Podcasts

The epic tome on cancer, The Emperor of All Maladies, is subtitled, A Biography of Cancer. I was intrigued by the biography portion of the title and asked the book’s Pulitzer Prize-winning author, Siddhartha Mukherjee, MD, assistant professor of medicine at Columbia University, why he used the term “biography.” In my latest 1:2:1 podcast, Mukherjee tells me he came to use the description “very late in the process of writing the book” and he chose the word “biography” for three reasons. I also asked him if cancer needed a new narrative and whether the words “race for the cure” and “war on cancer” had outlived their usefulness. “I think we do,” he said. “I think we need to re-create narratives to understand what is happening.”

Mukherjee also told me that his inspirations in writing his book were Rachel Carson’s Silent Spring and Michael Pollan’s In Defense of Food. He called both game-changers. “They laid out the issues in a way that was simultaneously so politically moving but also so comprehensive that it allowed you to put into perspective everything else behind it.” So do we need game-changers in the field of cancer, I asked? “Yes, we do … but I think that those game-changers will evolve out of the current paradigms of science. And we have a wealth of information, and I suspect that we’re underutilizing the wealth of information at this point in time.”

I also spoke to Mukherjee for a Q&A featured in the latest issue of Stanford Medicine magazine, a special report on cancer.

Osteoarthritis is easily the most common joint disease in the United States and in the world. Stanford immunologist and rheumatologist Bill Robinson, MD, PhD, says it’s a kind of physical counterpart to Alzheimer’s disease, in that both are debilitating – the former to the body and the latter to the mind — and both become increasingly common as a person grows older.

About 27 million people in the United States alone suffer from osteoarthritis, in which cartilage - typically in the knees, hips, fingers or spine - breaks down, destroying the shock absorber that cushions every motion’s impact on the ends of barely separated bones. These numbers are expected to skyrocket as baby-boomers hit their 60s and beyond.

Until now, the medical community has viewed osteoarthritis of as a somewhat inevitable result of a lifetime’s worth of wear and tear on the joints, often accelerated by trauma such as a knee injury. But a recent study in Nature Medicine by Robinson and his colleagues suggests othewise: Like Alzheimer’s, osteoarthritis may, in large part, be attributable to inflammatory processes that begin long before any noticeable symptoms emerge. That’s important, because it opens the door to finding diagnostic and therapeutic solutions that may someday be able to fend off the bone-grinding agony of this disease.

To learn more about the role of low-grade chronic inflamation in initiating the biochemical cascades that culminate in osteoarthrits, listen to this 1:2:1 podcast, in which Paul Costello, the medical school’s chief communications officer, interviews Robinson.

Previously: Inflammation, not just wear and tear, spawn arthritis

Why is nicotine such a seductive mistress? What is it about gambling that attracts and consumes so many people? And what about obesity?  Is there some magical line that separates thin people from those who are fat?  Johns Hopkins neuroscientist David Linden, PhD, says that “neural signals that converge on a small group of interconnected brain areas called the medial forebrain region pleasure circuit” regulate how and why we feel pleasure.  That means there’s a control tower in the brain that is hardwired to regulate a range of human behaviors that make us feel good.   

I first became aware of Linden’s book, The Compass of Pleasure, through his interview with NPR’s Terry Gross.  I thought about the book again after listening to the media debate about whether New Jersey Governor Chris Christie’s obesity indicated he wasn’t disciplined enough to be president of the United States. It made me consider the question: How much control do human beings actually have over bad behavior?  

Linden believes that we’re in a golden age of biomedical research and that our understanding about the intricacies of how the human brain functions and how it regulates behavior will unfold with increasing velocity.  In my latest 1:2:1 podcast, Linden reveals a lot of interesting facts about the human compass of pleasure  (for instance: sugary, fatty, salty substances rewire the pleasure circuit resulting in our desire to just want more, more, more) and makes you wonder just how much control we do have over our behavior. 

Presumably, lessons learned in neurobiology will at some point collide with public policy and make us rethink draconian punishments for human failings set by biology. Linden tells me, “Understanding the biological basis of pleasure leads us to fundamentally rethink the moral and legal aspects of addictions to drugs, food, sex and gambling and the industries that manipulate these things in the marketplace.” Hmmm – sounds rationale, right? But I wouldn’t bet the farm that public policy will catch up with neurological and scientific breakthroughs anytime soon. Not in this political climate, at least.

Will a deadly pandemic rule the fall box office?  That’s the question posed by Steven Soderbergh’s blockbuster film, Contagion, which opens nationwide on Friday.

The story is simple: It’s an action/thriller centered on the threat posed by a deadly disease, and on the international team of doctors contracted by the CDC to deal with the outbreak. The actors are stellar: Matt Damon, Kate Winslet, Jude Law, Marion Cotillard, Lawrence Fishburne and Gwyneth Paltrow. And the director, Soderbergh: one of Hollywood’s best and brightest. But does Contagion get the science right?  (Hollywood usually fails in that respect.)

