The Zika virus has been reported in 23 countries and territories in the Americas. Brazil is the hardest hit nation so far with more than 1 million infections. In the continental U.S. the 35 known cases of Zika have been the result of people who have traveled to infected areas and returned to the U.S. No local mosquito-borne transmission has been reported.
Globalization has changed the rapid nature in which viruses spread. To that end, broad calls for action have been engaged. The World Health Organization has declared Zika an international health crisis, and the U.S. Centers for Disease Control and Prevention declared it a Level 1 alert – the highest activation. Earlier this week, President Obama asked Congress to allocate $1.8 billion in emergency finding to vaccine research, surveillance and rapid response programs. The request also includes foreign aid to countries most impacted by Zika.
While the virus is not known to be deadly and most people who contact it will have no symptoms at all, pregnant women are most at risk. To protect their babies, the CDC is warning pregnant women not to travel to areas affected by the virus. There is no vaccine to prevent the disease.
The New York Times yesterday provided an interesting detailed history of the virus’ path since its discovery in 1947, and new information about the virus is emerging every day. Just yesterday, CDC Director Thomas Frieden told the House Foreign Affairs Committee that the CDC has uncovered new evidence supporting the link between Zika and microcephaly, a birth defect in which infants are born with unusually small heads and incomplete brain development.
In this new 1:2:1 podcast I spoke with Stanford infectious disease expert Yvonne Maldonado, MD, about Zika and the latest on the virus. She’s a professor of pediatrics at the school of medicine and the chief of pediatric infectious disease at Stanford Children’s Health.
When he was 12 years old, Stanford neurosurgeon Jim Doty, MD, met an unusual woman named Ruth in a magic shop in Lancaster, Calif., the town where he grew up. When she enters his life, she seems ethereal or perhaps even a dream. She arrives at the exact moment she’s needed, a young boy from a fractured home spinning without direction or parental love. Well before mindfulness became commonplace, Ruth taught him a series of mental exercises to ease his angst and focus on a world of possibilities not problems. Most significantly, Ruth offered hope to a somewhat hopeless life.
Doty has written an unusual memoir – Into the Magic Shop – detailing his life’s journey. In this 1:2:1 podcast I spoke with him about this most uncommon life – one of potholes and promise, detours and dreams, redemption and revisions, and, yes, contentment and even possibly peace.
Stanford physician and noted author Abraham Verghese, MD, gave advance praise to the book:
Into the Magic Shop is pure magic! That a child from humble beginnings could become a professor of neurosurgery and the founder of a center that studies compassion and altruism at a major university, as well as an entrepreneur and philanthropist is extraordinary enough. But it is Doty’s ability to describe his journey so lyrically, and then his willingness to share his methods that make this book a gem.
A few months before he died, I interviewed Paul Kalanithi, MD, for a 1:2:1 podcast about a gorgeous article he wrote for StanfordMedicine entitled “Before I Go.”I knew his days were short, yet when he came into the studio I was taken aback by his frailty. I think I was hit broadside because seeing him reminded me so much of my brother, Bill, in his last days alive. On the one hand each was still fighting cancer and yet there before you was a map illustrating how a disease overwhelms a body.
Paul spent his last months writing a book called When Breath Becomes Air. It’s a searing memoir that at times strikes you so hard, you cry. Already, it’s being heralded as a great book that is “indelible.”
One passage still stabs at my heart. It’s the rawest part of the article he wrote for Stanford Medicine, and it’s included in the book. It’s written as a note to his daughter, Cady, conceived after he was diagnosed and born while sand was slipping through his fingers:
When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with sated joy. A joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.
Now that his book has been published, it’s his widow, Lucy, a physician at Stanford, who has become his voice. As we sat down for this 1:2:1 interview I told her I had felt so unsure about the direction of my questions the day I spoke to her husband. How do you sit across from someone living and talk about their dying? The same anxiety was there before I spoke with Lucy. Were there areas of grief still bandaged over that I shouldn’t try to uncover?
