Do you do yoga, take probiotics, see a chiropractor, or follow a special diet? If so, you’re not alone; roughly 34 percent of Americans make use of complementary therapies, and these are among the most popular ways to do so.
There’s a quiet dignity that envelopes Abraham Verghese, MD. You can imagine other authors whose books have scaled to the top to be taken with themselves, hardly humble, but that’s not the case here. When you get to know him, you realize he’s a man of great depth, with a wonderful soul and a deeply felt sense of humanity. When he talks about treating patients it’s with reverence (“There’s a saintliness I saw in so many of my patients,” he told me) – as if each time he crosses the threshold into a patient’s room he’s entering hallowed ground.
Verghese has written two searing works of nonfiction: My Own Country, a paean to the young men he treated for HIV-AIDS when it was just emerging as a human scourge, and The Tennis Partner, a loving eulogy to a best buddy whose life went off the rails. Then the blockbuster novel Cutting for Stone: atop the New YorkTimes best seller list for two years and selling more than one million copies. It’s a sweeping tale of how time transforms family – jolting the reader from the first page, where a Roman Catholic nun gives birth to twins boys and dies on the operating table. I read it during the height of the global economic chaos in 2009 and was transported each evening, thankfully, to another world outside of monetary meltdowns and fiscal maelstrom.
In this 1:2:1 podcast, Verghese and I talk about time’s impact on medicine, novels and life. (Time is the theme of the current issue of Stanford Medicine magazine.) About life, he tells me, “There’s a poignancy to living because we won’t live forever… As John Irving says in one of his books, ‘Life is a terminal condition. It’s about to run out on all of us…’ There’s no exception to that. And I think, in a way, that’s what makes life so beautiful.”
This podcast is accompanied by a Q&A with Verghese in the magazine.
A New York Times review called Steven Brill’s book, America’s Bitter Pill, “a thriller.” Brill’s tome on the building of the Affordable Care Act (ACA), aka Obamacare, “a thriller?” I thought. What recent treatise on the inner workings of public policy has garnered that sort of description? Didn’t the term “thriller” belong to writers like Paula Hawkins, Dean Koontz, Gillian Flynn and James Patterson? But Brill’s meticulous narrative of how Obamacare was constructed is a public-policy thriller, and the suspense he writes about is how the law was brought from broth to soup.
While Brill is hardly a public-policy advocate (he’s a long time investigative reporter), he does laud the president’s herculean effort to give millions of Americans access to affordable health care. He just doesn’t believe that any of the big “players” in health care – hospitals, device makers, insurance companies or pharmaceuticals – felt a pinch of economic pain, and he sees America’s health care system still as an old “jalopy” financially out of control and enriching special interests.
The seed for the book was spawned in a 24,000-word article in TIME magazine in April 2013. A year later, while reporting on the rollout of the ACA, Brill was diagnosed with an aortic aneurysm – flipping the story and putting investigative reporter onto the operating table as a very real person needing cardiac surgery.
At that moment I wasn’t worried about costs; I wasn’t worried about a cost-benefit analysis of this drug or this medical device; I wasn’t worried about health-care policy. It drove home to me the reality that in addition to being a tough political issue because of all of the money involved, health care is a toxic political issue because of all of the fear and emotion involved.
At the end of my conversation I asked Brill if there was one question he’d been surprised that he’d not been asked during his media blitz, which began with a rollout by Lesley Stahl on CBS’ 6o Minutes. “Yes,” he said, “you just touched on it.” How would his book had been different if he’d not had an aortic aneurism, a cardiac operation and become a patient? So how would Chapter One have begun?
I hope you’ll listen to my latest 1:2:1 podcast to hear what he has to say.
A wave of changes in state laws on the use of marijuana for medicinal and recreational purposes has stirred the American Academy of Pediatrics. It’s taken 10 years for the AAP to update its policy on the legalization of marijuana, and they released its new one on Monday.
The organization still opposes legalization but it has opened the door to reform in several ways. First, recognizing that minority kids bear the brunt of criminal penalties for pot use, they call for decriminalization. Second, they call for the U.S. Drug Enforcement Agency to reclassify marijuana from a Schedule 1 listing for controlled substances to a Schedule 2. This action would effectively allow more research to be conducted and in turn scientifically determine where marijuana is most effective as a treatment. A review by the federal government is currently underway.
I asked Stanford pediatrician Seth Ammerman, MD, the lead author of the statement, what the AAP was trying to achieve with its policy redo and why such a restrictive stance on legalization since the train for legalization – recreational and medicinal – seems to have already left the “coffee house.”
In this 1:2:1 podcast, Ammerman cites major two concerns. First, if legalized and commercialized, marijuana will become a big business, and the same marketing efforts by tobacco companies that encouraged teens to take up cigarettes will lasso them to pot smoking. “Well, aren’t kids smoking pot already?” I asked. Ammerman fully realizes that any teen who wants pot can readily buy it – legalization, to the AAP, is an imprimatur. Secondly, Ammerman cited, as does the new policy statement, the compelling and growing scientific evidence that the brain in formation continues to gel through the teen years and into the 20s. Marijuana, just like alcohol and any other drug, is likely to play a lot of bad tricks as the prefrontal cortex solidifies.
