I was speaking recently with a friend who, concerned about his father’s health, accompanied his dad to the doctor’s office. The doctor asked his dad how he felt, and the dad replied that everything was fine. That seemed to satisfy the doctor until my friend spoke up, pointing out the weakness in one of his father’s arms as well as increased memory problems. Why wasn’t the doctor better able to spot the father’s problems during multiple visits in recent months, my friend wondered?

Poor patient-physician communication is a problem that many people experience. Philip Pizzo, MD, dean of Stanford’s School of Medicine, has co-authored a commentary on the need for improvements in this area in the Journal of the American Medical Association.

In a Q&A in today’s issue of Inside Stanford Medicine, he talks about the problem, noting that, “Listening to the patient is not the same as simply asking questions and getting answers. It begins with allowing patients to tell their stories - and to have the time to do so.”

Pizzo also addresses the ways that academic medical centers like Stanford can help solve this problem.

What happens when physicians latch onto a “wonder” drug for uses that are distinctly different from its original purpose? Stanford School of Medicine researchers today showcase a clear example of the harm that can potentially be done to patients.

In a pair of studies published in the Annals of Internal Medicine, the Stanford team documents the use of recombinant factor 7a - a powerful clotting drug that was intended for a subgroup of hemophilia patients. However, the researchers estimate that in U.S. hospitals from 2000 through 2008, only 4 percent of the drug’s use was for treating hemophilia patients. A staggering 96 percent of the drug’s use involved cases of heart surgery, trauma, brain hemorrhages and a host of other surgical and medical problems.

The team also found that the use of RF7a increased the risk of blood clots without improving the mortality rates. What’s more, RF7a is pricey - it costs an estimated $10,000 for an average dose.

As first author Veronica Yank, MD, notes in our news release, “The stakes are high with this one. Because it’s such a powerful clotting agent, it has the potential when used off-label to damage the lives of patients without providing any real benefit.”

An accompanying editorial by Harvard researchers commends the Stanford team for providing “compelling data about the runaway use, uselessness and risk for this expensive treatment.”

Yank says she hopes the two studies will prompt physicians and surgeons to be more cautious about the off-label use of RF7a. “Despite the miraculous ability of this drug to stop bleeding, we have an obligation to ‘first do no harm,’” she says.

Photo by Steve Fisch

Do you know your blood type? I was surprised when many of my friends and family members said they didn’t know theirs. But here’s an easy way to find out and also do a little good work at the same time - become a blood donor.

I’ve been a regular donor at the Stanford Blood Center for nearly six years. I already knew my blood type, thanks to an experiment in a high school biology class, and that’s part of what prompted me to become a donor in the first place. I have AB+ blood, which is on the rare side (about 3.4 percent of Americans have that blood type). What I didn’t know was that I had never had cytomegalovirus, or CMV, a widespread virus that rarely causes symptoms but can be dangerous to people who have weak immune systems. The Stanford center routinely tests donated blood for the presence of CMV antibodies as well as other viruses. That’s because the center is primary supplier of blood products to Stanford Hospital & Clinics and Lucile Packard Children’s Hospital, which cares for transplant patients and others with compromised immune systems.

Because I had never contracted CMV, I was asked to become a platelet donor. Platelet donations take a little longer (the whole process usually lasts about 2 hours), but they make it comfortable by providing individual DVD players and a library of movies and TV shows to choose from. You can relax in a warmed, reclining seat and watch a movie while an apheresis machine removes your blood, separates the components, retains the platelets and returns the remaining blood through the same needle.

Two weeks ago, I made a whole-blood donation for a specific patient who matched my blood type. Whole-blood donations are much shorter, usually under an hour. But no matter which type of donation you make, you always get juice and a snack - great cookies! - at the end. (Fellow blood donors, which cookies are your favorites? I crave the chocolate-chocolate chip ones.)

Each blood donation also provides a nice little snapshot of your health. They’ll check your blood pressure, pulse, temperature, cholesterol and hemoglobin (a protein in red blood cells that carries oxygen). Stanford’s center posts the results in each donor’s online profile, making it easy to track your numbers.

