In the News

Here’s a developing social media story of interest to scientists, clinicians and the general public. National Institutes of Health Director Francis Collins, MD, PhD, kicked a hornets’ nest on Twitter earlier today with a tweet asking researchers to describe the direct impact of the U.S. budget sequestration, which began in March, on their research and lives. He asked respondents to use the hashtag #NIHSequesterImpact. The responses (some of which I’ve included below) are fascinating and depressing:

“I am no longer encouraging undergraduates to consider graduate school. No future in it.”

“The NIH training grant I’m on was canceled”

“Watching top notch science go unfunded; bright, young investigators forced to close labs, it’s heartbreaking.”

“I know a lot of very smart USA young researchers that are seriously considering China”

“Nothing will impact treating patients more in the long term than poorly funded basic science. Nothing“

Check it out if you’d like to hear a real-time conversation about what it’s like to be a researcher today, and join in if you have anecdotes to share.

Previously: As budget sequester nears, a call for Congress to protect funding for scientific and medical research, Director of NIH discusses accelerating translation of biomedical research into clinical applications and Francis Collins profiled in New Yorker

I was so happy to learn that Stanford stem cell researcher Marius Wernig, MD, (here describing his research as part of the California Institute for Regenerative Medicine’s recent Elevator Pitch competition) has been selected by the International Society for Stem Cell Research to receive its Outstanding Young Investigator of the year at the organization’s annual meeting in June in Boston.

My colleagues at CIRM beat me to the punch yesterday (Wernig is a CIRM grant recipient) with a nice blog post about the award.

I’ve written several times (here and elsewhere) about Wernig’s research as part of Stanford’s Institute for Stem Cell Biology and Regenerative Medicine. Essentially, he’s shown that it’s possible to directly convert adult, terminally differentiated cells directly into other types of cells like neurons, without first having to force the cells through a stage called induced pluripotency. It’s exciting stuff.

Wernig, who was in a former life a composer of classical music, joins Stanford researcher Joanna Wysocka, PhD, in the ISSCR hall of fame. She won the award in 2010.

Previously: Stanford scientists turn human skin cells directly into neurons, skipping iPS stage, The end of iPS? Stanford scientists directly convert mouse skin cells to neural precursors and Stanford researcher wins Outstanding Young Investigator Award from international stem cell society.
Video courtesy of the California Institute for Regenerative Medicine

The CommonHealth blog drew my attention today to the story of a group of students who jumped into action after the Boston Marathon bombings. As one of the pre-med students explains in the Times Higher Education piece, the incident - as horrific as it was - solidified her decision to go into medicine:

Near the marathon’s finish line, 50 Boston University pre-med undergraduates had been volunteering in the medical tent, filling out record forms and carrying supplies, when the bombs went off.

…

Some of the Boston University volunteers worked to clear the aisles as the floor of the tent ran red with blood. They saw the wounded, including children, arrive with missing limbs, and physicians fashion tourniquets from belts and shirts. One was ordered to set up a morgue.

“There was nothing in a classroom that could have prepared us for this,” [Yeon Woo Lee] said. “Some of the students in my group were barely 18. People stayed calm. Nobody panicked. It was scary, but I’m glad that I was there to help out and very proud.”

The experience for her and the others, she said, was horrifying and inspiring. “It was a terrible, terrible, terrible week with a lot of pain and suffering, but at the same time there’s nothing else in the world I would rather do now than go into the field that I chose to dedicate my life to,” Ms Lee added.

Previously: “We are not innocents:” What prepared medical professionals to treat Boston bombing victims

The research on how stress affects our body can be confusing. Previous studies have linked chronic stress to a variety of health conditions ranging from the common cold to Alzheimer’s disease. However, researchers at Stanford and Yale have found that short-term stress can aid in recovery from surgery and, as senior author of the paper Firdaus Dhabhar, PhD, explained in a past Q&A, a growing body of scientific evidence shows that acute stress may have protective or beneficial health properties.

But what about brief bursts of stress when individuals are already coping with something upsetting or feeling anxious? Is this helpful or harmful to the body? To find out, researchers at University of California-San Francisco asked a group of chronically stressed women to give a speech in front of a skeptical panel of judges. The New Scientist reports:

For the stressed women, the extra challenge indeed proved particularly harmful: the threat of the test caused more cellular damage than in the non-stressed controls. Perhaps more intriguing, though, was an unexpected effect [researchers] found within the control group.

Among these normally relaxed women, those who found the task moderately stressful had lower levels of cellular damage than those who did not find it stressful at all. In other words, while chronic stress can have knock-on effects that damage cellular structures, short bursts of stress can reduce such damage and protect our health in some circumstances.

The idea that being under pressure helps to focus attention and makes us better at cognitive tasks has been around for almost a century. But [the UCSF] study is a first step to showing how it can sometimes make us physically healthier as well – although exactly what is going on at the cellular level to explain the result is still unclear.