New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.
Ammerman says that the AAP will follow closely what happens in states where marijuana has been legalized both for health and recreation, and it will look carefully at what future evidence suggests. Clearly, there’s still a lot of smoke around this issue.
As I age, I’m becoming more and more interested in how I can prolong a healthy life. I hope I have a long life but more importantly, I want a healthy one. I’ve witnessed the other side. My father died in his late 80s; his final years ravaged by Parkinson’s. He was infantile and had bolts of anger and confusion. It wasn’t pretty. In her early 90s, my mother had a stroke. She passed away from heart complications after being aphasic for nearly a year. This 30-plus year English teacher lost all ability to converse in the final year of her life; she was reduced to incoherency. As I held their hands or fed them, I kept on telling myself, not me. This is NOT how I want to live my final days.
In recent years, aging research has been turned upside down. As Stanford bioethicist Christopher Scott, PhD, and his co-author, Laura DeFrancesco, PhD, write in Nature Biotechnology, it has a new face and it’s longevity:
How science approaches the questions of aging has changed. Lifestyle, environment, epidemiology, nutrition, genetics and the tools of big data are coming together in a host of new ways. The new approach – called longevity research – is an effort to extend the period of healthy life by slowing the biological process of aging.
I can see the scrawl on the wall: Aging research is dead. Long live longevity research.
Penn bioethicist and public-policy guru Zeke Emanuel, MD, stirred a recent debate about how long a viable life when he thrust his body up against today’s immortality zeal of the baby boomer. In an Atlanticarticle entitled “Why I Hope to Die at 75,” he theorized that post-75, it’s all a pain. His article is a great read that might depress you if 75 is within focus, yet it poses one question clear for each of us: How do we want to live our final days on earth?
Will longevity research produce answers that quell the anxiety stirred by the belief that the aging process means everything is headed south? Scott and DeFrancesco signal that while aging research “failed to come up with any viable approaches, let alone therapies to forestall the ravages of aging,” longevity research in animal models “have shown that life span is indeed malleable, that it can be manipulated by genetics or the environment…” Is there a stairway to longevity emerging in science?
The Nature Biotechnologypaper poses some fascinating questions as the science of longevity joins with a new generation of commercial entities that hope to seize its potential. To be sure, longevity research will need to avoid inflated hype. The authors say that Craig Venter, PhD, who has started a company, Human Longevity (HLI) is “….frustrated that the handful of fully sequences human genomes, including his own, has provided little insight into aging.” But I assume, as do the authors, that Venter’s bet is that there’s an abundance of sunshine down this path and science will emerge with ways to manipulate aging that will lead to better health and disease management. But when?
In my latest 1:2:1 podcast I take up these questions with Scott as the longevity era of science develops and matures. My colleague Krista Conger also authored a blog post earlier this week on Scott’s feature.
Looking for something to listen to while you wait for a flight or take a wintery run over the holidays? Consider these five 1:2:1 podcasts, which were selected by host Paul Costello and producer Margarita Gallardo as among the best of the year:
Scott Stossel on ‘My Age of Anxiety’: The editor of The Atlantic and author of the best-selling book My Age of Anxiety describes his long-standing struggle with anxiety disorder and examines efforts to understand what is now considered the most common form of mental illness in the United States.
Dan Harris on being happier: A skeptic at heart, ABC news anchor Dan Harris became a devoted fan of meditation when he experienced its benefits in his own high-stress life. During the podcast, he shares how the practice has made him a happier person.
Bill Newsome, PhD, knows the brain perhaps as well as the back of his hand. The Stanford neurobiologist was vice chair of the federal BRAIN Initiative launched by President Obama, and he directs the Stanford Neurosciences Institute. From that spot, he’s just funded a first round of interdisciplinary grants to Stanford faculty that he calls “risk taking.” The need, he told me in this just-published 1:2:1 podcast, is critical:
When biomedical research money gets tight, as it now is, the funding agencies tend to get conservative. Right now we have these talented faculty at Stanford, many of them young faculty. They’re at the most creative parts of their career. They’re at a place where they’re thinking big and dreaming big. We wanted to create this mechanism to allow them to do that.
I asked Newsome about the greatest challenges for neuroscience in the next few years. He had one word: technology. “If we were to improve the technology… If we could read out signals from the human brain and read in signals, actually do the circuit-tuning in the human brain non-invasively, at a spatial scale on the order of a millimeter or less and with fairly rapid time, it would revolutionize neuroscience,” he said.
