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Pain, Podcasts, Stanford News

Exploring the mystery of pain

Exploring the mystery of pain

If I had to live with chronic pain, I’d be a pain to live with.

I’m a lap swimmer. A few years ago, I developed a pain in my neck (yes, an actual, cliched pain in the neck). It didn’t stop there: It radiated down my arm and moved from my arm to my head like a brushfire. I became totally consumed by the thought of pain, and the longer it lasted the more compulsively I thought about it. I began to wonder if I’d ever be pain free again. Through it all I developed a great sympathy for anyone who has to face chronic physical pain in their daily life.

For me, there weren’t any particular good medical solutions or relief. I wasn’t interested in pain meds so I didn’t go that route. Essentially, I toughed it out using intense massage therapy and switching to a swimmers snorkel so I wouldn’t have to turn my neck each time I gasped for air. I also started vigorously stretching my upper body after every workout. The pain soon vanished.

The memory of that pain is stamped in my brain, and I’ve wanted to revisit the mystery of pain in a podcast ever since that time. I came across a very cool TED lecture by Stanford Medicine’s Elliot Krane, MD, director of pain management services at Lucile Packard Children’s Hospital, and saw that – no surprise with a subject like pain – it’s been viewed nearly 700,00 times.

When I spoke to Dr. Krane I began with a simple question: What is pain? Listen in and you’ll find out not only that answer but also how pain still perplexes him – even though he has researched and treated it since the 80s.

(And if you want more about pain, go back to a 2011 podcast in which I interviewed Sean Mackey, MD, PhD, another of Stanford Medicine’s amazing physician-scientists focused on pain. He treats adult patients.)

Previously: More progress in the quest for a “painometer”, A call to fight chronic-pain epidemic, Relieving Pain in America: A new report from the Institute of Medicine, Elliot Krane discusses the mystery of chronic pain, Stanford’s Sean Mackey discusses recent advances in pain research and treatment and Oh what a pain
Photo by ashleigh290

Podcasts, Sleep, Stanford News

Stanford doc talks sleep (and fish) in new podcast

Stanford doc talks sleep (and fish) in new podcast

You know that famous song about love by Cole Porter with the lyrics, “Birds do it, bees do it. Even educated fleas do it.” Well, in addition to amour, Porter could have easily been referring to sleep. After all, even fish do it, as Rafael Pelayo, MD, with the Stanford Sleep Medicine Center, told me during my latest 1:2:1 podcast.

I hope you’ll listen in as Pelayo talks more about the mysteries of sleep, an endlessly interesting topic.

Previously: Catching some Zzzs at the Stanford Sleep Medicine Center, Ask Stanford Med: Rafael Pelayo answers questions on sleep research and offers tips for ‘springing forward’ and Catching up on sleep science

Neuroscience, Podcasts, Stanford News

Brain’s gain: Stanford neuroscientist discusses two major new initiatives

Brain's gain: Stanford neuroscientist discusses two major new initiatives

The brain has gotten a lot of attention lately. Last month, President Obama announced a $100 million decades-long research initiative to “unlock”, as he called it, “the mystery of the three pounds of matter that sits between the ears.” And, in the arena of jaw-dropping science, Stanford’s Karl Diesseroth, MD, PhD, and Kwanghun Chung, PhD, recently unveiled CLARITY – a process that rendered a mouse brain transparent. Thomas Insel, MD, director of the National Institute of Mental Health, called the Stanford researchers’ work, “frankly spectacular.”

Primed for this moment of brain fame is Stanford’s Bill Newsome, PhD, who has been toiling in the field of neuroscience for nearly three decades. His international renown as a research scientist catapulted him to two new key brain posts: vice chair of the federal BRAIN initiative and director of a new interdisciplinary neuroscience institute at Stanford.

I talked with Newsome about both efforts for my latest 1:2:1 podcast. I began by asking him, “Why now?” What has propelled the brain to the front of the food chain in federal funding?

He called the Obama administration “prescient” for putting forth the federal effort. “There has never been a bigger moment of progress for brain research than there is now,” he told me. He describes this time as a “tipping point” where putting the pedal on the accelerator will make a whole new world of research possible.

Newsome is also cautious. Over-promising breakthroughs is clearly not in his vernacular. Yet he see this moment with clarity and admits that accelerating what we’re already doing will allow us “to get new data about the brain that we never dreamed possible.”

