Volume 18 Number 2 Fall 2001




Spiritual approach helps addicts recover

Inpatient substance abuse treatment programs emphasizing the spiritually oriented “12-step” approach to addiction save money and promote abstinence more effectively than treatment programs that emphasize practical coping skills, according to a Stanford study. In fact, graduates from the 12-step-oriented programs like Alcoholics Anonymous slice their long-term health care costs by more than half by turning to community-based self-help groups rather than to professional mental health services for support in the year after discharge, say the researchers. They are also significantly more likely to remain abstinent in the year following their treatment.

“Groups like Alcoholics Anonymous and Narcotics Anonymous are taking a huge burden off the health care system,” says Keith Humphreys, PhD, assistant professor of psychiatry and lead author of the study published in the May 2001 issue of Alcoholism: Clinical and Experimental Research. He is also the associate director of the Program Evaluation and Resource Center at the VA Palo Alto Health Care System.

Humphreys and co-author Rudolf Moos, PhD, professor of psychiatry at Stanford, studied 1,774 low-income, substance-dependent men who had been enrolled in inpatient substance abuse treatment programs at 10 Veteran Affairs medical centers around the country. Five of the programs strongly emphasized the 12-step approach to addiction — a spiritually oriented philosophy that urges individuals to take responsibility for their actions and ask God for help in conquering their dependency.

The remaining five programs used an approach called cognitive-behavioral therapy that concentrates on teaching individuals coping skills to avoid relapse. The men in the study were evenly divided between the two types of programs.

Humphreys found that the men who had participated in cognitive-behavioral programs had mental health care costs that were about $4,700 higher than those who had been enrolled in 12-step oriented programs.

The 12-step oriented programs were not only cost-efficient, they were also effective — nearly 46 percent of the men who had been in these programs were abstinent one year after discharge, compared with 36 percent of those treated in cognitive-behavioral programs


A pill to improve women's sex lives

Physicians have few treatment options to offer women with sexual dysfunctions — there is no female Viagra. So when former Stanford physician Hank Wuh, MD, chairman of a nutritional supplement company, asked Mary Lake Polan, MD, PhD, chair of gynecology and obstetrics at Stanford, to guide the company’s study of a product for improving women’s sexual function, Polan agreed.

Polan, who now serves on the company’s scientific advisory board, is acutely aware of the seriousness of the problem of sexual dysfunction among women. About two years ago, she began asking patients about their sexual activity and was stunned to discover that nearly 70 percent reported sexual dysfunction. National figures for female sexual problems are also high: Over 40 percent suffer from some level of sexual dysfunction, such as low libido, slow arousal, difficulty reaching orgasm and painful intercourse.

In the face of such a seemingly intractable problem, Polan was dubious that Wuh’s readily available product — one of a number of nutritional supplements on the market for female sexual functioning — would prove useful. But the results of her study surprised her. She found that the capsules significantly improved women’s sexual desire and their overall satisfaction with their sex lives.

Polan and her colleagues evaluated the supplement ArginMax for Women, produced by the Daily Wellness Co., through a double-blind study of 93 women between the ages of 22 and 73 who indicated they were lacking in sexual desire. Forty-six received the nutritional supplement and 47 received a placebo. The participants used a questionnaire to rate their level of sexual function before the study and then after taking either a placebo or the supplement.

At the end of four weeks, 62 percent of the group that received the supplement reported greater satisfaction with their overall sex life compared with 38 percent in the placebo group. Additionally, 64 percent of those who took the supplement reported improvement in their level of sexual desire compared with 43 percent in the placebo group. In the supplement-treated group of women nearing menopause, 91 percent reported an increase in the frequency of intercourse compared with 20 percent in the placebo group.

The capsule’s ingredients include the herbs ginkgo, ginseng and damiana, the amino acid L-arginine, as well as the vitamins A, B-complex, C and E, and the minerals calcium, iron and zinc. Polan has no explanation for why the capsules work, she notes.

Says Polan, the supplement is clearly an option for some women, but it is not a panacea. She advises women to talk openly with their doctors about sexual dysfunction, noting that a full evaluation by a medical professional is critical to rule out serious medical conditions and to guide women to the best solutions.


Kornberg receives 2001 Welch Award in Chemistry

For his pioneering work in clarifying the process of transcription — in which DNA is copied into RNA — Roger Kornberg, PhD, professor of structural biology, was named the 2001 winner of the prestigious Welch Award in Chemistry, which carries a $300,000 prize.