So paint the picture, I asked, and look ten years out. What would you like to see as far as progress? He told me:
I would like to see fundamental, substantive change on at least one devastating neurological or psychiatric disease. I don’t really care which one. Give me Alzheimer’s. Give me autism. Give me depression. Give me Parkinson’s disease. At the end of 10 years, if we can really have a breakthrough in the understanding of what causes one of those diseases mechanistically and have a therapy that dramatically improves people’s lives… I would say, ‘It’s worth it. We’ve done our job.’
Any worries or words of caution? He laments the current state of federal funding for science and worries that fiscal constraints will squeeze out young star scientists. “How do you keep convincing talented people to come into the field?” he said. “We’re deprioritizing science… How do we convince our brightest, our best, that this is a field with a really bright future?”
Gray hair is sign of wisdom in the Middle East, geriatrician Mehrdad Ayati, MD, writes in the new book “Paths to Healthy Aging,” which he penned with his wife, Azerou (Hope) Azarani, PhD. Born into a family of doctors in Iran, Ayati moved to the United States in his 30s and soon discovered his passion for caring for older folks. The book aims to provide a easily digestible guide to aging, with chapters on mental health, exercise and nutrition.
Ayati recently sat down with Paul Costello, chief communication officer for Stanford’s medical school, for a conversation captured in a 1:2:1 podcast. During the talk Ayati explained why he was motivate to write the book:
One of the major complaints is there’s a lack of valid and easy-to-understand information about aging. They’ve been complaining to me that they’ve being bombarded by a lot of contradictory claims and a lot of instructions that are very difficult to follow.
Costello also asked Ayati about his transition from Iran to America — older people are treated very differently in those two cultures. Ayati responded:
In my culture, elderly people have a special status in their family, their community and their society. They are considered very sage. They are highly respected by other people… Since they are young, they have a dream to have this status someday in their life.
Ayati likened the Middle Eastern respect for the elderly to America’s love of babies. Both are vulnerable humans, and both need our love and support, Ayati said.
For more information on the book, which also includes a series of questionnaires for readers, visit Ayati’s blog.
When you talk to Susannah Cahalan on the phone, you’d never imagine that this is a woman who has been to hell and back. Without warning 5 years ago, she descended into a nightmare of paranoia, hallucinations, catatonia and near death. One moment she’s a journalist living the high wire life in the New York media world and the next, her brain is swimming in a world of severe mental illness without any diagnosis.
With the precision of an investigative journalist, Cahalan recreates what happened to her in the New York Times-bestselling memoir, Brain on Fire, My Month of Madness. There she describes the terror of what it’s like to be a patient without a medical diagnosis. A human being lost in a sea of clinical maybes. Violent, psychotic and considered a flight risk, she was all but a shadow of her former self.
Cahalan’s back at work now at the New York Post. She’s writing book reviews, science and health articles, all with a new perspective. In this 1:2:1 podcast and Stanford Medicine magazine piece, I asked her if she was a different person now, and she told me you can’t go through something like this and not be. “It has changed everything.”
In an effort to understand new and rare infectious diseases, researchers often use recombinant DNA technology to create novel strains in the lab. In 2012, researchers did just that, creating strains of the H5N1 influenza virus that were transmissible between mammals, setting off a debate about the ethics of creating viruses that were potentially more dangerous than those that occurred naturally.
Earlier this year, in July, a group called the Cambridge Working Group convened to continue discussing these questions. David Relman, MD, a biosecurity expert at Stanford, is a member of the group and spoke to Paul Costello about the risks and benefits of lab-created pathogens. Highlights of their conversation are in a piece in the most recent issue of Inside Stanford Medicine, where Relman notes:
My greatest fear is that someone will create a highly contagious and highly pathogenic infectious agent that does not currently exist in nature, publish its genetic blueprint, allow it to escape the laboratory by accident, or else enable a malevolent person or persons to synthesize the agent with the intention of releasing it in a deliberate manner. Although these may be unlikely scenarios, they could have catastrophic consequences, which is why I and others feel that we need to sensitize everyone to these possibilities and decide how to manage these risks ahead of time. I want to be clear: I am not opposed to laboratory work on dangerous pathogens, especially if they are known to exist in nature. Rather, I am opposed to high-risk experiments and, in particular, those that seek to create novel, dangerous pathogens that cannot be justified by well-founded expectations of near-term, critical benefits for public health — benefits that clearly outweigh the risks, and benefits that cannot be achieved through other means.
But not all researchers advocate the same level of caution. A few weeks after the Cambridge Working Group formed, another group called Scientists for Science to advocate in favor of using recombinant versions of pathogens in order to understand them better. Relman says that the two groups are probably not as far apart as they appear. He says he fully supports studying disease-causing bacteria, but:
The place where we may disagree is on whether we are willing to acknowledge that there may be experiments — probably few and far between — that perhaps ought not to be undertaken because of an unusual degree of risk. Just because a scientist can think up an experiment doesn’t mean it should be performed.
Relman elaborates on these topics in the 1:2:1 podcast with Costello above.