Making a Difference
Research from Bay Area hospitals is improving lives around the world.
GRAPPLING WITH SERIOUS illness or injury is nobody’s idea of a good time. But it ’s comforting to know the Bay Area is home to some of the nation’s top medical facilities. What you may not know: these institutions do more than just treat the local population. At any given time, they are actively involved in research studies intended to improve treatment outcomes for patients around the globe. We canvassed area hospitals and asked them to share some of their latest findings — or in some cases, offer a sneak peek at therapies still in the testing phase.
Saving Jaundiced Babies in Developing Countries
Newborn jaundice is a common condition that occurs when too much bilirubin — waste matter from old red blood cells — accumulates in the body. As the toxins build up, the infant’s skin and eyes take on a yellowish cast. Phototherapy is the process of placing affected newborns under special blue-light lamps to reduce bilirubin in the blood. These light waves are absorbed by the newborn’s skin and blood and expedite the breakdown of bilirubin.
In developing nations, however, not every hospital has access to blue-light lamps, or even to electricity, for that matter. As a result, more than 150,000 babies suffer brain damage or death from what should be a highly treatable condition. So Stanford researchers — in a joint venture with the University of Minnesota and the Massey Street Children’s Hospital in Lagos, Nigeria — decided to test out a low-tech solution. They constructed simple canopies with plastic sheeting designed to allow the lifesaving blue rays in sunlight to penetrate while filtering out dangerous ultraviolet rays. “Mothers could then sit under the canopies with their undressed newborn as the baby soaks up the blue light, allowing bilirubin levels to return to a safe range,” says senior study author David Stevenson, a professor of neonatal and developmental medicine. “The films were also designed to filter heat rays, preventing babies from overheating." The team then randomly assigned half the 450 babies in the study to receive this low-tech form of phototherapy. The other half received high-tech phototherapy. “We found the low-tech method to be just as effective. It’s a lifesaving therapy that’s easily scalable,” Stevenson says. Next step: researchers hope to investigate building greenhouse-like structures that can be utilized for phototherapy in areas with rainy or cold climates.
Birth Spacing May Affect Autism Risk
When is the right time to have a second child? It’s a question child-development experts often debate. Studies have looked at such timing’s impact on everything from academic success to family dynamics. But new research suggests it can also have an effect on neurodevelopment. According to a study by Kaiser Permanente’s Division of Research in Oakland, second-born children who are conceived sooner than two years or later than six years after the arrival of their older sibling have a substantially increased risk of autism spectrum disorders.
The study culled from the medical records of more than 45,000 children. In families where the second pregnancy was spaced three to four years after the first, the autism diagnosis rate was .81 percent. However, if women got pregnant with the second child six to eight months after the first, that rate jumped to 2.11 percent. The rate was also higher — 1.84 percent — in families who waited more than six years to conceive again.
“Because Kaiser Permanente has an integrated healthy delivery system, we have access to detailed patient information,” says Lisa Croen, senior author of the study and director of Kaiser’s Autism Research Program. “This allowed us to rule out past theories for what was driving the autism risk to closely spaced siblings.” For example, past studies have posited certain mitigating factors: a preterm first baby, an increase in starting weight of the mother during her second pregnancy, maternal age, use of antidepressants. But “we controlled for all these factors and none of these [mitigating factors] changed our findings. Future research will focus on clarifying the cause,” Croen says. “We’re now looking at nutritional components like, for example, the role of folic acid. However, it’s possible that the reason for the increase in autism in children spaced far apart has a completely different biological underpinning.”
Another Potential Benefit From Marijuana
California was the first state in the union to permit medical use of marijuana. Since then, 22 more states, the District of Columbia and Guam have fol lowed suit . Despite these gains, daunting legal red tape makes it difficult for researchers to launch studies verifying cannabis’s medicinal value. One crusader committed to navigating the bureaucracy is Donald Abrams, chief of hematology and oncology at San Francisco General Hospital. He and his team hope to prove that vaporized marijuana containing both the psychoactive THC (tetrahydrocannabinol) and the non-psychoactive but pain-relieving CBD (cannabidiol) can reduce pain, inflammation and disease progression in patients with sickle cell anemia, an incurable hereditary blood disorder that sometimes leaves patients in chronic pain. “Investigators at the University of Minnesota have already proved effectiveness in mice,” says Abrams. “We are trying to replicate the results in the first human proof of principle study.”
To date, Abrams has registered 12 patients for the study. He hopes to increase that number to 35 within the year. Volunteers agree to sign on for two five-day hospital stays. “During one stay they will be vaporing cannabis three times a day. During the other stay, [the substance] will be a placebo,” Abrams says. Patients’ blood samples then get sent on to the University of Minnesota to be eva luated by the same research team charged with proving synthetic CBD’s efficacy in mice. Sickle cell patients interested in qualifying for the study can call 415.476.4082, ext. 146.
