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Medicine and Literature, Podcasts, Stanford News

Into the Magic Shop: Stanford neurosurgeon Jim Doty’s captivating memoir

Into the Magic Shop: Stanford neurosurgeon Jim Doty's captivating memoir

Doty and Dalai LamaWhen 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.

Outside of the OR, Doty spends much of his time studying the neuroscience of compassion and altruism. He serves as director of the Center for Compassion and Altruism Research and Education at the School of Medicine, of which the Dalai Lama is a founding benefactor.

Into the Magic Shop may not be like anything else you read. But it will take you places where you might never have been.

Previously: What the world needs now: altruism/A conversation with Buddhist monk-author Matthieu RicardFrom suffering to compassion: Meditation teacher-author Sharon Salzberg shares her story and How being compassionate can influence your health
Photo of Doty and the Dalai Lama, from a 2010 Stanford event, by Linda Cicero

Medicine and Literature, Podcasts, Stanford News

When Breath Becomes Air: A conversation with Lucy Kalanithi

When Breath Becomes Air: A conversation with Lucy Kalanithi


Kalanithis - bigA few months before he died, I interviewed Paul Kalanithi, MD, for a 1:2:1 podcast about a gorgeous article he wrote for Stanford Medicine 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.)

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Podcasts

Most popular 1:2:1 podcasts of 2015

Most popular 1:2:1 podcasts of 2015

As the end of the year approaches, a look back at the 1:2:1 podcasts that you listened to most.

RoncaroloDays are long, years are short: Paul Kalanithi on time: Stanford neurosurgeon Paul Kalanithi, MD, touched many lives by writing and talking openly about disease and mortality before dying of lung cancer last March. This interview is the companion to “Before I go”, a beautiful Stanford Medicine magazine piece he wrote about his changing perception of time.

A conversation with the happiest man on Earth: Molecular biologist-turned-Buddhist monk and best-selling author Matthieu Ricard has been touring to spread his belief that “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.” While visiting campus last spring, he stopped to talk with 1:2:1 host Costello about altruism, the meaning of happiness, and the power of meditation.

Maria Grazia Roncarolo on fast-tracking stem cell and gene therapy to the clinicMaria Grazia Roncarolo, MD, was recruited to Stanford Medicine in 2014, to lead efforts in fast-tracking stem cell and gene therapy to the clinic and to bring basic-science discoveries to patients. Here, she talks about her work and about Stanford’s Childx, a TED-style conference focused on inspiring innovation in pediatric and maternal health.

Dean Lloyd Minor on his vision for Stanford Medicine: It’s been three years since Lloyd Minor, MD, took the helm as dean of Stanford’s medical school, and he talks about his time here and his plans for the future during this interview. Saying “this is an extraordinarily exciting place to work – a place where it’s easy to get out of bed in the morning with enthusiasm about what lies ahead in the day,” Minor goes on to talk about Stanford Medicine’s vision to lead the biomedical revolution, the promise of precision health, and his commitment to diversity.

How would you like to die? A conversation with Stanford’s VJ PeriyakoilVJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training, recently launched the Stanford Letter Project, a campaign to empower adults to take the initiative to talk to their doctor about what matters most to them at life’s end. In this podcast, she discusses the project and why it’s so important for patients to tell their doctors and family members about their end-of-life wishes.

Previously: Heart disease, old brains and happiness: Looking back on some of the year’s best 1:2:1 podcasts
Photo of Maria Grazia Roncarolo by Norbert von der Groeben

Education, Medicine and Literature, Podcasts

Recommended holiday reading for the medicine and science enthusiast

Recommended holiday reading for the medicine and science enthusiast

Waiting and Reading at Bryant ParkA good book can transform boredom into bliss in the amount of time it takes to buckle yourself into an airplane seat. Yet all too often we find ourselves stranded without a good book in sight. Reading is good for your brain’s health, so don’t get caught without a book you cannot wait to read. Here are a few page-turners to have in your back pocket this holiday season:

Mindset: Bill Gates recommends this bestseller by Stanford psychologist Carol Dweck, PhD, in his list The Best Books I Read in 2015 and in a separate book review. Mindset also made the list of 58 Books Recommended by TED Speakers.

