Can social media shed light on cardiovascular disease? Possibly, Stanford journal editors write

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Illustration by Clker-Free-Vector-Images

Clearly social media is part of our every day lives, recording our personal communications in a way previously unimaginable.

Researchers are now analyzing this wealth of social media data to better understand what people think and say about their health. Recently, researchers at the University of Pennsylvania sifted through 10 billion English-language tweets to identify and study more than 550,000 US-based tweets related to cardiovascular disease, as reported in JAMA Cardiology.

The research team found that people who tweeted about five cardiovascular conditions — high blood pressure, heart attack, diabetes, heart failure and cardiac arrest — were more likely to be older and female compared to the general population of Twitter users. They also tweeted within minutes or hours in response to events, such as celebrity deaths or to mark World Diabetes Day. 

This study was discussed in the issue’s Editor’s Note by Stanford journal editors Mintu Turakhia, MD, an assistant professor of medicine, and Robert Harrington, MD, a professor and the chair of the Department of Medicine. In the editorial, they acknowledged that the Penn Twitter study was atypical research to include in JAMA Cardiology but noted that digital health is now a major priority for the journal. They explained:

“We accepted [the paper] because it highlights the potential for using these emerging data sources such as Twitter for cardiovascular research, in this case to evaluate public communication about cardiovascular medicine in a manner not previously possible on such a scale.”

Turakhia, the journal’s associate editor of digital health, elaborated in an email: “Twitter and other social media data allow us to examine daily interactions in a connected life in ways not possible before,” he said. “Previously, in order to gain insight on the public’s perception or interest in cardiovascular disease, we were limited to examine historical news and media archives or direct surveys.”

Although the editors believe that Twitter is a new and important research tool, they raised a few questions about future studies. They wrote in the editorial, “The use of Twitter and other social media platforms for cardiovascular research is in an early, proof-of-concept stage. Many important questions remain: Is there signal in the noise? Are these data or results… from the ‘Twitterverse’ generalizable to a broader population?” They also emphasized the need to establish analysis standards and overcome any ethical issues in linking the data with medical or clinical information. Turakhia added:

“Twitter users do not represent the broader population, but that’s not really its purpose. Twitter allows us to examine a highly connected subset of society and learn how cardiovascular disease might manifest in their connected world.”

Ultimately, researchers hope to use this new information to improve their patients’ health, but the research is in its infancy, he said, adding:

“We haven’t yet figured out how Twitter or social media can be definitely used to improve health and health care. The obvious avenues would be through social and community engagement. Although sharing of personal information is at the cornerstone of the success of social media, I’m not sure that society is ready to be as open with posting health information, as they are with selfies or pictures of kids. However social media could be used to gamify health care behavior by providing incentives, and that won’t need disclosure.”

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

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Chronic pain is correlated with major depression — for sufferer and spouse, study finds

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Image by Stefano Vitale via Stanford Medicine magazine

Chronic pain — pain that lasts longer than three months — debilitates over 100 million Americans and costs the United States over half a trillion dollars annually, but we still don’t really understand its underlying risk factors.

According to a new study recently published in PLOS Medicine, genetics and your home environment substantially contribute to your risk of chronic pain. The study also found that chronic pain is correlated with major depressive disorder (MDD), and both conditions are in part caused by a variety of genes.

The study was conducted by Andrew McIntosh, MD, chair of biological psychiatry at the University of Edinburgh, and his colleagues using data from two large United Kingdom population studies — including 23,960 individuals from the Generation Scotland: Scottish Family Health Study and 112,151 individuals with genotyping and phenotypic data from the United Kingdom Biobank.

It makes sense that someone with chronic pain has a higher risk of being severely depressed. But the study found that you also have increased risk for major depression if you’re living with a spouse or partner with chronic pain.

The authors discuss possible reasons for this spousal effect, which were summarized in a recent news story:

  • “You may choose a spouse similar to yourself, with similar existing predispositions to the conditions (assortative mating).
  • It’s possible that caring for a spouse with chronic illness makes you more likely to develop depression.
  • The environment you share with your spouse may contribute to both your risks of chronic pain and MDD; shared environmental factors could include diet, infectious disease, and hobbies.”