Last Sunday, I read a New York Times article that described the technical team of scientists who served as advisors to the screenwriter, director and actors. Shortly after, I spoke with one of them, Ian Lipkin, MD, director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health, for a 1:2:1 podcast.

During our conversation Lipkin described how he prepped two of the actors for their roles in one of Columbia’s research labs, how the film’s soundmen gathered the authentic thumping noises that ooze from machines scattered throughout Lipkin’s research space and how he cajoled a reluctant Soderbergh to reshoot a scene to get it technically correct. He also told me that he hopes the audience will walk away from the film with a greater respect for scientists, along with a deeper understanding of what it takes to protect the nation’s health and how important it is to invest in scientific research and in government agencies such as the National Institutes of Health and the Centers for Disease Control.

Later, when I wrote to Lipkin to thank him for taking time to do the podcast, he replied: “Let’s persuade more kids to go into the hard sciences and engineering and educate those who don’t.”  Hopefully, this marriage between Hollywood and science just might resonate.

Before I head to the beach, I wanted to mention two 1:2:1 podcasts that complement articles in the latest issue of Stanford Medicine magazine.

Jill Bolte Taylor, PhD, is a brain scientist who wrote about her stroke in the New York Times best-seller, My Stroke of Insight. At the beginning of the book, she describes her stroke in remarkable detail. It felt like she was sort of looking at herself inside out: living and feeling the stroke on the one hand and on the other, observing her body and motor skills as they crash. It’s all rather unnerving in its clarity. She describes her neurological breakdown with such granularity that it makes you wonder who was taking the notes.

In our conversation for the Stanford Medicine article, she couldn’t talk about the day of her stroke (she’s muzzled by a movie deal in the works), but she does talk about the eight years it took to recover. You can hear the full conversation in the podcast, and if her story captures your imagination, take a look at her TED talk. It’s the second-most viewed presentation over the program’s past five years, with more than 8 million online viewers.

Another podcast pertains to survivors of extreme psychological and physical trauma. And it makes you ask, can the residue from unspeakable abuse at the hands of a terrorist government ever be diminished? That’s one of the questions posed by a United Nations-backed tribunal trying Khmer Rouge war criminals in Phnom Penh, Cambodia. For the first time and to an unprecedented degree, the trial is including victims’ testimonies as a central component of the proceedings. Thousands of survivors from Pol Pot’s reign of terror live in the Bay Area, and mental health workers here, some of whom are affiliated with Stanford, are helping these survivors with critical mental health issues like PTSD.

I talked with Daryn Reicherter, MD, a psychiatrist at Stanford, who works with Cambodian immigrants in San Jose, Calif. He’s seen survivors of some of the worst human crisis of the 20th century – not only Cambodian immigrants but also asylum seekers from Darfur, Congo, and the Middle East, along with refugees from Vietnam, and Central and South America. Tracie White has written an amazing story for Stanford Medicine asking the question: Can the testimony at the tribunal ever bring a sense of justice and help heal the psychological scars for the victims of the terror campaign? The horror of the physical and psychological abuse thrust upon the nation by their fellow citizens won’t leave your mind very easily.

Previously: Surviving survival: The new Stanford Medicine magazine is out

I consider myself very lucky. I am not one of the more than 110 million Americans who experience chronic pain every year. In the past, when I have had neck pain from daily lap swimming, it consumed me. It was all I could think of 24/7.  I remember how generally bad I felt both physically and emotionally. I was completely drained and not easy to live with.    

So it is astounding to consider that more than a third of the nation’s population walks around feeling lousy all of the time from pain. I think one of the main obstacles that prohibits treating pain effectively is that we’ve been taught from an early age to just suck it up. From that perspective pain is  just the price of being alive. That’s just plain nonsense. 

A new report from the Institute of Medicine doesn’t quite see it that way either. The study concludes that pain costs the economy a boatload of money -$635 billion annually. The IOM reported back in record time – their work began after Thanksgiving in 2010 – and concluded that pain is a major public health problem in America.

I spoke to Philip Pizzo, MD, dean of Stanford’s medical school and chair of the IOM panel, about the work of the committee and why pain is undertreated in the United States. Pizzo has seen pain from two perspectives, professionally and personally.  He tells me in my latest 1:2:1 podcast:

Pain does takes a toll, and I’ve witnessed it in the patients I’ve cared for, in my own personal life, and particularly in the lives of members of my family who  every day have a new reckoning in terms of how to accommodate the insults of pain and make the best of one’s life accordingly.

Something this significant and far reaching won’t be easy to solve. Culture change may be the biggest obstacle to recognizing and effectively treating pain. The report calls on Medicare, Medicaid, worker’s compensation programs, and private health plans to find ways to cover interdisciplinary pain care.  Because of the size of the problem and the “significant toll on individuals and society,” the report concludes, “pain warrants a higher level of attention and resources within the National Institutes of Health.”

