Last week’s C-IDEA global health symposium here at Stanford featured 20 presentations on low-cost ideas for preventing disease in developing nations. As I wrote in an Inside Stanford Medicine article on the event, one of the more clever ideas was “EZPZ,” a method for treating latrine waste with alkalizing lime so that pathogens that might leak into the water supply can be eliminated and the waste can be recycled as crop fertilizer. Developed by a Stanford team from the “Design for Extreme Affordability” course offered at the Hasso Plattner Institute of Design, this solution not only reduces diarrheal diseases, but it also provides Cambodian farming households with about $40 of fertilizer each year.

Another highlight of the conference was the keynote speech delivered by Jeffrey Sachs, PhD, director of The Earth Institute at Columbia University and author of the bestselling book The End of Poverty. Sachs’ call to action for the packed hall of global health innovators was this: The developing world needs you to create smart phone apps that connect people in isolated rural villages to good medical care, clean water and medicine.

Previously: What I did this summer: Stanford medical student helps India nonprofit create community-health maps and A story of how children from Calcutta’s poorest neighborhood became leaders in improving health

A new online tool can help seniors with advanced heart disease decide between two possible medical interventions - Coronary Artery Bypass Graft surgery or Percutaneous Coronary Intervention, a.k.a. angioplasty.

To use the tool, seniors enter in their age, gender, diabetes status, tobacco use and heart disease history. The tool then calculates a predicted five-year survival rate, based on outcomes of similar patients who underwent these procedures. These predictions are derived from data extracted from the medical records of more than 100,000 Medicare patients, and analyzed using a model recently published in a study led by Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford.

I had the pleasure of working with the amazing team of health researchers and programmers who developed this medical decision tool in a little under a month. For me, it was a sneak preview into the future of personalized medicine, where a person can review surgical outcomes of real-world patients with similar health histories, to reach an informed decision on a treatment plan with their physician.

“Studies usually focus on the results for the average patient, and not on how much the results vary among individuals. This model is a step towards personalizing treatment recommendations, based on each individual’s unique characteristics,” Hlatky told me. “The other exciting thing about this new methodology is that with relative ease, it can be applied to other medical conditions such as cancer and stroke.”

Hlatky will present his model and findings at the Institute of Medicine workshop “Observational Studies in a Learning Environment,” which can be viewed via a webcast on April 24-25.

Previously: Is stenting or surgery better for diabetics? New study provides answer, New test for heart disease associated with higher rates of procedures, increased spending and To stent or not to stent: not always an easy answer
Illustration by Dawn Johnson/iStock

Anyone who has ever eaten a rancid food-truck taco has a gut-level feeling for what it’s like to have the human immune system launch a full-scale attack along 30 feet of intestinal tract. Now you can watch this fascinating process at a microscopic level, pain free, thanks to a new animation posted by Nature: Immunology.

Watching it makes me appreciate the amazing complexity of the human immune system. It also serves as a graphic reminder of how much easier it is to understand these processes when you can see them in action.

Readers interested in irritable bowel syndrome might want to skip to minute 4:00, where the animation shows what happens when pathogens sneak past the gut’s protective mucosal barrier. Spoiler alert: Watch out for the “voracious phagocyte” and the “NETosis explosion.”

Previously: The dawn of a new era in microbiology, Study shows intestinal microbes may fall into three distinct categories and A social networking service for digestive health?

“All men are created equal” may be the guiding legal principle for citizens of the United States, but not when it comes to health care coverage and outcomes, says Victor Fuchs, PhD, one of the nation’s foremost health economists and the Henry J. Kaiser Jr. Professor, Emeritus, at Stanford.

In a Viewpoint published today in the Journal of the American Medical Association, Fuchs provides a history lesson on how and why the U.S. health care system spends more than double on per-person health expenditures than other advanced nations, and he offers some strategies for controlling future costs.

“This is the best short piece on U.S. health care that I’ve ever seen,” Howard Bauchner, MD, editor-in-chief of JAMA, told me.

Beginning today, the Affordable Care Act expands the number of Americans receiving preventive care, providing new federal funding to state Medicaid programs that choose to cover preventive services. It also requires that states pay primary care physicians no less than 100 percent of Medicare payment rates for primary care services.

While the health-care reforms mandated in the act include some provisions to motivate health-care providers to become more efficient, less fragmented and more accountable, it doesn’t include revenue sources for all its new services. Fuchs says, “More comprehensive reforms are necessary to avoid financial disaster.”