So, if you’d like to learn more about your overall health and do some good for others at the same time, contact your local blood center and find out about the guidelines for becoming a donor. And if you’re squeamish or have medical reasons that prevent you from being a donor, consider volunteering to assist with some of the administrative tasks. They’ll definitely appreciate the help.

Photo by American Red Cross - Oregon Trail Chapter

Studies have shown that low expectations for particular groups of people often cause these people to perform poorly, becoming something of a self-fulfilling prophecy. So, how do you counteract the effects of negative expectations?

Researchers at Stanford’s medical school are embarking on an interesting approach to this situation by examining how a phenomenon known as “stereotype threat” may affect women engaged in academic medical careers. Stereotype threats are situations in which individuals find themselves being evaluated on the basis of a negative stereotype.

Women have long been in the minority in the faculty ranks at the nation’s medical schools, especially among the ranks of full professors. With the aid of a $2 million grant from the National Institutes of Health, a team led by Hannah Valantine, MD, will try to identify some of the reasons that women don’t advance up the career ladder at the same rate as their male counterparts.

After first identifying the cues that trigger stereotype threat among women who are junior faculty members, the team will develop and test strategies aimed at counteracting the cues.

“Currently, the factors that prevent women from advancing in academic medical careers are ambiguous, and medical school administrators end up guessing as to how to best to address them,” Valantine recently told me. She hopes the study will give them concrete guidance as to the best ways to help women move forward in their careers.

Previously: Molly Carnes: Gender bias persists in academia
Photo of Valantine by Steve Fisch

The list of nutritional supplements that live up to their promises keeps getting shorter. The latest one on the firing line is pine-bark extract. Although it’s been touted by supplement makers as a way to lower blood pressure, researchers here discovered that it doesn’t.

In a study published today in the Archives of Internal Medicine, researcher Randall Stafford, MD, PhD, and his colleagues report that a 12-week trial found that the extract, which is an antioxidant, didn’t have any effect on the blood pressure levels of people involved in a clinical trial.

“While there’s a good biological basis to presume that antioxidant supplements might have a beneficial effect on heart health, this study is another example that they don’t,” said Stafford, associate professor of medicine at the Stanford Prevention Research Center.

The study did confirm that the pine-bark extract was safe for consumption even though it didn’t improve heart health, but Stafford said many other dietary supplements haven’t undergone the same rigorous safety testing.

The study is yet another warning to consumers to be cautious about the health claims for nutritional supplements.

We often hear news reports about the latest scientific research, but just how reliable are those findings? John Ioannidis, MD, DSc, has devoted much of his career to strengthening the way that research is planned, carried out and reported. And now he is bringing that expertise to Stanford.

On Sept. 1, Ioannidis will take over as division chief of the Stanford Prevention Research Center - an organization renowned for its work in identifying ways that individuals can control and prevent such disorders as heart disease, diabetes, obesity and high blood pressure.

Ioannidis, an expert in clinical research methodology, said he hopes to expand the Stanford center’s collaborations with geneticists, biostatisticians and epidemiologists to develop both population-based and personalized approaches to health improvement.

Ioannidis is perhaps best-known for his 2005 essay in PLoS-Medicine titled, “Why most published research findings are false.” The essay remains the most-downloaded article in the history of the Public Library of Science, according to the journal’s media relations office.

Photo by Jonathan Rabinovitz

Most of us put a great deal of faith in the medications that our physicians prescribe for us, believing that our doctor is adhering to medical guidelines in deciding which pill will best treat our illness. But that isn’t always the case.

Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, has spent several years studying how well doctors change their practices to response to clinical trial evidence and to new medical guidelines. What he’s found is that doctors are often slow to adapt.

His latest such findings appear today in the Archives of Internal Medicine. Stafford and his colleague, Dipanjan Banerjee, MD, tracked the types of medications that physicians are prescribing for a condition known as congestive heart failure. They found that the use of two types of drug therapy - both of which have proven highly effective in treating the disease - has steadily declined since the early and mid-2000s.