Determining the extent of these environmental factors was beyond the scope of the current study, but the authors recommend future research to identify the causal mechanisms that link chronic pain and major depressive disorder. They concluded in the paper:

“The answers to these questions are likely to signpost new directions for therapeutic interventions and highlight the symptoms that are most amenable to treatment, as well as prevention.”

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

“Ultimately about discovery”: High school students experience hands-on biology research

Photo of Seung Kim and former student Emma Herold (Steve Fisch)
Photo of Seung Kim and former student Emma Herold (Steve Fisch)

In high school, most science classes involve students reading a textbook and doing experiments with known answers. Not Bio 470: Biology Research — an experimental molecular genetics biology course developed in partnership with Phillips Exeter Academy in New Hampshire and Seung Kim, MD, PhD, a professor of developmental biology at Stanford.

Kim was inspired to develop this unique high school biology class several years ago after visiting Exeter, his alma mater. He explained in an interview:

“I became aware that they were teaching science in a way very similar to how I’d learned it, which gave me pause as a practicing scientist because it didn’t reflect how science is really done. When we learn things in school, there should be no distance between us and the primary material. When you learn to play baseball or music, you don’t just read about it in textbooks. Instead, you play and try to mimic what professionals do.”

As a result, two Exeter instructors, Anne Rankin and Townley Chisholm, and a few of their students came to Kim’s research laboratory at Stanford the following summer to learn basic techniques for breeding and genetically manipulating fruit flies. Based on this training, the team launched an 11-week biology research course with 12 upper level students per year. The instructors teach the course at Exeter each spring, but both the teachers and students are in regular contact with Kim and his colleague, Lutz Kockel, PhD.

Drosophila, or common fruit flies, are an important model organism widely used in thousands of bioscience laboratories around the world, because these fast-breeding insects share much of our genetic heritage – fruit flies have 75 percent of genes that cause diseases in humans.

In class, students delve into fly genetics, molecular biology and embryology to generate and characterize new fruit fly strains. Kim explained their research:

“People have developed ways to turn genes on or off in fruit flies, using genetic tools that exploit elements from yeast gene control factors; there are whole libraries of these yeast-based genetically-modified fruit flies stocked around the world. But you need more than one independent system, so you can study complicated things like how cells talk to each other or how they interact in time during development. The research goal of our class was to generate a whole new set of genetically-modified fruit fly stock that used bacteria instead of yeast — creating a resource for the scientific community to perform their own research.”

If they succeed, great. But success isn’t guaranteed.

“The students, instructors and researchers don’t know what the outcome will be of their work, so it creates the actual emotions, effort and experience of being a scientist. The goal is to give young people a deeper understanding of what science is, which is ultimately about discovery,” Kim said.

The model worked well for Maddie Logan, an Exeter alumnus who is now a premed undergraduate at Yale University. She called it an incredible experience: “Biology 470 was very different from other classes in that it was 90 percent lab work. Every day we’d come into class, check in with the theory behind what we were doing that day, and then go to the lab benches to do our research. I learned that things in the lab only occasionally go as planned, and a real scientist has to be able to figure out what went wrong and how to correct it for next time.”

After taking Bio 470, a few students like Logan come to Stanford each summer to continue the research in Kim’s lab. “The whole strategy was to not worry about finishing anything in 11 weeks,” said Kim. “Over the last four years, students have accrued reliable data that we’ve now put together into a unique paper.”

Their paper has just been published in the journal G3: Genes, Genomes, Genetics— a major milestone for the project. According to the manuscript’s peer reviews, the students have produced a novel collection of fruit fly lines that will be “very useful to the scientific community to study diverse biological questions.”

Starting this fall, Kim and Lutz are expanding their genetics educational program to include Commack High School, a public school in Long Island, New York. They are also hoping to create a similar biology research course in a “high-needs” high school in the future.

For Kim, the project is a personal passion. “The thing that gives me the most joy is to see students’ faces light up when they really understand and really engage in the scientific process,” Kim said. “I’m trying to get people to see the beauty in science.”