Previously: Sweating the small stuff may harm your mental health, How does your body respond to stress?, Using an app to get a better handle on what stresses you out, Study suggests anticipation of stress may accelerate cellular aging and Workplace stress and how it influences health
Photo by Sybren A. Stüvel

A million years ago (all the way back in 2006!) I wrote an article for Stanford Medicine magazine about genetic technologies and the eugenics movement in this country during the first part of the 1900s. I still remember it as one of the most fascinating of my articles to research, demanding as it did that I speak with a variety of geneticists and ethicists about the increasing control that humans have over their genetic destiny.

When, last year, I had the privilege of writing about Stanford biophysicist Stephen Quake, PhD, and his work on whole-genome sequencing of fetuses before birth, I couldn’t help but remember that article of yore. What are we getting ourselves into?

Now MIT Technology Review has recognized whole-genome fetal sequencing as one of its “10 Breakthrough Technologies 2013.” Accompanying the designation is an in-depth review of the technology and its implications - which are far more complex than I could have imagined six years ago. The article contains comments from several experts, including Stanford law professor and bioethicist Hank Greely, JD, and Quake:

Quake says proving that a full genome readout is possible was the “logical extension” of the underlying technology. Yet what’s much less clear to Quake and others is whether a universal DNA test will ever become important or routine in medicine, as the more targeted test for Down syndrome has become. “We did it as an academic exercise, just for the hell of it,” he says. “But if you ask me, ‘Are we going to know the genomes of children at birth?’ I’d ask you, ‘Why?’ I get stuck on the why.” Quake says he’s now refining the technology so that it could be used to inexpensively pull out information on just the most medically important genes.

In my opinion, experts are right to consider the impact of this type of technology before it becomes commonplace. The ethical implications of parents learning their child’s genome sequence within a few weeks of conception - and of possibly using that information to make decisions about the pregnancy’s outcome - are substantial. Thankfully, some really smart people have been asking these questions in one form or another for years, even though the answers seem to end up more grey than black and white. From that ancient article I wrote six years ago:

For example, even though sex selection of embryos fertilized in vitro has many people up in arms, there’s no evidence that it’s on track to alter the gender balance in this country: Boys and girls are nearly equally sought after, says [medical geneticist and associate chair of pediatrics Eugene Hoyme, MD]. And although some parents will terminate a pregnancy if the fetus has a genetic or developmental problem that they feel isn’t compatible with a meaningful life, different families draw this line at dramatically different points in the sand. For some, it’s too much to consider having a child with Down syndrome. For others it’s important to sustain life as long as possible regardless of the severity of the condition. Still others might choose to have a child as similar to them as possible, down to sharing disabilities such as deafness.

“Eugenics is here now,” says Stanford bioethicist David Magnus, PhD. “So what? We allow parents to have virtually unlimited control over what school their child attends, what church they go to and how much exercise they get. All of these things have a much bigger impact on a child’s future than the limited genetic choices available to us now. As long as these are safe and effective, why not give parents this option as well?”

Previously: New techniques to diagnose disease in a fetus, Better know a bioengineer: Stephen Quake and Stanford bioethicists discuss pro, cons of biotech patents
Photo by paparutzi

Did you see yesterday’s Well blog entry on the growing number of older adults seeking therapy? Abby Ellin reported:

“We’ve been seeing more people in their 80s and older over the past five years, many who have never done therapy before,” said Dolores Gallagher-Thompson, a professor of research in the department of psychiatry at Stanford. “Usually, they’ve tried other resources like their church, or talked to family. They’re realizing that they’re living longer, and if you’ve got another 10 or 15 years, why be miserable if there’s something that can help you?”

Some of these older patients are clinically depressed. The National Alliance on Mental Illness reports that more than 6.5 million Americans over age 65 suffer from depression. But many are grappling with mental health issues unaddressed for decades, as well as contemporary concerns about new living arrangements, finances, chronic health problems, the loss of loved ones and their own mortality.

…

That members of the Greatest Generation would feel comfortable talking to a therapist, or acknowledging psychological distress, is a significant change. Many grew up in an era when only “crazy” people sought psychiatric help. They would never admit to themselves — and certainly not others — that anything might be wrong.

“For people in their 80s and 90s now, depression was considered almost a moral weakness,” said Dr. Gallagher-Thompson. “Fifty years ago, when they were in their 20s and 30s, people were locked up and someone threw away the key. They had a terrible fear that if they said they were depressed, they were going to end up in an institution. So they learned to look good and cover their problems as best they could.”

Previously: The importance of combating loneliness among older adults and Elderly adults turn to social media to stay connected, stave off loneliness

In response to recent questioning of the integrity of the dissemination of results in biomedical literature, three medical researchers from Stanford and Duke University are pointing to the need for increased access to data from clinical research.

In a viewpoint article published online today in JAMA Internal Medicine, the authors, Robert Califf, MD, and Jonathan McCall of Duke, and Robert Harrington, MD, of Stanford, write that it’s time for both industry and academia to “catch up to other areas of society:”

The liberation of information once held in secret has toppled regimes and transformed societal expectations regarding progress and possibilities. Access to data from clinical research should be truly democratized.

