Grant Miller, associate professor of medicine and a Stanford Health Policy core faculty member and senior fellow at the Freeman Spogli Institute, has been working to help residents of a state in India access the micronutrients that they are lacking. The work, which involves a fortified rice, includes several Indian ministries, nonprofit organizations, and faculty from across the Stanford campus to assess and support the collaborative effort.

In this video, Miller says Stanford's collaborative community and institutes help projects like his in the southeastern India state of Tamil Nadu succeed. "Micronutrient deficiency rates in Tamil Nadu are extremely high," he says. "We're working with the government of Tamil Nadu to see if it's possible to introduce fortification into what's called the public distribution system — which distributes rice at no cost to all residents of Tamil Nadu."

And, Miller says, he would not be able to carry out that research without the teamwork generated here on campus.

The prestigious panel of medical experts who provoked a nationwide debate when it suggested fewer mammograms is standing by its recommendation that women 50 and older only get the screening every other year.

The U.S. Preventive Services Task Force issued an update of its 2009 guidelines on Tuesday, noting that women in their 40s with an average risk of breast cancer should discuss mammography with their clinicians and make individual decisions about whether to have the screening.

When the panel made the panel first made the recommendation, it provoked an outcry from some medical associations and cancer-awareness advocates who feared the advice would lead some women to delay having mammograms and put them at greater risk of death.

“In 2015, contentious discussions about breast cancer screening and prevention continued, with physicians, advocates, lawmakers, and scientists all lending their voices to the debate,” the Task Force said in an editorial on its website.

“Many of these stakeholders focused on the need for women to be able to make more informed health care choices about when to start screening without having to worry about the cost of an insurance copayment,” said the panel of experts, including Stanford Health Policy’s Douglas K. Owens, director of the Center for Health Policy and the Center for Primary Care and Outcomes Research.

“The role of the U.S. Preventive Services Task Force (USPSTF) in these discussions has remained unchanged: to empower women with the best scientific data about the benefits and harms associated with breast cancer screening, so they can make an informed decision with their doctor.”

Breast cancer is the second-leading cause of cancer death among women in the United States, according to the National Cancer Institute. In 2015, an estimated 232,000 women were diagnosed with the disease and 40,000 women died. It is most frequently diagnosed among women aged 55 to 64 years, and the median age of death from breast cancer is 68 years.

The task force determined that while screening mammography in women aged 40 to 49 may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger.

The balance of benefits and harms is likely to improve as women move from their early to late 40s, the task force said.

“In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime,” the Task Force said. “Beginning mammography screening at a younger age and screening more frequently may increase the risk for over-diagnosis and subsequent overtreatment.”

The independent panel of medical experts from around the nation said that women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.

Not everyone is pleased with the recommendations.

Florida Congresswoman and chair of the Democratic National Committee, Debbie Wasserman Schultz, issued a statement that suggested the Task Force recommendations could put younger women at risk because their insurance companies may stop paying for their screenings.

“These guidelines indicate that screening for women under 50 is less beneficial in detecting breast cancer than for older women,” said Wasserman Schultz, herself a breast-cancer survivor. “However, because insurance companies often use these guidelines to determine coverage for these critical life-saving screenings, these new recommendations could potentially bar millions of women from getting coverage for screenings they need.”

Judy Salerno, president and CEO of the Susan G. Komen breast cancer charity, said she worries the recommendation could target African-American women in particular.

“A lack of coverage would be most harshly felt in high-risk and underserved populations,” Salerno said. “African-American women, for example, are often diagnosed at younger ages with aggressive forms of breast cancer – and die of breast cancer at rates over 40 percent higher than white women. Screening at younger ages is a critical tool for these women.”

Members of the Task Force, however, emphasized that it was their role to evaluate scientific evidence and not make insurance coverage decisions.

“The USPSTF acknowledges the important role that insurance coverage plays in access to and use of preventive services,” the Task Force said in its editorial. “Coverage decisions are the domain of payers, regulators and legislators. Whatever we may believe about the importance of coverage in shared decision-making about mammography, we cannot exaggerate our interpretation of the science to ensure coverage for a service. This would lead to confusion regarding the state of science versus the politics of coverage.”

The U.S. Preventive Services Task Force recommends adults between the ages of 40 and 75 take a cholesterol-lowering statin drug to help prevent heart attacks and strokes if they are at risk of cardiovascular disease.

One in three Americans die of heart attacks or strokes. And those with no signs or symptoms, as well as no past history of cardiovascular disease, can still be at risk.

The independent panel of medical experts from around the nation said in a news release that statins could help those who have a risk factor for cardiovascular disease — such as high cholesterol or blood pressure, diabetes or those who smoke — and have at least a 7.5 percent risk of having a cardiovascular event in the next 10 years.

The task force also called for more research on the use of prescribing statins for children and adolescents who are at risk of heart disease.

The American Heart Association and American College of Cardiology have been recommending statins in adults for several years. The task force is now making a similar recommendation for primary prevention based on the latest clinical trials and research.

“The task force looked carefully at current data to identify who can benefit the most from taking statins,” said task force chair Albert L. Siu, MD, MSPH, who is also chair of the Ellen and Howard C. Katz Mount Sinai Health System.