Jonas Salk: A Life: This book by Charlotte DeCroes Jacobs, MD, professor of medicine, was named one of the 100 Notable Books of 2015 by the New York Times Book Review. This book was also the subject of a 1:2:1 podcast.

A Well Designed Life: Author Kyra Bobinet, MD, MPH, blends brain science and design thinking to address why it’s sometimes hard to get ourselves to do what we know is best for us and what we can do about it. In this recent podcast with Paul Costello, Bobinet, a behavior change expert, discusses her book and shares tips on designing a healthier life.

The Good Gut: This book by Stanford microbiologists Justin Sonnenburg, PhD, and Erica Sonnenburg, PhD, explores how gut bacteria affect physical and mental health. The Sonnenburgs discuss their book here on Scope.

Food Love Family: A Practical Guide to Child Nutrition: This book by Stanford child nutrition expert Maya Adam, MD, highlights how cooking simple, home-cooked meals can nourish and teach children about eating right at a young age.

The book that made me go to medical school: In this Scope blog post, medical student Natalia Birgisson talks about the book that inspired her to pursue a career in medicine and lists a few of her other favorite books related to the realm of medical science.

Previously: Stanford study shows how the brain responds to different types of reading instructionStanford Storytellers: Medical students write a children’s book to comfort and educateUsing texting to boost preschool reading skills and Reading, book sharing less common in immigrant families, Stanford study finds
Photo by Jens Schott Knudsen

Neuroscience, Podcasts, Stanford News

A word with Karl Deisseroth

A word with Karl Deisseroth

Karl D at Breakthrough eventAt 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.

Previously: Stanford’s Karl Deisseroth talks about the work he was “destined to do”Stanford bioengineer Karl Deisseroth wins 2016 Breakthrough Prize in Life SciencesInside the brain of optogenetics pioneer Karl DeisserothLightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact and An in-depth look at the career of Stanford’s Karl Deisseroth, “a major name in science”
Photo, of Karl Deisseroth receiving his Breakthrough Prize, by Steve Jennings/Getty Images

Podcasts, Research, Science

On communicating science and uncertainty: A podcast with John Ioannidis

On communicating science and uncertainty: A podcast with John Ioannidis

If you listen to one podcast this week, pick this one. It’s a crisp, thought-provoking exchange between health journalism critic Gary Schwitzer, publisher of HealthNewsReview.org, and epidemiologist John Ioannidis, MD, DSc, recorded at the recent METRICS (Meta-Research Innovation Center at Stanford) conference. They tackle the state of health journalism and the problems plaguing science, all in just 7 minutes and 49 seconds.

(Quick background: Ioannidis is well-known for his blockbuster 2005 paper, “Why most published research findings are false” – and the first METRICS conference brought together researchers from a variety of fields to examine ways to improve the quality of science.)

Schwitzer points out that from the public’s point of view, there’s a fine line between critiquing science and declaring the entire scientific enterprise rubbish.

Ioannidis responds:

Science is the best thing that has happened to human beings. One key reason for that is that it helps people think carefully about the world surrounding them and about themselves and their knowledge base…

The way to educate the public is really to offer them science as it is, not in any way that would be more dogmatic than it should be and then have to fight against other types of dogmas. I think we need to tell people that this is why science is important, that it does have that threshold of uncertainly that dogma doesn’t have.

Previously: A conversation with John Ioannidis, “the superhero poised to save” medical research, Shake up research rewards to improve accuracy, says Stanford’s John Ioannidis and John Ioannidis discusses the popularity of his paper examining the reliability of scientific research 

 

Behavioral Science, Neuroscience, Podcasts

Advice for changing health behavior: “Think like a designer”

Advice for changing health behavior: "Think like a designer"

When listening to our latest 1:2:1 podcast, featuring a conversation with Kyra Bobinet, MD, MPH, two things jumped out at me. First, Bobinet, an expert in design thinking and behavioral change who says she “leads by my curiosity,” has a very cool personal story, and second: We shouldn’t be so hard on ourselves when we struggle to make positive health changes. In short, it’s not us – it’s a design flaw.