Kornberg determined the structure of the RNA polymerase protein, one of biology’s pivotal molecules. The polymerase copies genes from DNA to RNA — an essential step in the transfer of information from gene to protein.

“Our work has accomplished two things,” Kornberg says. “First, an understanding at the atomic level of how transcription occurs, and second, a description of how it is regulated.” Kornberg’s research team isolated 48 proteins from yeast cells that are responsible for both transcription and its regulation. They also demonstrated that a virtually identical set of proteins performs the same function in human cells. These 48 proteins fall into three groups: 12 form the RNA polymerase that is responsible for the actual process of transcription; 16 direct the polymerase to the genes to be transcribed; and 20 form a “mediator” that regulates the process.

The group’s most recent discoveries relate to the RNA polymerase and the mediator. “Through nearly 20 years of work, we succeeded in determining the arrangement of the 30,000 atoms in the RNA polymerase,” Kornberg says. “Our latest work, which was published in the journal Science , shows all atoms of an RNA polymerase caught in the act of gene transcription. From this information we can deduce the mechanism of the RNA polymerase machine.” Kornberg is the first Welch Award recipient in the School of Medicine and the third Stanford winner. The other two are Henry Taube, PhD, professor emeritus of chemistry and winner of a Nobel Prize in 1983, and Richard Zare, PhD, professor of chemistry. The award, given annually by the Welch Foundation since 1972, recognizes outstanding basic chemical research.

Kornberg has a history of applying chemistry to biological problems. He received his undergraduate degree in chemistry from Harvard and his doctorate from Stanford. After postdoctoral studies at the Medical Research Council Laboratory of Molecular Biology, Cambridge, UK, and the Society of Fellows, Harvard University, he became an assistant professor in Harvard’s department of biological chemistry. Kornberg came to Stanford in 1978 as a professor in the structural biology department and served as chair of the department from 1984-92.


Cohen and Fogarty to enter National Inventors Hall of Fame

Two members of the medical school’s faculty were inducted into the National Inventors Hall of Fame in September.

Genetics professor Stanley Cohen, MD, and surgery professor Thomas Fogarty, MD, joined eight other inventors as this year’s new inductees.

Cohen, who holds the School of Medicine’s Kwoh-Ting Li professorship, is being honored for developing genetic engineering, which allows scientists to move genes from one organism to another. Genetic engineering has many applications in medicine: For example, most insulin taken by diabetics is genetically engineered. Additionally, many other human gene products with medical uses, such as human growth hormone, are available only because they can be made through recombinant DNA technology.

Fogarty will be honored for inventing a type of catheter that has revolutionized the way surgeons remove clots from blood vessels. The device, called the Fogarty® Balloon Embolectomy Catheter, has transformed a complicated, invasive operation involving many incisions and a hospital stay into one that can be done with a single, small incision using a local anesthetic. Today surgeons carry out more than 650,000 such procedures annually.


Pediatric Sleep Service

Some of the children who come to Lucile Packard Children’s Hospital at Stanford at night will have a very different experience from their daytime counterparts. Pajamas will replace hospital gowns, milk and cookies will stand in for cafeteria food, and VCRs and televisions will be available in every room. After snacking and socializing, the kids will get down to the serious business of the evening — sleeping.

After all, that’s what you do when you’re a patient at Stanford’s new pediatric sleep service — the first dedicated pediatric sleep program in Northern California to be accredited by the American Academy of Sleep Medicine. The program served its first patients in April.

As the children slumber, sensors taped to their skin record the length and phases of their sleep cycles. The following morning, researchers analyze the results to determine if any of the children suffer from sleep disorders. Rafael Pelayo, MD, director of the new sleep service, hopes the kid-oriented surroundings will help put young patients at ease and facilitate Stanford’s ongoing management of pediatric sleep problems.

“It’s meant to be a special night,” says Pelayo, assistant professor of pediatrics and of psychiatry and behavioral sciences. “The kids get to have the undivided attention of their parents, who can sleep in a bed next to their child. They can order take-out food. They can bring anything they want from home — except pets.” Pelayo also encourages parents to make the evening stand out, perhaps by buying matching sets of pajamas for the occasion.