Previously: Co-leader of Obama’s BRAIN Initiative to direct Stanford’s interdisciplinary neuroscience institute, Lightning strikes twice: Optogenetics pioneer Karl Deisseroth’s newest technique renders tissues transparent, yet structurally intact, Experts weigh in on the new BRAIN Initiative and A federal push to further brain research

Aging, Medicine and Society, Podcasts

A conversation about the end of life

A conversation about the end of life

My sister, Cathleen, recently passed away. She had been in a coma for nearly a year from an accidental fall while visiting her daughter in New York. She lay on a sidewalk after apparently tumbling down the stairs and bled out for nearly 20 minutes until an ambulance arrived. She never regained consciousness.

Many, many times over the past year I wondered what she would have wanted if she had known of her cruel predicament. It was hard to imagine that a woman whose credo was ‘live, live, live’ would have wanted to waste away in a nursing home unconscious with little chance of recovery. Yet she was a fighter. Would she have wanted to grasp for every final bit of air before she breathed her last? Or at some point would she have wanted to just die peacefully?

I never had a conversation with my sister about end-of-life matters. Thankfully I also never had to make any fateful decisions since I wasn’t her legal guardian. Her husband and two daughters were ultimate authorities. But the question still gnaws at me even today, several weeks after her death. What would she have wanted? And in that time, I’ve thought a lot about what I would want if I were in that situation.

Ellen Goodman, the Pulitzer Prize winning columnist from the Boston Globe, never had a conversation with her mother about the end of life either. In the last years of her mother’s life, Goodman found herself swirling in a fog of decisions. They were basic decisions about care, treatment and survival – decisions that her mother was incapable of making:

In the last year of my mom’s life, she was no longer able to decide what she wanted for dinner, let alone what she wanted for medical treatment. So the decisions fell to me. Another bone marrow biopsy? A spinal tap? Pain treatment? Antibiotics? I was faced with cascading decisions for which I was wholly unprepared. After all the years I had written about these issues, I was still blindsided by the inevitable.

After her mother’s death, having keenly observed numerous great social movements throughout her years of reporting, Goodman wanted to create another movement. And so The Conversation Project – an initiative “dedicated to helping people talk about their wishes for end-of-life care” – was born.

I spoke with Goodman for a 1:2:1 podcast when she was out west to evangelize her project and to meet with VJ Periyakoil, MD, director of Stanford’s Palliative Care Education and Training. As a great journalist Goodman knows how to communicate, and she articulately laid out why The Conversation Project is landing at the right moment to launch another historical social movement.

Previously: Talking about a loved one’s end-of-life wishes, The importance of patient-doctor end-of-life discussions, KQED health program focuses on end-of-life care and Facing mortality

Podcasts, Science

Alan Alda on communicating science. Yes, M*A*S*H’s Hawkeye Pierce

Alan Alda, best known to television audiences for his iconic portrayal of Hawkeye Pierce, MD, on the television series M *A *S * H, has thought a lot about communicating science. You probably would know that if you were a fan of the PBS series Scientific American Frontiers, which he hosted for 12 years and where he interviewed more than 700 scientists. In a recent conversation I had with him for a  1:2:1 podcast, Alda told me that he went into the majority of those interviews completely blank and would ask the most basic questions. Some scientists, he said, could give a good “elevator speech” and in 20 seconds distill the essence of their work. And for others, it was a struggle. But he learned early on how to draw information from even the most reluctant: “I learned my ignorance was an asset, as long as I had curiosity. I was so curious that I barraged them with questions, and if I didn’t get it, I said, ‘No, go back over that. I don’t get it.’ It was a very personal interaction.”

Alda has taken his passion for communicating science to the academy, where he co-founded the Center for Communicating Science at Stony Brook University on New York’s Long Island. There, he teaches science students the art of improvisation.

We started our conversation with a basic question: Why is understanding science so important today? “The things that we do in our daily lives,” he told me, “and the decisions that are made that affect our economy and the way we live are all based in science. Yet, most of us are divorced from science, we don’t speak the language, we often don’t understand the concepts.”