The interests of Bobinet, CEO and founder of a design firm using neuroscience to change behavior, can be traced back to medical school, when she was exposed to a program that taught health education in juvenile hall. “I became fascinated by the behavioral patterns of gang members who had violent pasts and came in and out of the system,” she says. These gang members vowed to stay out of jail when they were released but yet “two days later they were immersed” in their old lives and back in trouble. “Why is that happening? And how is that different than me saying I don’t want to eat french fries during Lent but then doing so the second day?” she wonders aloud.

Not long after, an experience with a patient wound up changing the trajectory of her career. During residency she saw a man with gout who had taken meth just three days prior. Bobinet had only ten minutes in clinic with him, and he only mentioned the drug use during the tail end of their conversation, before she had a chance to probe into it. “He changed my life,” she says. “I was so interested in the behavior that led to the medical condition – I [realized I] didn’t want to write prescriptions for the condition anymore, I wanted to focus on the behavior.” She went on to public health school from there.

In the podcast, Bobinet, who also teaches courses on patient engagement and empowerment in the Stanford AIM Lab with Larry Chu, MD, goes on to talk a lot more about behavior and what she has learned through extensive research of patients and caregivers. She talks about her new book, Well Designed Life, which lays the groundwork for those looking to design the changes they want to see in their life, and she offers more advice and words of encouragement for people who are struggling to, say, stay on a diet or quit smoking. “Think like a designer,” she says. Your failed attempt at making positive change “was just a version, just a protoptype… That was something that didn’t work – but it’s not you, it’s the design… And you have to redesign what will grab your attention now.”

Previously: Designing behavior for better health

Events, Global Health, Health Disparities, Health Policy, Podcasts

An optimist’s approach to improving global child health

An optimist’s approach to improving global child health

Globally, more than six million children die before their fifth birthday each year, most having been born into poverty. While great strides have been made over the last few decades in reducing global child mortality, some countries, like Pakistan, have lagged behind. Today, Pakistan has the third-highest infant mortality rate in the world and some of the worst child health and social indicators in the world.

In a new 1:2:1 podcast, Paul Costello, chief communications officer for the medical school, talks with Anita Zaidi, MD, an internationally renowned pediatrician and director of the Enteric and Diarrheal Diseases Program at the Bill & Melinda Gates Foundation, about the state of child health in her home country of Pakistan and what it takes to lift a nation up. The conversation was adapted from a recent global health seminar sponsored by the Center for Innovation in Global Health.

In speaking to an audience of Stanford students and faculty prior to her talk with Costello, Zaidi described herself as a “relentless optimist” who always takes the “glass half full” perspective. In looking back from 1990 to now, she said Pakistan has made some progress in reducing child mortality, but not as much as what it could have achieved.

Perhaps the biggest barrier to Pakistan’s progress stems from gender inequalities and the poor status of maternal health.

“Women are very marginalized in Pakistan, which affects their health and child mortality,” said Zaidi. “Unless we address those issues, [child health] is a tough problem to take care of… The citizens of Pakistan have a very big role to play.”

In 2013, Zaidi became the inaugural recipient of the $1 million Caplow Children’s Prize for her work in one of Karachi’s poverty stricken fishing communities, Rehri Goth, to save children’s lives. Through her work in Rehri Goth, she saw first hand the complex issues that impact whether a child will live to age five or not. In areas of extreme poverty, like Rehri Goth, improving primary healthcare is not enough.

“There’s no source of income. There are more than 10 kids in a family. Even if their newborn isn’t dying, the child dies at two or three months of age because there’s nothing to eat,” said Zaidi. “You realize there is this sub-population of extremely high-risk individuals, who need more than primary healthcare…They actually need some poverty alleviation types of interventions, food subsidies, to get them out of that.”