The fledgling sleep service, which is a joint program of the children’s and adult hospitals at Stanford, is not an entirely new endeavor for the physicians. Stanford’s Sleep Disorders Clinic and Research Center has treated pediatric patients for many years. Stanford established the world’s first clinic devoted to sleep disorders in 1970, and the center’s first patient was a child, says Pelayo. The center treats about 350 children per year.

“There has been a need to specialize further,” says Pelayo, who is board-certified in both pediatrics and sleep medicine. “We’re providing the same service we have for years, but in a more child-friendly environment.”

Children can suffer from the same sleep problems that plague adults, including sleep apnea, insomnia and narcolepsy. Pelayo says one-fourth of all parents are concerned about their children’s sleep. Parents should suspect a sleep disorder if a child is not refreshed after a night of sleep, is very difficult to awaken in the morning, is an extremely restless sleeper or snores. Parents should also keep in mind that some sleep problems are inherited, so if they have sleep problems, their children might have them too.

“Because some of these conditions can run in families, it’s not uncommon to find a similar problem with the parents,” says Pelayo. He conducts an annual community outreach seminar titled, “Sleepless in Silicon Valley,” to address sleep issues that can affect all family members, particularly babies.

Behavioral problems and learning difficulties at home or at school can also be a symptom of poor sleep. Pelayo and his fellow researchers are especially interested in studying the sleep of children diagnosed with attention deficit disorder, or ADD. The sleep physicians suspect that at least some of these children may actually be suffering from sleep problems that impair their ability to concentrate.

Treatment of sleep disorders can include surgery to remove the tonsils or adenoids that may be obstructing the airway of children with sleep apnea, or the use of medications or specialized breathing equipment to help the child obtain a more restful night’s sleep.

New chief of News and Public Affairs

Ritch K. Eich, PhD, has joined Stanford University Medical Center as Chief of News and Public Affairs. Eich, who has considerable experience working as an administrator in medical settings, began leading communications, media relations and public affairs for Stanford University Medical Center in April.

For the past two years, Eich oversaw public relations for Blue Shield of California. Prior to that, he spent nine years at Indiana University Medical Center in Indianapolis (which includes Riley Hospital for Children, University Hospital and the Indiana University School of Medicine), where he was vice president for public relations and marketing. He also served as senior vice president at Butterworth Health Corp. in Grand Rapids, Mich., and as vice president at St. Joseph Mercy Health System in Ann Arbor, Mich. At The University of Michigan, Eich was assistant to the vice president for academic affairs. Eich also dealt with national and international media during a 25-year stint as a Naval Reserve public affairs officer.

Among his many accomplishments, most notable is his ability to build bridges between academic medical centers and the community, says Philip Pizzo, MD, dean of Stanford’s School of Medicine. That will be an important aspect of his agenda at Stanford, Eich says.

Interim CEO for Stanford Hospital & Clinics

Michael J. Peterson began serving as interim CEO of Stanford Hospital and Clinics on June 1.

“I’m delighted that Michael Peterson has agreed to join us,” said Eugene Bauer, MD, vice president for the medical center, when he announced the appointment in May.

“He is an experienced leader in health care. He will continue to move our turnaround process forward and will complement the experience of the excellent senior management team assembled by Malinda Mitchell.”

Peterson has more than 30 years of experience in health care. He is the founding partner of The Peterson Network, a Santa Cruz-based company that provides health care organizations with transitional executive leadership. He has held numerous transitional roles at hospitals and regional health systems — most recently serving as interim CEO of Holy Cross Hospital in Chicago and interim COO of Alta Bates Medical Center in Berkeley.

Peterson succeeds Mitchell, who retired May 31. Bauer says the search for a permanent replacement for Mitchell is progressing.

New nerve cells for the brain

For the first time, researchers are testing whether human cells coaxed in the laboratory to become neurons can be implanted into the brains of stroke patients and pinch-hit for their stroke-damaged counterparts. Researchers at Stanford University Medical Center, where the study is taking place, are hopeful that the new neurons will relieve the long-term weakness and loss of motor control suffered by many stroke victims.

The implanted cells are synthesized from human tumor cells by Layton BioScience Inc. of Sunnyvale, Calif., which is sponsoring the study. The company uses a patented process to transform the tumor cells into non-tumorigenic, non-dividing human neuronal cells.