In the end, the conversation with Lucy feels like a bookend. What began with Paul, a discussion about the time that remained for him, is cemented now with her words after he’s gone. (As we began, I told her that months before when Paul and I had talked he had sat in the same chair she was in. It comforted her knowing that.)
At 44, Stanford bioengineer/neuroscientist Karl Deisseroth, MD, PhD, has achieved more success and accolades than most scientists receive in their lifetime. Two techniques, optogenetics and CLARITY, which open the brain to deeper and more penetrating explorations of its complexity, are among his seminal achievements. In November, he was awarded the prestigious 2016 Breakthrough Prize in Life Sciences, which comes with a no-strings attached monetary award of $3 million, and I sat down to talk with him for a 1:2:1 podcast shortly after he won.
Great scientific leaps, which optogenetics and CLARITY have been universally hailed as, are often preceded by challenges and detours that ferment doubt in the head of even the most determined researcher. And such was the case with optogenetics. Deisseroth told me there were arched eyebrows and skepticism from others during his quest. And he gave insight on how someone can keep those doubts at bay and remain focused on the endgame when their vision may not be shared or understood by others.
Deisseroth calls the human brain “the most complicated object in the universe.” So complicated, he says, that truly understanding its wiring and why and how it goes awry will take decades. “We don’t know what the finish line will look like,” he told me. “There [are] so many mysteries.”
Deisseroth’s track in neuroscience and medicine began in college, but from early on, as part of a family in which books and reading were venerated, words and creative writing were a strong interest. He told me, “I was just enthralled by how words could make you feel, how the emotions that could come from the words sometimes was independent of their formal meaning… I was so intrigued by their power to sway the mind and to uplift. Without making too sweeping of a claim, I also think that part of what got me interested in the brain is understanding how something like that could happen.”
So why psychiatry? What led him to that path, I asked? He said that he “trudged” into a psychiatry rotation as it was a required part of Stanford’s curriculum, but on the first day a passion was ignited:
There was a patient who was really on the inpatient ward, and really not doing well. This patient more or less accosted me. There was an interaction where there was just a stream of psychotic words and sentences directed at me, rageful, angry, loose in its framing and construction, very hard to understand, but in a way, there was a communicative effect achieved.
Although the words and the sentences didn’t mean anything relating to reality, there was definitely a communication that was achieved. I was so interested in understanding, from that moment, how an otherwise intact person could have a reality that was so different and could communicate in such an unconventional way.
It really hit all parts of me at once. It hit my interest in words and writing, my interest in neuroscience, and my desire to help people in the most direct way I could.
I started to look more into psychiatry, and I saw the opportunities, the depth of the mysteries, the extent of the suffering. It was like all the pieces of a combination lock clicking into place all at once.
We delved into numerous topics during our conversation. Why is the brain such a difficult organ to understand? How were optogenetics and CLARITY adding to the collective wisdom to the field? Why is the stigma of mental illness so pervasive and persistent? And, if he could answer any one question about the brain and a psychiatric disorder, what would it be? I hope you’ll listen to the podcast and hear his responses.
Shortly after leaving the White House in 1980, Jimmy and Rosalynn established the Carter Center. It is from there that their efforts at “waging peace, fighting disease and building hope” – the center’s mission – have been launched.
Along with his global travels to advance democracies around the world, his projects in global health, and his time building for Habitat for Humanity, Jimmy Carter is also a prolific writer. He’s written twenty-eight books. One of his most recent – A Call to Action, Women, Religion, Violence, and Power – details the discrimination that women and girls face worldwide. Widely recognized for his Christian beliefs and noted as a Sunday school teacher for more than 70 years – Carter challenges those who use religious texts to deny women equality. In a Call to Action, he writes, “Women and girls have been discriminated against too long in a twisted interpretation of the word of God.”
For the latest Stanford Medicine, a special on issue on pediatric research and care, I spoke with Carter about girls and women’s equality – an issue that he said would receive his highest priority in his final years. But this summer brought disturbing health news, and a different priority has entered his life: treating metastatic cancer that has spread to his brain.