The goal of clinical research should be to add to the body of evidence that can guide decisions about personal health and health policies, the authors write - but things like selective omission of important findings, inaccuracies in published studies, and the use of unreliable data systems are all hindering this. Harrington and his colleagues outline the critical issues that need to be addressed - issues that concern “(1) the value of the research question, (2) the quality of the execution of the research, and (3) the complete and balanced presentation of all relevant data in the publication” - and sound a hopeful note:

The good news is that powerful tools exist to address and potentially surmount these issues. These tools are the ClinicalTrials.gov registry and the ongoing movement toward data transparency.

ClinicalTrials.gov was originally created to provide researchers, physicians, and the public with ready access to information on clinical trials. More recently, legal requirements to register studies have expanded to encompass the reporting of results, including adverse events, within 1 year of ascertainment of the last primary end point. These requirements are designed to ensure that findings from almost all trials relevant to US medical practice that involve a drug or device are available in a single, accessible public registry. If the requirements of ClinicalTrials.gov and other international registries are maintained and strengthened in areas where they are currently deficient, the benefits should be substantial…

Previously: Research shows small studies may overestimate the effects of many medical interventions, Outing bias in scientific research, A critical look at the difficulty of publishing “negative” results, Examining the impact of unpublished research on medicine and Testing medical ‘truths’

Much has been written about the tragic events in Boston on Monday, but I have to draw attention to a New Yorker piece detailing how the doctors and nurses at area hospitals leapt into action to treat victims’ war-like injuries. Atul Gawande, MD, describes what happened at the hospitals that afternoon, and his take on why people there worked with such “grim efficiency”- and why, in turn, so many victims survived - is compelling:

…Something more significant occurred than professionals merely adhering to smart policies and procedures. What we saw unfold was the cultural legacy of the September 11th attacks and all that has followed in the decade-plus since. We are not innocents anymore.

The traumatic events at yesterday’s Boston Marathon have many of us bracing ourselves for what might be coming next. And, as explained in a Healthland piece, this feeling of being on high alert is a result of how our brain processes traumatic experiences.

As writer Maia Szalavitz explains, “when the brain is under severe threat, it immediately changes the way it processes information, and starts to prioritize rapid responses.” While this behavior is important to our survival, it can be be harmful to our health if it persists after the threat has passed. So what can we do to help each other heal from the tragedy and reduce the risk of those most affected from developing post-traumatic stress disorder (PTSD)? Szalavitz writes:

Fortunately, our brains are designed to modulate fear responses and at least 80% of people exposed to a severe traumatic event will not develop PTSD. Studies show that the more support, altruism and connection people share, the lower the risk for the disorder and the easier the recovery. Because such interactions aren’t always easy in the immediate aftermath of a harrowing experience, Hollander is investigating whether medications based on oxytocin— a hormone linked with love and parent/child bonding— might help to ease this connection.

If fear short circuits the brain’s normally logical and reasoned thinking, social support may be important in rerouting those networks back to their normal state. Which is why the selflessness and altruism we see in the wake of terror attacks is often the key to helping us to process and overcome the shock of living through them.

Szalavitz’s message of using compassion to combat fear was echoed in this TED blog post, which encourages people to “look for the helpers” as we process what happened yesterday, and in Mashable’s list of touching acts of kindness at the marathon.

Previously: Can social media improve the mental health of disaster survivors?, Grieving on Facebook: A personal story and 9/11: Grieving in the age of social media
Photo by Alex E. Proimos

Chronic sleep problems affect an estimated 70 million Americans, according to the latest data from the Centers for Disease Control and Prevention. Among those who have trouble sleeping soundly is KQED reporter Scott Shafer, so he recently spent the night at the Stanford Sleep Medicine Center to better understand what was keeping him from resting easy.

Shafer describes his experience staying overnight at the clinic and analyzing his sleep results with Stanford’s Rafael Pelayo, MD, in a new segment on the California Report. In describing what it’s like to snooze at a sleep clinic, he says:

It was time to get ready for bed, no small thing at the Sleep Medicine Center. I went to my room — called simply Sleep 18. Technician Robert Tognoli hooked me up with 28 wires in all — attached to my legs, my head, my abdomen - all of it designed to sense and measure my breathing, eye motions, blood oxygen, snoring, leg and chest movements.

Tognoli told me the wires would monitor the phases of my sleep, when I dreamed and if there were any “interruptions to my sleep architecture,” as shown by my brain waves. Then he stuck all the wires into a box that he hung around my neck. Next, he turned on a machine that blew air to dry the glue holding the wires attached to my head. Finally, I was ready to hit the sack. How did I sleep, and what story did all those wires tell?

Listen to the full segment to find out what Shafer learned from spending a night at the clinic and why it can be tricky to accurately evaluate one’s quality of sleep without having a lot of data.

Previously: Stanford center launches Huffington Post blog on the “very mysterious process” of sleep, Study: Parents may not be as sleep-deprived as they think, Exploring the effect of sleep loss on health and How lack of sleep affects the brain and may increase appetite, weight gain
Photo in featured entry box by Juan Antonio Flores Segal