“Our expectation was that there would be continued improvement in the use of these drugs, but that hasn’t happened,” Stafford said. “We’re not sure what’s gone wrong.”

It’s a good reminder that patients should seek out information about the therapies recommended by reputable sources (such as guidelines from medical societies) for conditions that affect them. In some cases, there may be legitimate reasons for prescribing alternate therapies - for instance, the recommended medication may have side effects that would be particularly bad for certain patients. But the dialogue between patient and physician is always important.

More information about the heart-failure study is available in this news release.

Photo by Steve Fisch

If you’re looking to shed a few pounds, you’re probably focused on the amounts of fats, carbs or protein you can eat under the various diet plans available. But a new Stanford study suggests that you should also pay attention to how a diet will affect your consumption of key vitamins and minerals.

The study involving four popular diets - Atkins, Zone, Ornish and the LEARN diet based on the U.S. Department of Agriculture’s food pyramid - showed that only those assigned to follow the Zone diet were able to avoid increasing their risks for inadequate intake of essential vitamins and minerals.

Christopher Gardner, PhD, associate professor of medicine at the Stanford Prevention Research Center and the lead author of the study, urged people to consider the overall nutritional quality of any diet plan they select, rather than focusing solely on the “macronutrients” such as carbohydrates and fats.

The study, which will be published in the August issue of the American Journal of Clinical Nutrition, is a follow-up to a 2007 paper in which Gardner and his colleagues did a head-to-head comparison of the four diet plans.

In the new study, Gardner looked at the vitamin and mineral levels of participants at the time they enrolled in the study and compared them to the levels eight weeks into their diets - when the women were the best at sticking to the new food plans. They found that in three of the diet groups, significant portions of the women increased their risk for inadequate intake of several micronutrients, such as vitamin C, vitamin E, thiamine, folic acid, iron, calcium and zinc.

That wasn’t the case for the women assigned to the Zone diet, who actually increased their intake of some nutrients. Gardner noted that the Zone plan is a “moderately low-carbohydrate” diet, and speculated that this approach to reducing carbs may help dieters maintain a healthier balance. “You can cut a lot of calories out of your diet by eliminating refined grains and added sugars - the least nutritious carbs - without sacrificing nutrient adequacy,” Gardner said.

Photo by Steve Fisch

The Stanford School of Medicine will offer an elective course this summer in which medical and graduate students will have the opportunity to have their own personal genotyping done, and then use the data to understand the benefits and limitations of such testing. As far as school officials know, Stanford is the first medical school to offer such a course:

“Over decades, Stanford scientists have contributed substantially to our understanding of the human genome, and now the potential clinical implications of these discoveries are being investigated,” said Charles Prober, MD, the school’s senior associate dean for medical education. “It is critical for our students to develop a deep, rich understanding of the hope and the limitations of personal genomics. We are in the perfect place and at the perfect time for this type of educational approach.”

Stanford’s decision to offer the course during an uproar over the propriety of genetic testing for college students. In May, the University of California announced plans to ask incoming first-year students to be tested for genes linked to the ability to metabolize alcohol, lactose and folic acid, with the goal of spurring discussion about the evolving world of medicine and genetics. At Stanford, the testing will assess a broader number of genes but will be limited to medical and graduate students who enroll in the course and elect to be genotyped.

You can read more about the elective class in the School of Medicine’s news release.

There’s a multibillion marketing practice in the pharmaceutical industry known as “detailing” in which representatives visit physicians’ offices to share information about their company’s newest drug in hopes of convincing them to prescribe it. While the practice has its critics, it’s been an effective way of boosting drug sales.

And now a Stanford researcher who has spent years examining the marketing practices of the pharmaceutical industry says it might be time for the National Institutes of Health to consider funding an independent form of “detailing” to educate physicians about treatments for which there is clear evidence of benefit for their patients.