On-Call Midwives and Obstetricians Lead to Lower C-section Rates
Nearly 33 percent of women in U.S. hospitals give birth via cesarean section, up from 21 percent in 1996. Given that the procedure increases the risk of health problems, including hemorrhage, hysterectomy and infection, it’s a disturbing trend. Previously established reasons for the increase include a greater number of induced labors, older moms and multiple births. However, a joint study by researchers at the University of California, San Francisco and Marin General Hospital uncovered a new factor: women are less likely to deliver by C-section when hospitals hire in-house midwives and obstetricians to manage patients’ labor and delivery.
The study evolved after researchers noted Marin General’s private-health insurance patients had significantly higher C-section rates than public-health patients. However, those numbers began to even out after April 2011, when Prima Medical Group — a large doctor-owned practice with offices in Marin, Napa and Sonoma — changed its maternity coverage model. Previously, doctors answered calls from home or from the office and managed most of the labor remotely. “But then our practice began following the same model as the public health system, where we have midwives and obstetricians staffing the hospital round-the-clock,” says Sheri Matteo, director of midwifery service for Prima Medical Group. The result: the primary C-section rates dropped from 31.7 percent to 25 percent. And the VBAC rate (vaginal birth after C-section) jumped from 13.3 percent to 22.4 percent.
Researchers speculate several reasons the in-house model may have resulted in fewer C-sections. One theory: previously, competing surgical and office responsibilities might have influenced a provider’s decision on C-section during labor complications. Another factor: Prima’s new maternity protocol allows patients to choose whether the in-house midwife or the OB manages delivery. And since the on-site staffing change was implemented, the majority of patients — 60 percent, up from 16 percent with the old model — chose the midwife option. “Doctors tend to favor early intervention, while a midwife is more willing to work with a woman wanting to take a waitand- see approach,” Matteo says.
New Treatment for Alcohol Abuse
According to the National Institute for Alcohol Abuse and Alcoholism (NIAAA), more than 17 million adults struggle with drinking problems. Current interventions are only minimally effective in helping patients overcome the urge to drink excessively. But hope for those struggling to overcome alcohol addiction may soon come in the form of a pill. California Pacific Medical Center (CPMC) is among 10 sites collecting data for a clinical trial to see if the drug gabapentin can reduce alcohol cravings in people who can’t seem to reduce or stop drinking on their own.
The trial, sponsored by the NIAAA, aims to replicate results of smaller-scale studies. “This is a phase three trial,” says John Mendelson, co-director of Addiction and Pharmacology Research at CPMC. “It ’s the final step before the Food and Drug Administration will approve labeling indicating gabapentin’s usefulness in treating alcohol abuse.” Currently prescribed for a number of conditions, including epilepsy, neurological pain disorders and restless leg syndrome, the drug may be effective for functional alcoholics — people who have three or four drinks a day, along with at least one day of heavier drinking. “They’re not sick enough to have destroyed their lives, but they have measurable problems,” says Mendelson. “But if we can decrease their binge drinking habits, this can have tremendous health benefits.”
Sleep More, Sneeze Less
Despite your mother’s warnings, you won’t catch a cold from running around with a damp head in winter weather. But when she nags you about getting enough sleep, you’d be wise to listen. A new study from the University of San Francisco’s School of Medicine led by Aric Prather, an assistant professor of psychiatry, is the first to objectively connect lack or sleep with susceptibility to illness. “People who sleep less than six hours a night are four times more likely than others to catch a cold,” Prather says. “We factored for a number of circumstances we thought might be at play, including stress levels, socioeconomic demographics and alcohol use — but sleep was still the strongest predictor of who got sick.”
To learn how sleep affects the body’s response to infection, researchers recruited 164 volunteers to undergo two months of health screenings, interviews and questionnaires. The participants were fitted with watch-like sensors that measured quantity of sleep over a week. Later, these same volunteers were sequestered in a hotel, where nasal drops containing the cold virus were administered. “We then took daily mucus samples to see if the virus was replicating,” says Prather. “Lack of sleep predicted the likelihood of a person getting a cold, but it didn’t affect the severity of a person’s symptoms.”
A New Campus
The state-of-the-art, 183-bed UCSF Benioff Children's Hospital San Francisco at Mission Bay opened last year and offers urgent and emergency care, primary care and specialty outpatient services for children. Together with its sister campus, UCSF Benioff Children’s Hospital Oakland, the award-winning hospitals are involved in more than 400 research protocols led by more than 500 investigators researching cures for hundreds of pediatric and adult diseases. The hospital has already enjoyed many successes including founding the world’s first fetal surgery program, bringing about North America's first cure of alpha thalassemia major and establishing one of the world’s first neonatal intensive care units, where researchers developed lifesaving treatments for premature infants whose lungs aren't fully developed. The campus also has the largest brain tumor treatment program in the nation and the only comprehensive epilepsy center in Northern California.