According to Fuchs, there are three fundamental differences in the U.S. system — driven by its history — that make it difficult for the U.S. to adopt a less costly government-financed health care system. There is a distrust of large government that began when America broke away from the strong-armed British Empire. There is a reluctance to redistribute wealth across all citizens, in part because of the country’s cultural diversity. And there are “choke points” in the U.S. political system — such as the cost of election campaigns and the Senate filibuster — that give deep-pocketed special interest groups the upper hand in preventing sweeping reforms.

As a new Congress returns to work with health care reform high on its new year’s resolutions, Fuchs’ editorial provides a starting point, grounded in history, for a new round of negotiations.

Previously: Study: If Americans better understood the Affordable Care Act, they would like it more, Does the Affordable Care Act address our health-cost problem?, Stanford economist Victor Fuchs: Affordable Care Act “just a start” and An expert’s historical view of health care costs

From Dec. 24 to Jan. 7, Scope will be on a limited holiday publishing schedule. During that time, it may also take longer than usual for comments to be approved.

With rising health care costs threatening U.S. global competitiveness, Arnold Milstein, MD, urges physicians to focus their efforts on more efficient and effective ways of practicing medicine, rather than lobbying Congress to protect their incomes.

Milstein lays out this “urgent choice” in this perspective piece published yesterday online in the New England Journal of Medicine.

I’ve been following Milstein’s efforts to build the Stanford Clinical Excellence Research Center for the last two years, and I’m impressed with the progress that he and his graduate research fellows have made in designing better, more efficient ways to deliver medical care. His overarching philosophy is summed up here:

U.S. health care needs to adopt new work methods, outlined in the Institute of Medicine’s vision for a learning health system. Such methods would enable clinicians and health care managers to more rapidly improve value by continuously examining current clinical workflows, management tools from other service industries, burgeoning databases, and advances in applied sciences (especially health psychology and information, communication, and materials technologies). They could then use the insights gained to design and test innovations for better fulfilling patients’ health goals with less spending and rapidly scaling successful innovations.

By adopting these new technologies and methods, Milstein predicts that physicians’ short-term income drops will be replaced with new income-generating opportunities. For example, with Internet-based video and instant translation services, physicians will soon be about to export their expertise to rapidly developing countries facing physician shortages.

He ends the editorial with a quote from Sir William Osler, the father of modern medicine:

Medical care must be provided with the utmost efficiency. To do less is a disservice to those we treat, and an injustice to those we might have treated.

Which path will physicians choose?

Previously: How can we slow growth of U.S. health-care spending?, When it comes to health-care spending, U.S. is “on a different planet” and U.S. health-care costs rising faster than abroad

Last night I went to an inspirational talk by Melinda Gates, chair of the largest philanthropic organization in the world, where she discussed innovative approaches to reducing infant mortality in the developing world.

To the crowd of mostly Stanford engineering students, Gate’s message was somewhat surprising. She said that sometimes the most effective solutions to global health problems are low tech and the hard part is figuring out how to spread these life-saving ideas in a culturally appropriate way.

She shared a story about a typical birthing procedure in northern India to illustrate her point. In remote villages there, newborns are placed on the bare ground for extended periods of time while a birth attendant tends to the mother’s well-being. After the mother’s condition is stable, the attendant scrubs the birthing debris off the newborn with a gritty, sandy paste from a nearby river and then rubs mustard oil over the baby’s skin for protection. While most people well versed in germ theory would blanch at this scenario, it is a generations-old tradition in this region that is hard to change.

Gates and her global health partners discovered that by convincing the power brokers in this culture — the mother-in-laws — to make four simple changes in their birthing procedures, they could reduce newborn deaths by half. The list:

1. Immediately place a newborn on the mother’s chest and wrap both mother and child in a sari, a protocol often referred to as “kangaroo care.” This protective pouch keeps a newborn warm and stimulates the mother’s breast milk production.
2. Clean the infant with a more sanitary solution.
3. Rehydrate the newborn with breast milk rather than river water.
4. Use sunflower oil on the infant’s skin rather than the more astringent mustard oil, which can often cause allergic reactions.

To spread the word on the success of this checklist, the foundation is leveraging the most efficient social network available in this region — the women who talk while cooking, washing and tending their children.

In addition to reducing infant mortality, Gates has also launched a campaign to expand access to contraception. She discussed the initiative and why family planning looms so large in both her heart and her mind in the latest issue of Stanford Medicine.