So, what does it take to lift a nation up? For Zaidi: “Girls getting educated will change the world, and more and more girls are getting education. We know that [education] one of the strongest predictors of improving child health outcomes.”

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: Pediatric health expert Alan Guttmacher outlines key issues facing children’s health todayCountdown to Childx: Global health expert Gary Darmstadt on improving newborn survival and Training program helps dramatically reduce stillborn rates in developing countries

Podcasts, Stanford News

Lloyd Minor shares his vision for Stanford Medicine, talks about its “paradigm‑shifting advances”

Lloyd Minor shares his vision for Stanford Medicine, talks about its "paradigm‑shifting advances"

It’s been almost three years since Lloyd B. Minor took helm of Stanford’s medical school as dean, and he talks about his time here and his plans for the future in a new 1:2:1 podcast. Saying “this is an extraordinarily exciting place to work – a place where it’s easy to get out of bed in the morning with enthusiasm about what lies ahead in the day,” Minor goes on to talk about Stanford Medicine’s vision to lead the biomedical revolution, the promise of precision health, and his commitment to diversity. He also discusses Stanford’s many strengths, including the interdisciplinary nature of the work done here (“our ethos is one that really does encourage collaboration”) and our researchers’ drive to do big things: “For sure, there’s a role for incremental advances, but our unique strength [is in] being able to come up with paradigm‑shifting advances.”

Previously: How Stanford Medicine will “develop, define and lead the field of precision health”At Big Data in Biomedicine, Stanford’s Lloyd Minor focuses on precision healthStanford Medicine’s Lloyd Minor on re-conceiving medical education and A closer look at Stanford Medical School’s new dean

Podcasts, Precision health, Research, Stanford News

Big data holds great promise for medicine – but what about for the patient-doctor relationship?

Big data holds great promise for medicine – but what about for the patient-doctor relationship?

Big data is opening up all kinds of doors in health and medicine. Genomics and other ‘omics, wearable technologies, combining detailed patient datasets for precision medicine – the possibilities seem endless.

In the most recent episode of Raw Data, a new podcast produced by Worldview Stanford, my co-producer Mike Osborne and I explored the landscape of big data in medicine. We had the opportunity to interview several Stanford researchers, including Michael Snyder, MD, who talked to us about his working taking the quantified self to the extremeEuan Ashley, MD, who explained to us the promise that wearables hold for early diagnosis of cardiovascular disease; and Sylvia Plevritis, PhD, who discussed how patient datasets are revolutionizing cancer biology research.

Talking to these researchers offered an eye-opening dive into the intersection of big data and health and excited my imagination and optimism. But at the same time, a question lingered for both Mike and me. If algorithms can diagnose us accurately and help make decisions about treatment, what is the role of the human doctor in this scenario?

We were invited to the recent Stanford Medicine 25 Skills Symposium led by Abraham Verghese, MD, and to gain perspective on that question, we talked to physicians from all around the world. The doctors there were not anti-big-data in any way; in fact, they all agreed that data will greatly benefit the practice of medicine. But we heard many anecdotes about how the presentation of that data to doctors – via computers and tech devices – can intrude on the doctor-patient relationship, and take away from the trust and empathy that we can only find in human connection. It struck me that there’s a clear parallel with the wider grumbles about ever-present smartphones and technology intruding on every day, human moments.

Putting together this episode was a true pleasure. I look forward to a future in which we all receive early diagnoses, and precision health and treatment. At the same time, I agree with the Stanford Medicine 25 group that there are some parts of medicine that can’t and shouldn’t be handed over to a computer or an algorithm. We are human patients, and at the end of the day, we need human physicians to participate in the healing process.

Leslie Chang is the social media producer for Worldview StanfordRaw Data is supported by the Stanford Cyber Initiative and can be found on iTunes and SoundCloud.

Previously: Stanford Medicine 25 Skills Symposium to focus on building leaders for the bedside medicine movementWhat is big data?Experts at Big Data in Biomedicine: Bigger, better datasets and technology will benefit patientsRising to the challenge of harnessing big data to benefit patients and ‘Omics’ profiling coming soon to a doctor’s office near you?

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