Randall Stafford, MD, PhD, is the lead author of a study published today in the Archives of Internal Medicine on the subject. He and his colleagues examined a highly regarded 2002 clinical trial (known as the ALLHAT study) in which researchers determined that thiazide-type diuretics should be the initial drug of choice for reducing high blood pressure. Stafford said the diuretics are low-cost medication that have been on the market for years and have a good safety profile. However, many physicians and patients often incorrectly believe newer, costlier medications to be better than the old standbys.

To determine whether an educational effort would persuade physicians to follow the ALLHAT guidelines, Stafford and his colleagues analyzed an NIH-funded “academic detailing” effort in which 147 trained representatives made presentations to small groups of practitioners on the blood-pressure recommendations.

The result was that in the areas where the academic detailing effort was the most intense, prescriptions for the diuretics increased as much as 8.6 percent compared to areas where there was little or no educational outreach.

“The bottom line is that it made a difference, but it was a modest effect,” Stafford said. “It’s a testament to how difficult it is to change these physician practices, even when we have what seems like overwhelming evidence.”

With all of the money that the NIH spends on research, Stafford said he thinks it would be worth a further investment to make sure that physicians are prescribing drugs that are beneficial and cost-effective for their patients.

“Without academic detailing, clinical trials will have a suboptimal impact on physician prescribing patterns,” Stafford said. “But if you are going to do it, you need to put enough resources into the process to reach physicians, convince them that the data are reliable and help them change their prescribing patterns.”

Photo by Steve Fisch Photography

It’s a conundrum for the ages: We all know that we’d be better off if we ate healthy food and exercised regularly. And yet we inevitably find ourselves sitting in front of the TV with a burger in one hand and a large soda in the other.

Health professionals have spent decades trying to find more effective ways to convince us to improve our health habits. But Thomas Robinson, MD, MPH, at Stanford’s School of Medicine thinks he’s found a secret weapon: Instead of focusing on the personal benefits associated with a healthy diet, find social causes that people are excited about and that result in a healthier lifestyle as a side effect.

Robinson, a professor of pediatrics and of medicine, observed that many people will make large, sustained changes in their lives if they believe it serves a greater good. “A commitment to larger belief system seems to be more compelling than personal health reasons for changing behavior,”

He tested his approach by studying Stanford undergraduates who took a “Food and Society” course the researchers taught during the winter of 2009. The course focused on food-related social and environmental issues, rather than the health or nutritional aspects of food and eating.

By the end of the course, Robinson and his colleagues found that students were eating better by the end of the quarter than they were at the beginning. More details about the study and the “stealth” approach can be found in this news release.

So, if you’re struggling with diet and exercise issues, maybe the answer is to focus on an issue like curbing the effects of global warming. If you walk instead of drive, and eat locally grown produce instead of processed food that’s been transported across the country, you’ll be reducing your carbon footprint - and also your waistline.

Sounds like a win-win situation.

Photo by Shutterstock

Science education isn’t faring well in many U.S. high schools, with American teenagers being outperformed by their counterparts in several other developed countries. But universities and colleges might be able to help change that.

In the March 10 issue of the Journal of the American Medical Association, Marilyn Winkleby encourages her higher-education colleagues to develop “pipeline” programs that funnel interested high school students into the fields of science and medicine. Winkleby, PhD, is a professor of medicine at the Stanford Prevention Research Center and the faculty director of the Stanford Medical Youth Science Program. Through SMYSP, 24 high school students are selected each year for a five-week residential program on the Stanford campus where they are immersed in a hands-on science and medicine curriculum. Priority is given to students who are first-generation college students, have faced personal hardships and are from under-resourced schools or communities.

In the editorial, Winkleby and co-author Judith Ned, executive director of the program, recount SMYSP’s success among the 500 students who have completed the program since its inception in 1988 (97 percent of whom have been tracked following their participation):

Of these, 78 percent of black, 81 percent of Latino, and 82 percent of Native American participants have earned a four-year college degree (excluding those currently attending college). In contrast, among 25- to 34-year-old U.S. adults, only 15 percent of blacks, 10 percent of Latinos, and 10 percent of Native Americans earn a four-year college degree. Among the Stanford Medical Youth Science Program’s college graduates, 47 percent are attending or have completed medical or graduate school and 43 percent are working as or training to become health professionals.