If you’ve known (and loved) Alan Alda as an actor, there’s another piece of his life that is just as formidable: science communicator extraordinaire. With the Center at Stony Brook, he’s created The Flame Challenge, an international contest that asks scientists to communicate complex science in way that interest and inform an 11 year old. Last year’s challenge was answering: What is Flame? This year’s: What is Time?

Think about it. How would you distill a question that seems so simple into a concept that every 11-year-old could understand?

Previously: Challenging scientists to better communicate their ideas to the public, Want to become a better science communicator? Try explaining science to a child and A conversation about the importance of conveying complex scientific concepts to broad audiences
Photo credit: CBS Television

Neuroscience, Podcasts, Research, Stanford News, Women's Health

Stanford expert talks estrogen therapy and Alzheimer’s

Stanford expert talks estrogen therapy and Alzheimer's

Estrogen-based hormone therapy has been a hotly debated issue for years. In 2002, the Women’s Health Initiative, the largest-ever federally sponsored study of postmenopausal women’s health, halted part of its trial examining hormone therapy. Published data showed that the combination of estrogen and progestin increased the risk for heart attacks, strokes, blood clots and breast cancer among postmenpausal women. It seemed certain to slam shut the door on hormone therapy for many women. Yet, a series of studies has softened that judgment. And now comes another.

As my colleague mentioned just yesterday, a new study from Stanford professor Natalie Rasgon, MD, PhD, and others has found that some women – specifically those who carry a gene that puts them at increased risk for developing Alzheimer’s – may benefit from an estrogen regimen. The word ”may” is a huge caveat here, as the study was small and certainly not definitive.

San Francisco Chronicle writer Erin Allday teased out the research in an article yesterday. And I spoke with Rasgon earlier in the week for a 1:2:1 podcast, as I was curious about yet another possible rebound for estrogen therapy. Rasgon reiterated to me that her study is far too small to be conclusive – “it opens more questions than it answers” - but it’s intriguing nonetheless.

Previously: Hormone therapy halts accelerated aging seen in women with Alzheimer’s genetic risk factor, Hormone therapy soon after menopause onset may reduce Alzheimer’s risk and Common genetic Alzheimer’s risk factor disrupts healthy older women’s brain function, but not men’s

Aging, In the News, Neuroscience, Research

Are we less suspicious as we age?

Are we less suspicious as we age?

Years ago, I helped my mother clean up some old file drawers in a cabinet in her long-term care facility. There I found reams of letters – evidence of financial scams and fraudulent sweepstakes to which she had been sending small checks each month. Now you have to realize my mother wasn’t a financial pushover. She was a Depression-era baby who squeezed every cent out of her pocketbook, so I was greatly surprised she had succumbed to such flim-flam schemes.

New research in the Proceedings of the National Academy of Sciences, which you may have read about last week, sheds some light on what was likely happening with my mom. That study is the first to show, as described on The New Old Age Blog, “that older adults’ vulnerability to fraud maybe rooted in age-related neurological changes.”

It now makes sense. Even when I argued with my mother and told her she was sending her hard-earned money to pump up some chiseler preying on the elderly, she blew me off.

More from the blog:

“The warning signs that convey a sense of potential danger to younger adults just don’t seem to be there for older adults,” said Shelley Taylor, the leader researcher and a professor of psychology at UCLA.

Sometimes throughout my life, my mother would say to me, “I just don’t understand you.” Well, Mom, now I understand you better.

Medical Schools, Podcasts, Stanford News

Meet the medical school’s new dean: Lloyd Minor

Meet the medical school's new dean: Lloyd Minor

Lloyd Minor, MD, the former provost of Johns Hopkins University, officially became dean of the Stanford School of Medicine on December 1.

A few days before he assumed his post, I sat down with him for a 1:2:1 podcast. We had a wide-ranging conversation, beginning with his childhood in Arkansas. We talked about his parents – his mother was a kindergarten teacher whose most famous student was Chelsea Clinton, and his father worked for the Internal Revenue System, helping Minor prepare his taxes every year until he passed away. And he described how his world-view changed when he discovered the stark inequities between black and white schools as a young teen bussed to a former all-black junior high school in Little Rock.

We talked about Minor’s values and why he believes collaboration, not hierarchical top management, is the key to success for any leader. When I asked him whether this was the best of times or the worst of times for health care, he replied, “Both.” He believes academic medical institutions can play a significant leadership role in the reshaping of medicine, and he sees Stanford as a place that is uniquely qualified to be at the forefront of that change.