Preliminary results of a phase-I trial conducted at the University of Pittsburgh on 12 patients indicated the cells were safe for use in humans. The results also hinted that the new neurons might be able to correct at least some of the permanent neurological symptoms that linger after a stroke. “Although the study was not designed to prove efficacy, because the number of patients was too small, there was a suggestion that half the patients experienced improved motor function six months after implantation,” says Gary Steinberg, MD, PhD, professor and chair of neurosurgery and co-investigator for the phase-II clinical trial.

Now scientists at Stanford, the University of Pittsburgh and the University of South Florida are seeking patients for a larger study to determine if the implanted neurons can benefit chronic stroke patients. A total of seven patients will participate in the first round of the trial at Stanford.

To date, two patients at Stanford have been treated with 5 million of the manufactured neurons, says Steinberg, who anticipates treating the remaining patients in the first round by the end of the year. A second group of trial participants will receive 10 million transplanted cells if the results from the first round are promising. Though it is too soon to draw conclusions, says Steinberg, the two patients transplanted thus far have reported improvements over their baseline. Also, some of their neurological evaluations look encouraging, he says.

Steinberg continues to recruit participants for this phase-II clinical trial. To qualify, patients must have suffered a stroke in the basal ganglia region of the brain one to six years ago and must have permanent, major weakness or partial paralysis on one side of the body. They must be between the ages of 18 and 75 and be able to participate in eight weeks of physical therapy at Stanford following the implantation procedure.

Those chosen to participate will be randomly assigned to either a treatment or a control group. Throughout the first year following implantation, physicians will assess the participants’ degree of motor control and the extent of weakness in the affected sides of their bodies. Then for the next four years, physicians will assess patients annually.

New tests for toxoplasmosis help prevent unnecessary abortions

If infectious disease specialist Jack Remington, MD, could tell pregnant women just one thing, it would be: “Eat all your meat well cooked.”

Pregnant women who consume undercooked meat run the risk of ingesting the parasite that causes toxoplasmosis — an infection that often causes serious birth defects.

But since Remington can’t do that, he and his Stanford colleagues have done something else to limit harm caused by toxoplasmosis: They’ve developed a panel of serologic tests to better gauge a pregnant woman’s risk of passing on the infection to her fetus. Their findings, published in the January 2001 American Journal of Obstetrics and Gynecology , show that this panel can dramatically reduce the number of women who have abortions due to concerns about transmitting the infection.

The toxoplasma infection results from eating undercooked or raw meat, or from contact with infected cat feces. Determining when the toxoplasma infection has occurred is critical to determining the health of an unborn baby. A woman infected prior to her pregnancy has essentially no chance of giving birth to an infected child. But if the woman first becomes infected during pregnancy, her fetus may be at significant risk. And that infection can cause disastrous results in the newborn — blindness, epilepsy, psychomotor retardation or mental retardation, Remington says.

Between 1,000 and 4,000 infants born in the United States each year have congenital toxoplasma infections. Though these newborns often appear healthy at birth, if untreated, 90 percent later become disabled.

According to Remington’s study, 60 percent of the pregnant women who underwent standard tests for toxoplasmosis either registered a false-positive or had their test results misinterpreted. When informed that additional tests indicated they actually had little chance of passing on the infection to their fetuses, only 0.4 percent of these women aborted their pregnancies. In comparison, 17.2 percent of the women whose positive result was confirmed by the additional tests had abortions.

“This is a wake-up call for those responsible for the health of pregnant women and their offspring to recognize the importance of appropriate serologic testing for pregnant women,” says Remington, professor of medicine at Stanford. “We’re facing a problem with incorrect interpretations of tests, and tests on the market that are inadequate.”

The new panel of serologic tests, developed by Remington and his team, includes an avidity test, which allows physicians to see if the infection is new, and potentially harmful, or if it’s a chronic infection that poses no risk to the fetus. “We can for the first time — with a very high degree of accuracy — tell a woman in her first trimester of pregnancy that if she has a high avidity test, there is no risk to her fetus,” he adds.

Says Remington: Reference laboratories should be set up throughout the United States to offer accurate testing for risk due to toxoplasmosis. Currently, the lab at the Palo Alto Medical Foundation, where Remington is chair of immunology and infectious diseases for the foundation’s Research Institute, is the only toxoplasmosis reference lab in the United States to offer the advanced serological testing.