I worked in the Carter White House. Like many others who served there, I wasn’t prepared for this news – we viewed Jimmy Carter to be indestructible. Even the word “cancer” in regards to Carter seems oxymoronic when you know firsthand his indomitable spirit and boundless energy.
I spoke with him for this 1:2:1 podcast and Q&A before his diagnosis. Later in the summer, I followed up with an email wishing him well and a speedy recovery, and he responded: “Thanks, Paul. I am at ease, and grateful. Jimmy”
And then late last month, just two days before Carter’s 91st birthday, Habitat for Humanity announced that his medical team approved his traveling to Nepal in November to build a home there. (Note from editor: Habitat for Humanity has cancelled the trip due to safety concerns.) Talk about an indomitable spirit and boundless energy.
When I think of New England, I don’t naturally conjure up an image of heroin. Yet today, many cities and towns in the bucolic northeast are facing a heroin epidemic. Clearly at odds with the image of the Atlantic Ocean lapping at seaside resorts, Maine, Vermont, New Hampshire and Massachusetts are each seeing disturbing trends. Illustrating the magnitude of the problem engulfing his state, Vermont’s Governor Pete Shumlin devoted his entire 2014 State of the State address to what he called “a full blown heroin crisis.”
Across the country too, heroin death are skyrocketing: According to the Centers for Disease Control, more than 8,000 Americans died of heroin-related overdoses in 2013 – nearly three times as many as those who died in 2010.
So what’s fueling the explosion of heroin use? Stanford addiction expert Keith Humphreys, PhD, told me in this 1:2:1 podcast that it’s largely propelled by the huge number of prescriptions for opioid pain killers. According to the National Institute on Drug Abuse, more than 2 million Americans abuse prescription pain killers – and Humphreys says when the pills run out, many turn to heroin as a cheaper alternative and an equivalent high.
Recognizing the rippling toll on communities and families across the nation, the Obama administration announced a new program in August to combat the trafficking and use of the drug. The Washington Post first reported the plan, saying that the initiative will pair public health officials and law enforcement in an effort to shift the emphasis from punishment to the treatment of addicts.
After hearing the heroin crisis also popping up in conversations from several presidential candidates during their jaunts to New Hampshire, I turned to Humphreys to dig deeper into the issue. In addition to being a professor of psychiatry and behavioral sciences at Stanford, Humpreys also spent a year in the White House Office of Drug Policy as a senior policy advisor during the first year of the Obama administration.
In 1954, Charlotte DeCroes stood in line with her fellow second graders in Kingsport, Tennessee and received the polio vaccine. Her Tennessee hometown was one of the test sites for what was then the largest and most significant clinical trial in the history of medicine. By the end of 1953, there were 35,968 reported polio cases, and the United States was desperate to solve this devastating illness. A survey at the time ranked fear of polio second only to fear of atomic warfare.
Fast forward to 2015. Charlotte Jacobs, MD, professor of medicine, emerita at Stanford, has written a highly acclaimed biography of the famed researcher/physician Jonas Salk, MD, who developed the polio vaccine. In this 1:2:1 podcast, she told me that her ten-year journey into Salk’s life was instigated partly because she couldn’t find a thorough autobiography on him, something she considered a historical lapse.
Jacobs has written a finely honed and balanced portrait – saluting Salk’s great accomplishment while not flinching from describing a man who was enigmatic, complex and all too human. She conducted more than a hundred personal interviews and spoke to two of his three sons along with his longtime private secretary. The dichotomies of his life are fascinating. While he was loved and lauded by the public and the media, he was a pariah in the scientific community – never appreciated, accepted or awarded. (His scientific colleagues thought he was a press hound, an impression that was fueled by the media’s adoring gaze – covers and feature articles in the most popular media of the time, including Life, Time,Colliers, Consumer Reports, PopularMechanics and U.S. News and World Report.)
Today, with vaccine wars sweeping certain areas of the country, Jacobs reminds us of a time when a major public-health crisis engulfed the nation and of a hero who made a difference and changed the landscape of medical history. It’s worth remembering.
