

They conclude the paper with a call for more research to identify the barriers to birth control accessibility.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Drug blocks Zika and other deadly viruses in cells cultures, Stanford study finds

Photo of Jan Carette by Paul Sakuma

A team of Stanford researchers is developing approaches to thwart a family of deadly viruses, called flaviviruses, by targeting the human cells that host these invading pathogens.

Flaviviruses include the dengue-fever, yellow-fever, West Nile and Zika viruses transmitted to humans by mosquitoes, as well as encephalitis transmitted by ticks. Unfortunately, approved antiviral drugs for these diseases aren’t currently available.

So, instead of the traditional approach of attacking an individual virus directly, the researchers focused on the cellular factors of their human hosts that are essential to many viral infections.

“Generally, when you develop a drug against a specific protein in dengue virus, for instance, it won’t work for yellow fever or Zika, and you have to develop new antivirals for each,” said Stanford virologist Jan Carette, PhD, in a recent Stanford news release. “Here, by targeting the host rather than a specific virus, we’ve been able to take out multiple viruses at once.”

Earlier, the team genetically profiled human cells to identity the host factors necessary for the viruses to replicate inside the cells — revealing new candidate targets for antiviral drug development. Specifically, they demonstrated the importance of the oligosaccharyltransferase (OST) complex that attaches sugar molecules to proteins. They found flaviviruses did not infect their genetically engineered cells without OST.

In the new study, recently published in Cell Reports, the Stanford researchers collaborated with scientists at Yale University to test the effectiveness of a drug called NGI-1, which inhibits the activity of the OST complex.

They showed that low concentrations of NGI-1 could be used to block the viruses from replicating without harming the host cells — successfully reducing the infection by 99 percent when treating cells immediately after they were infected by Zika or dengue virus, and by 80 percent when administered 24 hours after infection.

Their study also indicated that the viruses are unlikely to become resistant to NGI-1. “When you target a host function rather than a viral protein, it’s usually much more difficult for a virus to develop resistance,” Carette said in the release.

The researchers are now busy with follow-up studies to test NGI-1 in small animal models of dengue fever and are also developing similar drugs with improved specificity.

This is a reposing of my Scope blog story, courtesy of Stanford School of Medicine.

Researchers investigate fruit flies as a step towards understanding the human brain

Photo by nuzree

Researchers have been trying to map out the brain’s complex neural circuits to understand how diseases like Parkinson’s disrupt healthy brain communication, in hopes of designing better therapies.

That, obviously, is not easy. So a Stanford research team led by biology professor Liqun Luo, PhD, and bioengineer and physicist Stephen Quake, PhD, are instead studying fruit fly brains — yes, those pesky bugs that fly around your bananas.

Specifically, they have mapped out a blueprint for the fruit fly’s olfactory neurons — identifying how specific gene and protein activity correlates with the biological circuitry of different neuronal cell types. The researchers focused on a fruit fly’s sense of smell because the function, physiology and anatomy of its olfactory system are well known, making it a simple and ideal test bed for their research.

They measured the gene expression profiles using a single-cell sequencing technology developed for mice and human cell types, which they modified to work for the smaller and simpler fruit fly cells.

The team determined different types of neurons express genes differently during development, but gene expression between the neuron types becomes indistinguishable as the flies mature, as recently reported in Cell.

“Once the brain is wired up, the fly doesn’t need to express those genes that help them in choosing the connection partners,” said first author and Stanford biology postdoc Hongjie Li, PhD, in a recent news release. “So there is less gene expression in the adult flies.”

The researchers are a long way from using their technique to map the human brain, but they aren’t daunted by the challeng. “By further developing this approach, we hope to one day reverse-engineer and perhaps even repair defective circuitry in the human brain,” Li said in the release.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.