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

Kangaroo Mother Care: Researchers search for biological basis of its effectiveness

Photo by Tom Andriaenssen
Photo by Tom Andriaenssen

My niece just had a son. Despite the 110-degree summer heat, she has been holding him against her bare chest using a special newborn carrier because she knows kangaroo mother care is important. This bare skin, chest-to-chest contact has many demonstrated health benefits, including reduced mortality for low-birth-weight infants.

I recently spoke with neonatologist Vinod Bhutani, MD, about kangaroo mother care and his new pilot study — in partnership with Kari McCallie, MD, Susan Crowe, MD, and David K. Stevenson, MD — that is examining exactly how it works.

How is kangaroo mother care beneficial?

“The primary advantages of kangaroo mother care are keeping the baby warm and improving maternal-infant bonding, but there are additional benefits. When the baby is put on the mother’s breast, he is more likely to root and breastfeed. The baby also hears and feels the vibrations of the mother’s voice as she speaks or sings, and he feels the soothing rhythm of the mother’s heart that he’s used to hearing inside the womb. Finally, it improves the brain development of the baby on a long-term basis. We think skin-to-skin care is particularly important for premature babies, since their brains are not fully developed at birth. Fathers and other family members can participate too; many benefits of skin-to-skin care are not just limited to the mother.”

What barriers prevent effective kangaroo mother care?

“There are three main types of barriers: cultural ones, sick or premature babies and healthcare providers’ lack of knowledge or comfort level.

In most developed communities, the baby is separated from the mom for the first six hours after birth while the baby is being evaluated. Wearing clothes is also very important in western society, so direct skin-to-skin contact is not uniformly practiced — particularly in communities where babies are delivered at home or sent home soon after birth and mothers don’t have privacy.

In addition, sometimes babies are very sick so they are separated from their mother, placed in incubators and attached to medical devices. Studies have shown that a premature baby stabilizes better on his mother than in an incubator, but there are problems with implementation. Most hospitals in the U.S. and Western Europe discharge the mother after two days, so there are no places in the hospital for her to sleep with the baby and do kangaroo mother care. Often mothers also need to go back to work to save their maternity leave for when the baby stabilizes and comes home. And sometimes the baby is very sick and is attached to lots of technology, which can be intimidating and frightening to parents. Plus many healthcare providers aren’t convinced that kangaroo mother care is beneficial, particularly for premature or sick babies.”

What are you researching now?

“Our study stems from observations in horses made by our colleagues at the Univeristy of California, Davis led by veterinarian expert John Madigan, DVM. He found that foals exhibiting abnormal behavior shortly after birth had elevated fetal levels of neurosteroids, which was ameliorated by squeezing their chest to mimic the birth canal.

In our pilot study funded by the Gates Foundation, we looked at nine key “brain” hormones in 39 human babies, measuring hormone levels in the umbilical cord blood and 24 hours later in the baby’s blood. We studied the natural history of these neurosteroid hormones to see how they’re related to infants’ sex, mode of delivery (vaginal birth or cesarean section), maturity, and duration of skin-to-skin care.

We just finished collecting the data. Our preliminary analysis shows a significant decrease in most stress hormone levels over the first day. The decrease is more apparent in vaginal deliveries, underscoring the need to institute kangaroo mother care after a C-section. Once our analysis is complete, we hope to identify one or two key hormone levels that are the best index of birthing stress. In future work, we want to develop a test for these key hormones from the baby’s saliva to be used as a point-of-care test. A saliva test is something that a health provider could do to determine if the baby is stressed.

We need to understand the biological basis of kangaroo mother care to convince healthcare providers and policy makers of the importance of skin-to-skin contact. We need mothers and family members to be part of the healthcare team — they have a therapeutic role.”

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

Intermittent fasting: Fad or science-based diet?

Photo by Jean Fortunet
Photo by Jean Fortunet

The diet regime of intermittent fasting recently caught my attention when listening to an episode of  This American Life on my car radio. And then a close friend told me he’s planning to switch from a low-carbohydrate diet to some form of intermittent fasting.

I got to wondering, though: Are the health-benefit claims from intermittent fasting backed up by scientific evidence?

Research studies have shown that reducing your daily caloric intake by 20 to 40 percent is an effective way to lose weight and improve cardiovascular and metabolic health. However, it’s very difficult to eat less every day for a long time. So people are looking for more manageable ways to improve their health, and many are turning to intermittent fasting — short periods of eating little to no energy-containing food and drink.