Remember “death panels?” In the summer of 2009, in the midst of the debate about the Affordable Care Act, aka Obamacare, a small item in the legislation allowing Medicare to reimburse physicians for end-of-life conversations with patients unleashed a tsunami of criticism. Opponents charged that so-called “death panels” – anonymous Washington bureaucrats – would be making decisions about rationing health care and ultimately deciding who would live and who would die. As foolish as that charge was, the Obama administration choose not to fight the opposition and the payment proposal was dropped.
We asked Stanford’s VJ Periyakoil, MD, a nationally recognized leader in palliative care, for comment, and she said, “Medicare’s proposal to reimburse doctors to have a conversation with the patient about their values and preferences for care is a quantum leap forward towards the lofty goal of improving quality of care for all Americans at the end-of-life.” But she emphasized that this is just one part of the solution:
Advance care planning is not an event but a process. The key is having conversations in plural, over time as patients’ goals of care change as their illness progresses.
Early in the illness, most patients prefer to have a trial of high-intensity treatments including life support, and this is a very reasonable thing to do. However, there is a tipping point in the illness trajectory where we go from prolonging life with quality to prolonging the dying process. Beyond this tipping point, most patients, if given a choice, prefer to die gently and naturally at home minimizing the burden to their loved ones. But in order for this to happen, we need doctors who are well trained and highly skilled at conducting end-of-life conversations with their patients. We need to ensure that patients and their proxy decision makers are well supported to make end of life decisions. Finally, it takes significant support of both the patient and caregiver by a skilled team of clinicians to ensure a gentle and peaceful death at home.
Unless we have all these components in place, we can’t expect to see major and sustained improvements in end-of-life care.
The “skin” issue of Stanford Medicine magazine is out and online. In it, I have a Q&A with actor and playwright Anna Deavere Smith. TV audiences came to know Anna through her work as Nancy McNally, the White House national security advisor on the famed series “The West Wing.” And now, after seven seasons, she’s ending another acclaimed role, hospital administrator Gloria Akalitus on Showtime’s “Nurse Jackie.” Bur her seminal work has been in the theater, in two groundbreaking plays early in her career: “Twilight Los Angeles” and “Fires in the Mirror.” Her last theatrical piece, “Let Me Down Easy,” was a paean to the human body in its strength and fragility.
There are few actors who get into and under the skin of their characters more acutely than Anna. We thought it would be interesting (and different) for this issue of the magazine, which focuses on skin diseases, to talk with Anna and get another sort of take on skin. “In the early part of my career [my skin color] was a big stumbling block,” she told me. “There were stereotypes. As a woman, if you didn’t fit into the idea of a tragic mulatto or mammy it was really hard to situate yourself.”
Ricard is on a cross-country speaking tour spreading his belief of how “altruism is the vital thread that can address the main challenges of our time, from economic inequality to environmental sustainability, from life satisfaction to conflict resolution.”
The French native is an internationally bestselling author (an earlier book, Happiness, A Guide to Developing Life’s Most Important Skill, was a huge global success), a scientist with a PhD in molecular genetics, and a photographer. The new book is a tome and perhaps even a salve for these turbulent times when the seams of the world seem to be tearing apart.
Ricard is a gentle man. He resides in a monastery outside Katmandu that sustained significant damage when an earthquake devastated Nepal in April. (His foundation, Karuna-Shechen, is raising funds for disaster relief.) At the age of 20, he went to India to meet the great masters of Tibetan Buddhism. He returned again in 1972, to study full time and lead a contemplative life, often times in isolation for long stretches of time. I asked him if the life of solitude was difficult; he told me it’s a question he’s frequently asked.
In this 1:2:1 podcast, we spoke about the intersection of neuroscience and meditation and the enormous growth of mindfulness in the U.S. I wondered whether he thought mindfulness was becoming too commoditized. For instance, would the world be better off with mindful drone operators? He thinks not. I also asked him about his purpose in life. But the main focus of the interview is his new book and his view that now is the time to spread altruism as the world desperately needs it and is primed to respond.
Ricard left the Bay Area over the weekend moving on to Los Angeles, Washington and New York to spread the word and demonstrate altruism in action.