I know there’s a lot on the federal government’s table right now. Yet pain shouldn’t be dismissed as insignificant or peripheral to overhauling health care. It’s part of the puzzle. And it’s clear that it’s time to deal with this major public health problem.

Previously: Relieving Pain in America: A new report from the Institute of Medicine

A post today from the California Institute for Regenerative Medicine’s blog, Research Results, caught my attention with the announcement that noted UC Davis stem cell researcher and CIRM grantee Paul Knoepfler, PhD, has added a podcast feature to his stem cell blog. According to CIRM communications manager Amy Adams:

Several organizations such as CIRM, the Canadian Stem Cell Network and the Australian Stem Cell Centre also have blogs that promote stem cell science and attempt to put recent scientific advances into context. However, to my knowledge Knoepfler is the only stem cell scientist attempting to reach the public online. I look forward to hearing more podcasts from Knoepfler, and wish him much success in providing accurate information about stem cell research at a time when it is so clearly needed.

I haven’t listened to it myself yet, but it looks like the first 16-minute-long podcast takes on stem cell tourism in the US (a particular interest of mine), recent goings-on at CIRM and, intriguingly ‘stem cell hype on aging’. I’m going to cue it up as soon I can coax my reluctant computer speakers to work again by employing my tried-and-true combination of a reboot plus cursing. If you hurry you can beat me to it.

Photo by Carbon Arc

How much is your body worth? Investigative reporter Scott Carney, author of the new book The Red Market, figures his is worth $250,000. Carney spent five years tracing the financially lucrative and deeply secret trade in human bodies and body parts. Despite government crackdowns — selling body parts is banned in nearly every corner of the world — Carney says the “red market” is where several billion dollars’ worth of humanity changes hands every year. In my latest 1:2:1 podcast, Carney discusses what he discovered “on the trail of the world’s organ brokers, bone thieves, blood farmers and child traffickers.” It’s truly a dark portrait of humanity at its worst.

An audio copy of the book will be available later in the summer.  You can hear an excerpt here.

I met Mark Meier last week just as he was about to mount his bike and cycle across the continent to raise awareness about depression in men. He was in Palo Alto meeting with Alan F. Schatzberg, MD, and researchers from the Stanford Mood Disorders Clinic (.pdf) just days before he was to begin the journey from San Francisco to New York City. (At Stanford, more than 150 research projects on depression and other psychiatric illnesses are under way.)

While he was daunted by the roadmap – crossing the Sierras and the Rockies is not for the faint of heart – he was exhilarated by it too; especially the scheduled events along the way where he’d be having conversations about the disease and raising awareness. According to the National Alliance on Mental Illness, more than six million men in the United States have major depression. Most men suffer in silence and are never treated for the illness.

Meier’s own story is harrowing. Ten years ago, severely depressed, he was moments away from blowing his brains out. A shotgun in his mouth, ready to pull the trigger and a sound from another bedroom stopped him. I’ll let you listen to this 1:2:1 podcast to hear more details about that day, but suffice to say, it’s heart-stopping. (Depressed men commit suicide eight times more often than women.)

You can follow Mark’s journey on his website.

Previously: Breaking the silence about depression among men.

Who amongst us hasn’t had, at one time or another, sleep problems? Raise your hand. If you kept your hand lowered, consider yourself very lucky. You’re in the minority.

When it comes to sleep, I consider myself pretty lucky. At middle age, I seem to have found a zone where sleep comes easily. It’s rare that I will spend a night tossing and turning, unlike other times in my life when nodding off just didn’t happen on schedule. (Truth be told I would be a terrible insomniac. I am one of those people who is completely perplexed by those who thrive on 4 or 5 hours of sleep.)

Sleep patterns, experts contend, are layered into our brains early on in life. I grew up in a family that knew how to sleep and appreciated it. My father was an early to bed, early to rise kind of guy. He was a Midwesterner with a sense of purpose in the morning. My mother, on the other hand, stayed up late. No eggs, bacon and coffee around the table in the morning. It was out of bed, down the stairs, out the door and in the car all within 30 minutes. But she rarely missed a solid night of snoozing.

The number of people in the United States plagued with sleep disturbances is staggering. Nearly one of every four Americans says finding a good night of shut-eye is, but a dream. In my latest 1:2:1 podcast, I spoke to Stanford sleep expert Rafael Pelayo, MD, about the ups and downs of nodding off. Pelayo tells me that he got interested in sleep as a science because he was always fascinated by the question: Why do we sleep? You’ll hear his answer in our conversation.

So no matter where you are on the continuum – whether you fall into a dreamy state once your head hits the pillow or you toss and turn throughout the night, I think you’ll find this podcast an interesting conversation about the mystery of the zzzzzzzzzzzzzz’s.

Previously: Stanford expert: Quality, not quantity, of sleep is what counts, Exploring popular sleep myths and Stressed out and not sleeping