To learn more about intermittent fasting, I turned to fasting expert John Trepanowski, PhD, postdoctoral research fellow at the Stanford Prevention Research Center for answers:

What are the health benefits of a calorie-restricted diet?

Calorie restriction is probably the most scientifically established diet regimen for improving health. The main benefits include improvements in risk indicators for cardiovascular disease and type 2 diabetes, which include reductions in total cholesterol level, blood triglycerides, blood pressure, carotid intima-media thickness, insulin and fasting glucose. The biggest limitation is that most people find it incredibly challenging, and some find it impossible, to follow a calorie-deprived diet for any notable length of time.

Why has intermittent fasting become increasingly popular?

Michael Mosley’s “Eat, Fast and Live Longer” documentary on the BBC introduced millions of people to intermittent fasting. Beyond that, I think intermittent fasting is appealing to many people, because they can lose weight on the diet but still have guilt-free days of eating what they want on a regular basis.

There is an increasing number of studies that suggest that intermittent fasting is a viable approach to weight loss for some. But you will have to wait until the results of my doctoral thesis are published to see if intermittent fasting is as effective for weight loss as daily calorie restriction (shameless plug!). And no study to date has examined whether intermittent fasting is effective in people who previously tried and were unsuccessful at calorie restriction.

Can you give examples of different types of intermittent fasting?

The 5:2 diet is a particular form of intermittent fasting, with five consecutive “normal” days of no restriction followed by two consecutive days of eating only 25 percent of your energy needs. I believe there have been two studies on the 5:2 diet in humans, and both studies found that the benefits were mostly the same as calorie restriction, such as weight loss and decreases in insulin.

Time-restricted feeding involves reducing the window of time to anywhere between four to twelve hours that someone takes in calories each day. The theory behind this dietary plan is that we have a circadian rhythm that calls for food intake at times and no food intake at other times in order to experience optimal health. Continuously eating, without periods of no food intake, disrupts the circadian clock and leads to metabolic derangements — such as lowered energy expenditure and elevated glucose and insulin.

Time-restricted feeding could lead to weight loss by harmonizing our eating pattern with our circadian rhythm, or it could be simply due to the fact that there are fewer “opportunities” to take in energy. And some people will lose weight due to following any type of structured eating plan, regardless of the specifics.

It’s very hard to do an accurate intermittent fasting study in humans, because it’s really difficult to get an accurate measurement of what people eat at any particular time of day. The main disadvantage of time-restricted feeding is resisting the temptations that come from our 24-hour-access-to-food environment, but that disadvantage exists with all dietary plans.

What inspired you to study different diets?

I met a very inspirational professor, Richard Bloomer, PhD, at the University of Memphis. I helped him run some studies on the Daniel Fast, which is a more stringent form of veganism based on the biblical book of Daniel. From there I wrote some review articles on fasting and calorie restriction, and I decided to study a form of intermittent fasting called alternate-day fasting for my PhD.

As a postdoctoral research fellow at the Stanford Prevention Research Center, I’m now studying factors that predict weight loss success on low-fat and low-carbohydrate diets. I am also doing meta-research — basically “research on research” to find ways to do science better.

Have you ever fasted?

I have done the Daniel Fast. It’s pretty tough. If you want to expand your cooking skills, I suggest doing the Daniel Fast. There’s no way to eat anything on this diet that is both warm and appetizing without following good cooking principles.

A cautionary note: In his review of fasting studies, Trepanowski said daily calorie restriction and alternate-day fasting do not appear to increase eating and mood disturbances among research participants who did not have an eating disorder. However, it’s best to speak with your physician before starting an intermittent fasting regimen, particularly for those with a history of or at risk for eating disorders.

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

SPARKing a global movement

browser-98386_1280Many academic researchers are tenacious, spending years in the lab studying the processes that lead to human diseases in hopes of developing treatments. But they often underestimate how difficult it is to translate their successful discovery into a drug that will be used in the clinic.