“People with no signs, symptoms, or history of cardiovascular disease can still be at risk of heart attack or stroke,” said task force member Douglas K. Owens, MD, a Stanford professor of medicine and director of the Center for Health Policy and Center for Primary Care and Outcomes Research at Stanford Health Policy.

“Fortunately, for certain people at increased risk, statins can be very effective at preventing these events,” said Owens, who emphasizes that adults who fall into those risk and age groups must first consult with their physicians.

The task force said all adults could reduce their risk of cardiovascular disease by not smoking, eating a healthy diet, engaging in physical activity and limiting alcohol use. Managing high blood pressure and high cholesterol and taking aspirin when indicated can also help prevent heart attacks and strokes.

Based on the current evidence, the task force said, it is not yet clear whether taking statins is beneficial for people who are older than 75. But they did find the effectiveness of statins is the same for both men and women.

This is the first time the task force has changed its fundamental approach since 2008, when it recommended screening for abnormal amount of lipids in the blood. While screening remains key, most adults are now routinely screened as part of an overall cardiovascular risk assessment.

Therefore, the task force found the more relevant clinical question is no longer whom to screen for elevated cholesterol, but rather whom to treat with preventive medication once increased cardiovascular risk has been identified in an individual.

The Preventive Services Task Force also announced that there is not enough data and evidence to assess the balance of benefits and harms in screening for high cholesterol in children and adolescents up to age 20.

While some experts have recommended lipid screening in children and teens, the task force found that the evidence shows it’s difficult to predict which children who have high cholesterol will continue to have it as they age.

“There is currently not enough research to determine whether screening all average-risk children and adolescents without symptoms leads to better cardiovascular health in adulthood.” said Task Force Vice Chair David C. Grossman, MD, MPH. “In addition, the potential harms of long-term use of cholesterol-lowering medication by children and adolescents are not yet understood.”

The public can review the findings and comment on the task force website.

Other articles on the recommendation include:

The Associated Press

MedPage Today

Reuters

HealthDay

Most prescriptions for opioid painkillers are made by the broad swath of U.S. general practitioners, not by a limited group of specialists, according to a study by researchers at the Stanford University School of Medicine.

This 2016 newsletter from the Stanford Department of Medicine is neither a yearbook of our recent accomplishments nor an annual report replete with facts and figures. It’s most like an anthology, giving readers glimpses of some recent progress we’ve made as we addressed Stanford Medicine’s tripartite mission: to teach our students and trainees, to do research, and to care for our patients. As we move toward the future, it’s important to reflect on the past, which created the culture of the Stanford Department of Medicine. The report also features Stanford Health Policy's Marcella Alsan's work about the impact of the tsetse fly on African economies.

In this video, Robert Harrington, MD, chair of the Department of Medicine, gives an overview of the department's vision for the future, as well as highlighting the department's four strategic priorities.

See the multimedia report here.

The cold and flu season is upon us — and with that comes the potential overuse of antibiotics. All too often, physicians prescribe antibiotics for viral infections, which typically is ineffectual and can even be dangerous for elderly Medicare patients.

An estimated 2 million Americans are infected with drug-resistant organisms each year, resulting in 23,000 deaths and more than $20 billion in excess costs, according to the Centers for Disease Control and Prevention.

Excessive antibiotic use in cold and flu season is not only costly, but it also contributes to antibiotic resistance, writes Stanford Health Policy's Marcella Alsan and her co-authors in a study published in the December edition of Medical Care. The study’s objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of clinically appropriate or inappropriate prescribing.

Alsan and senior author, Dartmouth economist Jonathan Skinner, concluded that flu-related antibiotic use was correlated with prescribing high-risk medications to the elderly.

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When Former New York City Mayor Michael Bloomberg took a stand on sugary drinks, banning large sizes to encourage moderation, his efforts were met with some applause—but also with jeers of derision, one New York Post headline dubbing him the “Soda Jerk.”

But with one third of the nation’s adult population considered obese, and alarming evidence about the health dangers and economic toll of obesity, research on ways to slim America’s collective waistband is sorely needed.  

Stepping back from the frenzy, faculty and students at Stanford Law School are digging into the issue to try to tease out the data and offer an unbiased empirical view. 

Last spring, Jordan Flanders, JD ’15, worked with Michelle Mello (BA ’93) and David Studdert, two members of Stanford Law’s health law faculty, on a research paper that analyzed legal, economic, and political issues raised by sugary drink laws in different countries, explaining five major categories of regulations (taxes, government procurement regulations, school-based regulations, advertising restrictions, and labeling rules) and parsing out the biggest challenges to implementing each. The result, “Searching for Public Health Law’s Sweet Spot: The Regulation of Sugar-Sweetened Beverages,” was published in July in PLoS Medicine, a highly regarded international medical journal, and went a long way to inform the debate. 

Stanford has taken the need for lawyers working in the critical area of health law seriously. Mello and Studdert, both professors of law with joint appointments with the medical school, were hired in the last two years. They joined Hank Greely, Deane F. and Kate Edelman Johnson Professor of Law, and Daniel Kessler, professor of law—increasing to four the number of faculty who are fully focused on health law. They are joined by half a dozen law faculty whose scholarship often touches on diverse subjects such as psychology, drug regulation, and environmental issues at this intersection of law.

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