Previously: Simple program shown to reduce infant mortality in African country and Simple program shown to reduce infant mortality in African country
Photo by DFID - UK Department for International Development

You may have heard about the new research showing that bypass surgery is better than stents for diabetics: In a Mount Sinai School of Medicine study of 1,900 diabetics with multi-vessel coronary disease, heart bypass surgery increased the five-year survival rate by 30 percent compared to the use of artery-widening stents.

I spoke with Mark Hlatky, MD, professor of health research and policy and of cardiovascular medicine at Stanford, who said that this study should settle the 17-year debate on bypass-vs-stent effectiveness with “compelling evidence.”

In a New England Journal of Medicine editorial, Hlatky goes on to say that many of the stent procedures today are performed on the fly, during a diagnostic angiogram, with the same physician making the diagnosis, recommending the treatment, and performing the procedure. He feels that these new findings will result in a change for the better in clinical practice and will enable patients to be better informed about their choices.

This study should settle the 17-year debate on bypass-vs-stent effectiveness with ‘compelling evidence.’

“Patients and their doctors need to allow time for discussions on which procedure should be done, based on outcomes that are important to them,” said Hlatky. “They need time to digest the information, discuss it with family members and members of the heart team, and come to an informed decision.”

It’s worth noting that cost may be a factor in treatment discussions. Bypass surgery costs more than implanting stents, but because it results in fewer deaths and heart attacks, it is worth the front-end expense, said researchers on the cost-analysis part of the study. After factoring in the stent-related costs of new heart attacks and follow-on operations to re-open arteries, bypass surgery still costs about $3,600 more than the stent procedure over five years.

Previously: New test for heart disease associated with higher rates of procedures, increased spending and To stent or not to stent: not always an easy answer

When I interviewed Manali Patel, MD, a Stanford oncologist, for an article on improving poor-prognosis cancer care, she cited a shocking statistic: Less than a third of oncologists have end-of-life discussions with terminal cancer patients. She went on to tell me:

Many patients are rushed off to chemotherapy without understanding the big picture. And when predictable treatment side effects happen at night and on weekends, patients who are unable to reach their oncologist end up in misery in emergency rooms and hospitals. Later in their illness, many die painfully in intensive-care facilities that bankrupt their families emotionally – and sometimes financially.

With gritty determination, Patel is working to change all this. A little over a year ago, she joined a small, idealistic band of physicians, engineers and management scientists at a new Stanford center tasked with battling the waste and perverse financial incentives in America’s increasingly unaffordable medical system.

I followed Patel for six months, as she refined her plan for better cancer care and went on the road to sell it to a medical system resistant to change — in the middle of coping with a mother with cancer.

To read her inspirational story, check out the latest issue of Stanford Medicine magazine, which also includes a special report on the money crunch in medicine.

Previously: The money crunch: Stanford Medicine magazine’s new special report and New Stanford center to address inefficient health care delivery
Photograph by Jamie Kripke

In this amazing video, Tom Kirchhausen, PhD, a Harvard Medical School professor of cell biology, shows how tiny protein-bubbles form to carry cargo, such as nutrients and hormones, across cell membranes. Using Total Internal Reflection Fluorescence microscopy (TIRF), researchers were able to capture, for the first time, real-time footage of how this crucial cellular mechanism happens, providing new insights on how drugs might interact with life’s moving parts at the molecular level.

These findings were published in the August 3 issue of Cell.

I call it the ultimate “blue light special:” an oral cancer screening tool that costs just a few dollars and can be used in rural regions of developing nations to help with early detection of a disease that kills more than 270,000 people a year.

Developed by a Manu Prakash, PhD, and his Stanford bioengineering team, this elegantly simple device, called OScan, attaches to any smartphone’s built-in camera, allowing anyone to take a high-resolution, panoramic image of a person’s complete mouth cavity. Illuminated by the device’s blue fluorescent light, malignant cancer lesions in the oral cavity can be easily detected as dark spots, by dentists or oral surgeons receiving these images wirelessly.

As I wrote in this Inside Stanford Medicine article, one thing I found shocking was how serious the epidemic of oral cancer is in India, due to the widespread use of chewing tobacco and the scarcity of dentists:

Although oral cancer stands as the sixth-most frequent type of in United States, it accounts for more than 40 percent of cancer-related deaths in India, not surprising considering that nearly 57 percent of males and 11 percent of women consume tobacco in that country.

OScan, which leverages the camera technology in ubiquitous smartphones, is a clever solution to the growing global problem of oral cancer. Today the device won first and second place, respectively, for the mHealth Alliance Award and the Vodafone Americas Foundation Wireless Innovation Project.

Photo by Steve Fisch