They conclude by noting that if one university in each state supported such a program, “in 20 years more than 10,000 diverse low-income students could potentially enter science and health professions.” It would also dovetail with the Obama administration’s “Educate to Innovate” campaign, which encourages a broad sector of organizations and companies to champion science education.

The full editorial is available online to those who have subscriptions to the journal.

Photo courtesy of Stanford Medical Youth Science Program

If you’re planning for the umpteenth year in a row to make a New Year’s resolution to lose a few pounds, here’s a strategy you might want to consider: Cut back on your TV time.

A study published today in the Archives of Internal Medicine shows that overweight adults who reduced their TV viewing by half burned about 120 more calories a day than they did before changing their viewing habits.

Lead study author Jennifer Otten, a postdoctoral scholar at the Stanford Prevention Research Center, notes that 120 calories is the equivalent to walking more than a mile. So, the next time you reach for the remote, take a few seconds to consider which is more important: the program, or the chance to burn off those calories.

Here’s our news release about Otten’s research.

Photo by XiXiDu

Four years after Hurricane Katrina hit the New Orleans area, Stanford medical school alum Sheri Fink, MD, is publishing a disturbing investigation into whether patients at one hospital were euthanized.

“The deadly choices at Memorial” will appear in the Aug. 30 issue of the New York Times Magazine. It was written by Fink, who is now a reporter at ProPublica, a nonprofit organization devoted to investigative journalism.

Fink is an old hand at probing the delivery of medicine under extreme circumstances. In 2003, she published the book, War Hospital: A True Story of Surgery and Survival, describing the conditions faced by physicians involved in the Bosnian war. You can read more about Fink in this profile we published in Stanford Medicine magazine in 2004.

For the Katrina piece, Fink spent two years gathering accounts from nurses, doctors and others who were at Memorial Medical Center in New Orleans in the days immediately after the hurricane. What emerges is a gruesome account of doctors with little experience in triage deciding to evacuate the sickest patients last. When it became clear that evacuation options were dwindling, according to the people Fink interviewed, many of those sickly patients received fatal injections of either morphine or another powerful sedative.

Because the story was posted by the Times‘ Web site in advance of its print publication, readers are already weighing in. Some of them are appalled at the medical professionals’ actions; others say the doctors and nurses were heroes left with few choices in the most dire of circumstances.

NYT Magazine editor Gerald Marzorati says he published the story in part because “ours is a world not immune to pandemics and terrorist attacks or natural disasters. The issues surrounding medical care in such dire situations require a public conversation our country has yet to really have.”

Let the conversation begin.

Let’s say you have high blood pressure and that during your most recent clinic visit, your doctor prescribes the newest calcium-channel blocker. You’ve seen commercials for it, and you are eager to give the new drug a try.

Then you get to the pharmacy and find out that, because it’s new, your insurance company has set your co-pay for the drug at $100 per prescription. And then you read the materials that come with the medication, and you see this statement: “Although this drug has been shown to lower blood pressure more effectively than placebo, it has not been shown to be more effective than other members of the same drug class.”

Would you want to keep shelling out $100 a month for it? I wouldn’t. At least, not until I had proof that that this drug was better at treating my high blood pressure than any of the other treatments on the market.

It’s just this kind of labeling that a trio of School of Medicine researchers is advocating. In an essay published online Aug. 12 in the New England Journal of Medicine, the researchers call for the U.S. Food and Drug Administration to require drug manufacturers to state how new medications compare with similar, existing treatments.

In many instance, these statements would indicate that there is no evidence that a new drug is more effective than older ones. They believe this information would make patients and health-care insurers less likely to pay for newer treatments without evidence that they lead to improved patient outcomes.

Here’s the news release I wrote about their essay.

Photo by Bitzi