That’s why Daria Mochly-Rosen, PhD, founded SPARK, a hands-on training program that helps scientists move their discoveries from bench to bedside. SPARK depends on a unique partnership between university and industry experts and executives to provide the necessary education and mentorship to her academic colleagues.

In recent years, Stanford’s program has sparked identical programs throughout the world; at TEDMED 2015, Mochly-Rosen described this globalization. I recently spoke with her about the SPARK Global program, which she co-directs with Kevin Grimes, MD, MBA.

How has SPARK inspired similar programs throughout the world?

We’ve found our solution for translational research to be particularly powerful. Of the 73 completed projects at Stanford, 60 percent entered clinical trials and/or were licensed by a company. That’s a very high accumulative success rate. So I think it has showed other groups that we have a formula that really works – a true partnership with academia and industry. It’s the combination of industry people coming every week to advise us and share lessons learned and our out-of-the-box, risk-taking academic ideas that makes SPARK so successful.

We feel that what we’ve learned is applicable to others. Kevin and I also feel very strongly that universities need to take responsibility to make sure inventions are benefitting patients. So we’re trying to do our part.

How do you and Dr. Grimes help develop the global programs?

When a university asks about our program, we invite them to come visit us for a couple of days so they can talk to SPARKees (SPARK participants), meet SPARK advisors and watch our weekly meeting. Sometimes they also ask Kevin and I to come to their country to help set up a big event or assist in other ways. If they begin a translational research program at their institution, we offer for them to be affiliated with SPARK Global. Everyone is invited.

There are now SPARK programs throughout the world, including the United States, Taiwan, Japan, Singapore, South Korea, Australia, Germany and Brazil. We are also working with other countries, including Norway, Israel, Netherlands, Poland and Finland to help them start a program.

Do researchers in other countries face the same challenges as those in the US when developing new drugs?

There are many common challenges. And there are also some advantages and challenges that are different in other places. So it’s a mix, both within and outside the US.

There are several key components to the success of translation research. It’s important to have a good idea. It’s even more important to have good advisors from industry to help develop the idea. And it’s very important that the people involved are open-minded and are not inhibited by hierarchical structures. In some places, there is a big problem with hierarchy – particularly in parts of Europe and East Asia. In some cultures, it’s also difficult to get experts to volunteer and academics can’t afford to pay multiple advisors. Also, some universities don’t have a good office of technology to help with patent licensing, which can be a major challenge.

You recent held the first International SPARK conference. Do you have future events planned?

The first international SPARK conference was held last summer in Taiwan. We only invited those with an existing SPARK program, because it was an organizational meeting. We spent a lot of time discussing what we want to do together.

The next SPARK Global meeting will be open to every university and will be held at Stanford this fall. There will be half a day for those thinking about starting a new SPARK program at their institution, and then one-and-a-half days for those already involved. We’ll celebrate SPARK’s 10-year anniversary and the formation of SPARK Global. Our overall agenda is to continue to promote SPARK-like programs in universities, as well as come up with ideas that the global network can work on together.

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

Hope for an anti-Nicotine Vaccine

Photograph courtesy of Ianier67 via Creative Commons.

A friend once told me that it was 100 times harder for him to quit smoking cigarettes than to quit drinking alcohol. He was successful and hasn’t smoked a cigarette for over 10 years, but he’s a lucky minority. I have several other friends who still struggle with smoking cigarettes – willpower, counseling, exercising, nicotine replacement patches and antidepressants like Zyban haven’t been enough.

Clearly nicotine is highly addictive. About 45 million people in the U.S. smoke cigarettes, even though cigarette smoking leads to 1 of every 5 deaths each year. In a National Health Interview Survey, over half of the smokers reported trying to quit in the past year without success.

In the future, these smokers may get a vaccine to help protect them from nicotine addiction.

Researchers from Weill Cornell Medical College and Scripps Research Institute have developed a new vaccine that may treat nicotine addiction, by blocking the pleasurable sensations that nicotine creates in the brain. Dr. Ronald Crystal and his colleagues have demonstrated that they can prevent nicotine from reaching the brain in mice using a single injection of vaccine. If these findings are confirmed in people, this vaccine could be an effective therapy to help prevent nicotine addiction.

For more information about this research, check out my KQED Quest blog.