Minor is a physician-scientist whose ground-breaking work on a debilitating inner ear disorder was featured on the popular prime time medical drama “Grey’s Anatomy,” which we talked about, too.

And why did Minor choose to come west to Stanford and leave Baltimore after 19 years at Hopkins? You’ll hear him discuss that in the podcast.

Previously: An introduction to Lloyd Minor, Stanford medical school’s new dean and Lloyd Minor named dean of Stanford’s School of Medicine

In the News, Podcasts, Stanford News

Phil Pizzo, the marathon man, moves on

Phil Pizzo, the marathon man, moves on

Philip Pizzo, MD, bids adieu to his position as dean of the School of Medicine on December 1. His twelve-year tenure at the helm of the school has seen accomplishments both great and large. In fact, the school has experienced a rebirth under his watch. New organizational structures strengthened collaborations between basic scientists and clinicians. The faculty has become more diverse. And the school has seen its biggest building boom since it moved to the Stanford campus from San Francisco in 1959. The list of accomplishments is, well, staggering.

Nobel Laureate Paul Berg, PhD, a professor emeritus of biochemistry, said of Pizzo, “His tenure here has been the most productive and transformative time in the history of the medical school on the Stanford campus.”

I sat down with Pizzo in the twilight of his days as dean for a 1:2:1 podcast. We covered a lot of ground in our forty-minute discussion: his childhood in New York City, the early days of HIV crisis and his leadership on that issue at the NIH, and his move west to Stanford, where he achieved perhaps the most far-reaching accomplishments in a storied career. Knowing him, I have to say this is not the epilogue of his life’s story. There’s still a lot more to come.

Previously: Lloyd Minor named dean of Stanford School of Medicine, Dean Pizzo receives top honor from American Pediatric Society, Philip Pizzo wins prestigious pediatrics medal and A new era in education at Stanford’s medical school
Related: Marathon man, Philip Pizzo nears the end of his remarkable run as dean
Portrait by Gregory Manchess

In the News, Mental Health

New thinking on schizophrenia, it’s the mind, body and social experience

New thinking on schizophrenia, it's the mind, body and social experience

There’s a fascinating take on schizophrenia in the Wilson Quarterly that upends the strictly genetic model. New thinking on severe mental illness contends it’s much more complex and the simple biomedical approach is a road that’s reached a dead end. Thankfully, earlier and more damaging theories have been thrust aside. For instance, the psychoanalytical theory that blamed the schizophrenogenic mother for her child’s mental illness, which left a lot of collateral damage in its wake, is now viewed as garbage. New thinking emerged in the 1990s that concluded it’s all in the genes. But researchers are finding it’s not that simple. The trauma that happens to an individual has a large impact on on the strength of the mind and its vulnerabilities. Mental health and mental illness are a combination of not only mind and body but social experience.

As author Tanya Marie Luhrmann, PhD, explains:

In his Second Discourse (1754), Jean Jacques Rousseau describes human beings as made up out of each other through their interactions, their shared language, their intense responsiveness. “The social man, always outside of himself, knows only how to live in the opinions of others; and it is, so to speak, from their judgment alone that he draws the sentiment of his own existence.” We are deeply social creatures. Our bodies constrain us, but our social interactions make us who we are. The new more socially complex approach to human suffering simply takes that fact seriously again.

The epidemiological data in the article on migrants is eye-opening:

Epidemiologists have now homed in on a series of factors that increase the risk of developing schizophrenia, including being migrant, being male, living in an urban environment, and being born poor. One of the more disconcerting findings is that if you have dark skin, your risk of falling victim to schizophrenia increases as your neighborhood whitens.

After reading this article, it feels as though we’re finally on to something big — fresh thinking, new treatments and hope:

All this—the disenchantment with the new-generation antipsychotics, the failure to find a clear genetic cause, the discovery of social causation in schizophrenia, the increasing dismay at the comparatively poor outcomes from treatment in our own health care system—has produced a backlash against the simple biomedical approach. Increasingly, treatment for schizophrenia presumes that something social is involved in its cause and ought to be involved in its cure.

Stanford Medicine Resources: