35 Burst results for "Neurology"
The Essential Oil Revolution
"neurology" Discussed on The Essential Oil Revolution
"I get my patients using pure essential oils. I always make sure it's one that they like the smell of. Of course, if they don't like it and I feel it's really going to be important. I have them apply it to the bottom of their feet. You don't have to smell and it's still going to work. But if they like the way it smells, they're going to use it more often. I give them usually their own personalized diaphragmatic breath treatment, something from yoga. I remind them about meditation, apps, a splashing cold water on the face. Humming, there are a lot of different techniques that can be used for stimulating the vagus nerve for ton of the vagus nerve for putting the parasympathetic system back in charge so that we can actually take a full deep breath. We can relax our shoulders. We can digest our food. And we can find that calm in our lives. Yeah. How often should we be aiming to be in that parasympathetic mood? I wonder if there's any research done on how that's off great question. The parasympathetic versus fight or flight versus us now, you know? And Sam, I think we're on the cutting edge of a great question. I think that's for the next research. Yeah. You know those fitness bracelets that people wear? Does that track and those tell if you are in parasympathetic? Yes. Some of them do a pretty good job of that. And there are we talked about the electrocardiogram can measure heart rate variability. So and heart rate variability is usually not something that's going to change. Although, I mean, it can change. It's not going to change immediately. That's interesting. Yes. Well, something you had brought up earlier was good stress. So I'm thinking people are curious about what does she mean by good stress or what you call EU stress? Tell us about that. Yes. So good stress would be planning for a party. It would be excited about something wonderful that's going to happen. For athletes, you stress or good stress would be, you know, running that marathon, you know, and or even training for it. The birth of a baby, a wedding. These are all you stresses. So it takes you out, you know, it's going to increase the heart rate it's going to get everything going. And of course, we don't want to we don't want to take away these wonderful things. We want a beautiful balance. I would say we want to be an ideally. I would say we'd want to be in parasympathetic 70, 75% of the time. I think that's why it's suggested that we have meditation morning and evening some cultures advise that forest bathing. We being out in nature and I think that there are a lot of tools out there that haven't even been. You know, getting a massage. Connecting with your Friends. Those are all ways that we, that we soothe ourselves that we help our vagus nerve. And I think that it's easy to use to utilize essential oils. I mean, when my patients ask me, well, how often do you use them? It's like, well, I start my day with essential oils. I end my day with essential oils because I have oils that help me wake up. I have oils that soothe me and prepare me for sleep. And then I have oils to use throughout the day. So there, essential oils are a very important part of my life. So it's easy for me to talk about them. What are some of your personal favorites that you like to wake up to and go to sleep with? Well, when I wake up, I love peppermint and cypress together. I will, I just find that's great. And bergamot, bergamot actually has been shown to reduce cortisol levels. So I feel that it's makes me happy while keeping me calm. That's that nice mix that we like to have. Of course, vetiver is great any time because not only is it centering, grounding, I love it combined with lavender. I have a lavender roll on that I use at bedtime. Vetiver is also been shown to greatly reduce the effects of ADD with kids and adults. So it's interesting that hear this grounding calming oil. You know, that helps us sleep also helps us focus. It's like it's taking away the distractions. That makes absolute sense when we're distracted or our bodies or our minds are trying to do a billion different things. We can't focus on things in front of us. Of course, every everyone who knows about how amazing frankincense is, you know, has frankincense nearby. I always say that you want to go to headquarters. You want to deal with the brain. You use frankincense. You know, it just goes right to assisting the nervous system and amazing ways. And then there are so many great oils that blend well with it. Personally, I love the tree based oils. Frankincense, sandalwood. Cedar cypress, the furs. Doesn't it feel like there's just this inherent wisdom with the tree oils? It does. Yeah, it really does. And connection rarely do you find a tree by itself? So it's about community too. Support for our show comes from athletic greens. This partner has a product I use literally every day. I started taking athletic greens because I was really tired of having to take.
The Essential Oil Revolution
"neurology" Discussed on The Essential Oil Revolution
"The headquarters. And all of the other nerves are communication systems, working with a chemical electrical process. It's and the vagus nerve is like, you know, the ruler of that system in that it creates the brain gut connection. It creates a communication, almost instantaneous communication between the brain because it starts in the brain being a cranial nerve. And most of the other organs. So it's so when I say I utilizing practical neurology to assist my patients in improving faster and getting to root causes, I'm working a lot with the vagus nerve. Yeah. So there's a lot of education. Absolutely. I can imagine a lot of people come in. They're like Vegas what and essential oils what and neurology why makes us a lot of your taking really what I see as the best parts of research that have come out in even just the past 5 years, you know, of on the vagus nerve in particular, I find super fascinating. So let's start there. Talk a little bit about the research that's been done on the vagus nerve and how why it's getting so much attention and also for those unfamiliar with it. Where exactly is the vagus nerve in their body? Yes, let's start at the beginning. The vagus nerve is one of 12 cranial nerves. So that means that along with the other cranial nerves, it starts in the brain. Whereas most of the other cranial nerves stay there. Think of your senses. We have cranial nerve four smelling for seeing hearing, et cetera. The vagus nerve actually leaves the brain. So Vegas is Latin for vagabond or wander and it wanders along it leaves the brain pretty much right behind the ear goes down the neck. Both split. It's yes. Right and left. When we say vagus nerve we're actually talking about the pair of nerves. And it's such a, it's such a cool nerve. I mean, it's such an exceptional nerve that we're continuing to find out more about through research and just how powerful it is and how we can tone it. So imagine this nerve is coming down from behind the ear, which is where we will talk about applying. Essential oils to regulate or assist with regulation of the vagus nerve. It goes down alongside the trachea on the sides of the neck. And it's listening to and responding to the lungs and the heart. Okay, we've got cardiovascular. That's why one sign of good vagal tone is a good response after exercise. Define that what exactly does that mean? In other words, you've been working hard, you've been jogging. You're able to recover. Your heart's not beating hard or having trouble. And that is controlled by the vagus nerve or impacted by. Yeah, so the vagus nerve is one aspect of good cardiovascular system. Then it does not control or innervate the muscle at the diaphragm, but goes through the diaphragm, which.
Mark Levin
American Academy of Neurology Open Themselves for a Lawsuit
"So Going to train people you see, now they're going to feel better. Look, we trained people. You should see, we have changed the wording What word you can and cannot use. I mean, we're going to take bold action around here at the Academy of Of, uh Neurology. Should be the Academy of narcissism. But what do I know? And she read that the way uh Secretary of state blinking red his video on his video. Obviously, with a lot of passion, none. And so the academy, the American Academy of Neurology, where there's obviously deep rooted racism, sexism. All kinds of ISMs. Uh, is obviously a hotbed of white supremacy. And white domination because they need to train their people. What's known as ideas. Apparently there, hasn't it? You know what? It's a perfect lawsuit. If you've been working at the American Academy of Neurology Have a perfect lawsuit. Because only now are they getting around to inclusion? Diversity Equity, anti racism, social justice also known as ideas. Only now, are they getting around to treat other people as human beings? Isn't that what you get out of this rich? So bring your
Mark Levin
American Academy of Neurology CEO Mary Post Promotes White Supremacist Agenda
"Here's Mary Post with the American Academy of Neurology cut 17 go at the A. M. We believe, embracing and leveraging our organizational values of inclusion. Diversity, equity, anti racism and social justice, also known as ideas. This is critical for success, and it's an ongoing focus in our pursuit to be indispensable to our members. In 2021, all committee chairs, committee members and our staff. Will receive anti racism education. This is just one example of many commitments that we're putting in place for sustained change. We are resolved to pursue bold action beyond rhetoric and to stand with the communities that we serve to eliminate inequities that are antithetical to our values and the pursuit of our vision and mission. And what are those inequities that you're going to eliminate? That are antithetical to your values in the pursuit of your vision and mission. What are the inequities that you're going to eliminate you dope? And what's the bold action beyond rhetoric? What's that? What is it? No, wait. The poison spreads. It's not enough to be a color blind society. It's not enough to be a free people, all of us. To pursue your interests. No. Any training on racism and segregation. That's what it is. That's what it
Break The Rules
Cold Laser Therapy: A Health Revelation With Dr. Kirk Gair
"You define cold laser therapy or so. We look at at at cold laser therapy. That means it's non-thermal because there are some lays out there that are thermal. There's some high powered ones that work by heating up the tissue low level lasers. They've been used since the nineteen sixties. And they're really pioneered in the former soviet union where there was so much research by nineteen seventy four that the russians were using them in their state-sponsored Medical care so they're using them for every branch of medicine basically even if it was. Obgyn if it was a oncology neurology orthopedics because they were able to see that it can help people to heal much faster. By the way the laser actually stimulate. Some changes will be called photo biochemical changes so the easiest way to think about lasers. Let's start with plants. Let's look at photosynthesis so you've gotta plants leaf and when sunlight hits the plant's leaf. They will absorb the photons of energy. Sounds like star trek but it absorbs photons and then the plant will convert that into food through photosynthesis so that's one simple way that living organisms can use light in humans when sunlight hits us. We can't make food but we can absorb that energy and make vitamin d that goes throughout the body in order to cause you to me stronger bones or affect the immune system and inflammation or the sunlight can cause you make me Melon for a suntan melatonin for your sleep wake cycles and for some people. They can't even get seasonal affective disorder. Where if they don't get enough light they can get depressed so we know that our bodies are already light reactive now. What happens when we get laser on the skin. You're not gonna make food or vitamin d or a melanin. But you're gonna make some other molecules that have a really powerful impact. One of the primary ones is you're going to make atp which is made in the mitochondria and so you have listeners. Who have autoimmune conditions fibromyalgia. Very common especially in females Where they have issues with their mighty country. The laser supports that by helping it to make extra energy extra. Atp and that can affect every single on your body brain cells as
The Bio Report
Building a Better Path to Neurotherapeutics
"South. Thanks for joining us right to be here. We're going to talk about her office. The challenges of developing drugs to treat neurologic conditions and offices platform to address those challenges. I think neurologic conditions tend to be an area of some of the hardest targets therapeutically. My sense is this is an area with relatively high failure rates for drug developer's. Why is that is a lack of understanding of the complexity of these conditions. Lack of animal models delivery challenges or is it something else. I think the reason that neurology and psychiatry has categories have have some the lowest Success rates in drug discovery are primarily for two reasons. these are complex conditions of Very complex organ. Not well understood how the brain works and when when things go wrong why why they go wrong so it's complexity of disease and And secondarily i think because of that complexity to develop effective therapies. We might have to take more more sophisticated approaches and it goes through the two two major issues the other issues that you brought up a animal models are certainly more challenged the translate ability of Of behavior between species is hard and and of course There are challenges of getting into the brain but you know to to be fair. Plenty of plenty of drugs do get into the brain. Ruffalo has developed a platform for discovering therapies for neurologic disease. Easing patient derived human models known as organ. Lloyd's what's in organized. And and how do you create them. Yes so org. Annoyed is some kind of a scary science fiction sounding word But you know it happened to. It is the word that the industry in the field has has settled on and It sounds it. Sounds fancy new in in ways it is. It's a new way to culture. Cells typically stem cells typically derived A reprogram from patient samples either blood or fiber blasts
KDWN 720AM
"neurology" Discussed on KDWN 720AM
"Neurology If you missed Brian Kilmeade, you missed 40. Some 1000 apprehended Probably another three or 4000 came in and what California is dawn to medical Mean Laura, Where does this and I'll tell you where it ends, totally undermining our country, bankrupting our states and our federal government, destroying our democracy. I'm worried about my Children. My grandchildren and everyone watching better understand that the Democrats, their actions by the Democrats in Washington are no less than treason. They're selling out our country, and this is why it was one of the few Republicans That stood with the president and said, And look tariffs are always the last resort. But there are powerful tool and and by the way that was Dan Patch is the lieutenant governor. He's a fine talk show host. He owns the Texas the Houston station. Where on it was very nice of them a Republican in Texas who understands this issue better than almost anybody, and we've never seen numbers like this and we don't have any financing for accommodations. I just saw Elizabeth Warren's tweet. She's been. She's condemning the conditions for the illegals, but not doing anything to stop them from coming or providing insurance fund money. Uh, for them, But if they're condemning him, really the split by the Border patrol supposed to pull money out of their pocket. And I pay for this and get bunk beds in there and maybe get maybe get Jim James Taylor. He did such a great job in France after their attack. Maybe James Taylor can play at the Rio Grande Valley sector. But 27 this guy Jerry Robin that he is a former San Antonio ice agent. He knows what's happening there. Cut 27. It has gotten it has overwhelmed our resources. Our capabilities. It's like what's next, Uh, the agency officers along the border there drinking out of a fire hose Right now they're barely keeping up with their responsibilities. You have a lot of resources are being dedicated to address with what you're seeing today. My biggest concern is at what sacrifice what else? What is it that we're not doing that we should be doing because of all the attention and all the resources that are being diverted to deal with this influx. And now you have California saying, Hey, illegals free healthcare! Put $98 Million aside for you. Not enough by the way, and they evidently I don't know this for sure. I heard this. This morning from one of our legal guess that they turned down, giving seniors health care, But illegals 98 million Coming your way. Brian Kilmeade, weekday six AM to nine AM on 101.5 FM. 7:20 A.m. K d WN The talk of Las Vegas medication Managed Las Vegas.
Scientific Sense
"neurology" Discussed on Scientific Sense
"I i know that you know we have learned a lot last fifteen twenty years. What do we know about their function. of our officers sites in the okay. So you know the easiest thing to do. It's to think about what they do in that one day doing this right. So in the first of june development they will guide you know newroz. Extend these accents right. These kind of like extensions so astro Guide those accents in addition astra sites with also guide the formation of a series of membranes. That kind of wrap or the central nervous system and they are called the manages. The blood brain barrier died is tightly controlled blabbering tightly controlled by the astros sites and then also with astronauts do is a provide nutrients they provide factors for neurons to do well right. I'm also you might know that. Neurons you know. They communicate by secreting chemicals. Right that produced by one. The essentially anuron so astros sides can regulate the secretion on app. Take those chemicals and by doing so they can actually regulate sitemap communication neuro to neuro communications so then they can having ten roads in behavior for example the memory. Now that's five of kind of like what we call a mere static right like functions faster exciting have in the context of the seas. They first before they can stop doing all of them right. And obviously that creates problems out boost when we call near the generation which is just another death. He added on top of that they can actually drive inflammation within the brain with. You can imagine very by than literally they can secrete molecules that killed nuris and that. It's even stronger driver of near the generation. so so is it. Correct francisco thing about sort of the neurons is like the hardware and astral sites through right. Your function sectors cried provides energy utopians it regulates communication so s sites is sort of like the software is likely to think about it afterward certain extent i would say that both duro sastre the other legal sales right of had way which has each one has his own programs on software but what is important to understand is that only the consequences of the function of the central nervous system. They resigned from the directions and communication between all those different parts of hard work. And they don't take to put where they feel has been for years. Is that for years. We've focused on the neurons as the main source of program know function but now we need to zoom out a little bit staticy with all those other cells and the their communication. What do they do in order to produce what we know as a function of the central nervous system has to the given that they have a video important set of functions that that affects the neurons if -bility to work.
Scientific Sense
"neurology" Discussed on Scientific Sense
"My district is confident franscisco. Kim who is a professor of neurology at the center for neurologic diseases. Brigham and women's hospital. Harvard medical school at an associate member at the broad institute. Harvard and mit Investigate signaling pathway said control they knew discounts at euro. Degeneration the document goal of identify noble therapeutic targets and by loggers for immune mediated disorders. Conference is go. Hi thanks for having made today show you. Thanks for doing this. You have couple of recent papers that i would outdo love to go to the first one is Got licensed interferon gamma cells. Drive and information. astral saris you say astra cited a glee of cells that are abundant in the central system and that important kobe promoting functions. How little is known about the static. Anti inflammatory activities of ezra sites and deregulation before we get into the details of this francisco. What exactly are astro sites. So he's actually an interesting question right. Because if i were to ask you what is the most uncertain your brain. Most likely you'll tell me the neuron right yet yet. The most of on themselves in the brain are astro sites. They got that name because they looked like straw. Look at them in the microscope under the microscope and in four years there were so band they were just kind of thought to be glittered. Glue literally were thought to be some kind of providers for neurons to do their things. However nowadays we realize that these cells being stored on that are not just passive bystanders. Right there they are very important for our the functioning of our brain and spinal cord. We call this the central nervous system. You encounter a known so very important drivers of neurologic diseases so he you know you have the most random cell in the cnn yet. You don't know what it does. So so as a everybody knows about the neurons and their importance. But you have this. Microbe leah and mac leukemia cells. Right in the brain so astra slice is sort of a cell exactly when you think about leo sales from the brain. You'd think about microbes you think about which are kind of macrophages right these ourselves. That eat up stuff random. Then you have another center which is called audio dangerous site. Which were they does it. Produces it synthesizes. The insulation around the neurons right the neurons ahab Insulation tissue. I mean we could that actually allows to work and then the third type of lille sell you. Having the brain is the astra site. That's why sometimes you would hear. They are referred to as astronaut leah. I see okay and so so what do we know..
Scientific Sense
"neurology" Discussed on Scientific Sense
"Welcome to the site of accents. Podcast where we.
The CyberWire
Cyberespionage and influence operations. Reading the US State Departments mail.
"Kitten also known as phosphorus or t a four fifty three the well-known thread actor associated with iran's is revolutionary guard corps has resurfaced in cyber espionage campaign directed against israeli and us medical researchers proof point researchers conclude that the current campaign. They call bad. Blood is fishing for credentials belonging to geneticists neurologists and oncologists. The campaign uses email spoofing. Communications from israeli scientists proof point is confident in its conclusions but also admits that as is often the case. Attribution is based on circumstantial evidence. Bad bloods objective. Remains obscure record points out. Proof point told the record that the pandemic has produced a surge in collection against biomedical research targets. But the specialties said to be of interest to charming kitten. Genetics oncology and neurology. Don't bear any close. Immediate connections to covid nineteen research nonetheless. The collection proceeds and continues to prospect senior researchers politico reports that russia's holiday bear may have sex accessed. Us state department e mails. It doesn't appear that classified. Communications were compromised but emails exchanged by foggy bottom bureau of european and eurasian affairs and bureau of east asian and pacific affairs. Were apparently being read in moscow. Dark reading has a summary of the current state of knowledge about the sunburst exploitation of solar winds orion platform the. Us is still considering. Its options with respect to response retaliation defense and deterrence in. What the atlantic council characterizes as a strategic failure the council's report said quote. The sunburst crisis was a failure of strategy more than it was the product of an information technology problem or a mythical adversary overlooking that question of strategy invites crises larger and more frequent than those. The united states is battling today the. Us government and industry should embrace the idea of persistent flow to address this strategic shortfall emphasizing that effective cybersecurity is more about speed balance and concentrated action both the public and private sectors must work together to ruthlessly prioritize risk make lynch pin systems in the cloud more defensible and make federal cyber risk management. More self adaptive and quote
Scientific Sense
"neurology" Discussed on Scientific Sense
"Our understanding of that structure to determine which of the the current drugs that we have are the best. And how can we improve on them. Which by using pharmaceutical chemistry. So i would say combination of you know. A crystal structure computational chemistry medicinal chemistry pharmaceutical chemistry and clinical observation. Made very optimistic that over the next decade or two. We're going to have some much better ways to treat our patients with both acute and chronic pain. Just a quick question. Also do you think. Do you think we get closer to sort of simulating. What is happening in the rain. The whole siennas system In silicone somehow so that you can in a chronic pain before knowing anything about. It's almost like a stop. It seems like that's the question and might ask. I generally tend to be an optimist. But i would say that. Yes so far. We haven't had the. I would say the theoretical aspect The computational aspect for four brain function We really don't yet understand. Fully how information is represented in the in the nervous system. We know about cells. We know about synapses We can record from lots of different cells. But it's a huge computational problem if you have to record from thousands of cells at multiple sites in the brain were starting to approach. Then we have to come up with some theoretical concepts about how the information is represented in the The next station at the different stages of these of the circuit function. Oh we'll get there a but we're not there yet. And what i would say is we need a stronger. Theoretical approach to information processing in the brain. We've got the chemistry got the anatomy of. We've got the tools to manipulate the brain but we need some better ideas if we're gonna understand how it works yet I sometimes associated humor. Yeah i can't even remember something. So i think it was physicists that there might have been physicist turned into a neuroscientist z. Said you know if if if if we were smart enough to understand the brain. The brain would be too complicated. I understand right excellent yet. It has been a lot of fun but by thank you. This is a scientific sense. Podcast providing unscripted conversations bit leading academics and researchers on a variety of topics. If you like to sponsor this podcast please reach out to in full. At scientific sense dot com..
Scientific Sense
"neurology" Discussed on Scientific Sense
"And so i wondered if it kind of bleeds into the statistical observations. I haven't really thought about it but not the history doesn't it. it has to. I would think yes he does he. Just say you know. Some people are going to think that you know. Let's call them optimistic. That got the drug they going to good effect. The indicate over some people are always going to say going to that. They go to the sugar. Nothing is going to happen. Saying is that you can reduce the variability within a population by matching people who have similar expectations right. Yes yeah now the question would be. The debate wired has any by sure that's true. That's a really good point. I would say yes to that and then you go back to something you said earlier in the segment is you. Everybody's different if you do that that i think like you mentioned it. You know at some level you could standardize but if it is a why. The wiring diagram itself. Had somebody says than than will always find some type of people in those buckets. Populating does focus and But but but the idea is is is a good one. Harvard avenue snow just for paid. It's it's pretty much for eighty clinic. Tried i would. Well i would say any clinical trial or your outcome is a subjective measure right so for depression for anxiety for pain for which you know a lot of a lot of things. There may when it's if you're using an objective measure so for example. Let's say you're looking at breast cancer. You've got new chemotherapy. You can do a imaging studies and show that you're chemical actually reduces the size of the tumor over a period of time. That's that has nothing to do with the patient's subjective experience but don't see placebo effects even That has not been possible to show i. I look for that intensively when we were doing is placebo research. And it really really the the effects of of placebos on objective measures. It's quite minimal. There are some papers that show improvements in wound healing with experimental wounds. Yeah but that's about it. I'd seen bath. So maybe Maybe there's something to do with the brain so you know if it is a cns art type issue. There are decisions being in the brain. Different sources involved and the premium is sort of more leading between two circuits. And so so so you would think Maybe to see die issues disconcert. If that's where i put my money. Yeah and there's there's evidence from functional imaging that it is specific places in the cns that are associated with placebo responding number. One you get a reduction in the neurological pain signature for any given intensity of pain. So that's for sure happens. But then there's another set of circuits that we generally considered to be involved in the decision making process. These are activated an correlated. With placebo responses. I want to Congruent with your people opioid so i. it's entirely understand the opioid for board You said opiates are the most potent logistic income. In clinical use. Hold their powerful. Awarding properties can heat to addiction and scientific challenges to retain on just potency while the meeting the development of tolerance dependence and addiction..
Scientific Sense
"neurology" Discussed on Scientific Sense
"To. What are they gonna clinical research organizations. Cro's right and and that's what they do rate so we have templates and and at this time for trial also quite require more patient so it has an impact on the cost demand. Well i would argue no right. Not necessarily i mean if if you say that what you're doing is reducing the variability and you wouldn't need a big cohort. You could reduce variability with the same number of patience and you could pull your results from the two groups that is true. Yeah and and i said it could also make some trials turn out to be positive. That is marginal today on. It might actually actually show effect and it also it also could be. So here's here's another thing to consider. Is that for those people who are expecting to have a drug effect. Their central nervous systems could be operating differently from those who think that they're getting the placebo right. And if you're saying well i've got a drug. That's acting on the nervous system. The effect of the drug may depend on the state of the nervous system. When the drug enters the brain right so you could say you know in the clinical situation. In general a doctor comes in you know the got great hair or wearing white coats of have a nice voice. You know they're friendly. They've taken their time in to give you a thorough examination. They say he looked in a. Here's this new drug had a lot of good responses to it. I think this is really going to help you. And then you give the drug. And i'm saying that in the clinical situation you're going to have a big drug effect and that's why you need the you know. Show that expectation has this big effect and then the other thing that i always tell all my all my friends who are taking care of paint patients is you need to actually ask. People what they expect is going to happen. You know from your treatment. Right is a lot of times. People will say. Look doc. i've tried everything in. Oh nothing's worked right. They're they're coming to this referral center. And i and i'll say well. Do you think i can help you. They'll say will. I hope so. Now i said do you think can help you said well. I don't think so. And then i wire you hear well 'cause you know my uncle told me i absolutely had to come to ucsf. Ah that that is what i bic. Worry that going back to the clinical trial design. There could be some personality and behaviour vices into a spark. There have to be you know.
Scientific Sense
"neurology" Discussed on Scientific Sense
"Doctor's white coat with a a needle in a syringe causing pain or we come to associate a bottle of pills with relief of a headache. Let's say couple of aspirin relief of headaches. So these cues are neutral right but they predict that dull either be a painful experience or there will be a pain relief right. So these neutral cues come to acquire a predictive quality and it turns out that that predictive quality through these same top pain modular tori systems can either relieve pain or enhance pain so we call the pain relief due to expectation. That's what we call a placebo response so everybody is heard of while you take a sugar pill because you think it's going to relieve your pain it actually relieves your pain but it hasn't really relieved you're paying well. The fact is yes. It actually has relieved your pain. And there's evidence that it has relieved your pain through. Same circuit is activated by morphing. This top down pain. Inhibitory system in this was something. Back in the seventies jon levin and i looked into the endogenous opioids endorphins were discovered in nineteen seventy five and we were working in the lab at that time and we said we'll let's see if there's something going on here you know in people then. It turned out that we could block the placebo. Analgesic effect with the laaksonen lock zone is a drug that blocks the the mu opioid receptor. Which is the target of warfare. Which is the target. Dodging his opioids that act to reduce pain when pain relief is predicted. So it looked like you know that. It was a similar pathway for a drug induced effect and for an expectation induced affect right. So that's how we came to understand how expectations can actually change what you feel at any given level of tissue damage and that turns out to be very important. in fact there was a recent study. I refer to this twenty eighteen paper out of canada where they looked at over two thousand patients with chronic pain. Who were entering into a multidisciplinary pain treatment program and then they were followed up for six months and they were looking for you know. What is it about these patience. That predicted whether they would respond well to whatever the treatment was that was given and the amazing thing that they found. The study was the best predictor of whether a treatment for chronic pain was effective was whether the patients expected that the treatment would be beneficial when they entered the study right. So this isn't just a cute little. You know psychological phenomenon. This is something that has big big clinical implications and it's critical to understand it and think we are beginning to have some kind of understanding of this. Yeah it It puts the the placebo effect in a slightly different context. Right so the then you think about. Clinical trials began this control group. We had the cleveland group and betrayed. You look at the difference between the do but if you are saying that the placebo has a systemic effect it actually creates effects that a bitty analogous to a drug induced effect then Then you know how you conduct. Clinical trials may may need to be. Perhaps absolutely and people are giving this allowed thought. I think you've put your finger on Absolutely critical concept and in a failure to understand this has led to the failure clinical trials in the past. So obviously one of things you wanna do..
Scientific Sense
"neurology" Discussed on Scientific Sense
"To a certain extent they're they're kind of straightforward incentive. You know what's ideal for the cells and all you have to do is detect from the ideal state and then all of a sudden you gotta motivation and this motivation can be encoded in action potentials and sent to the appropriate place to say okay. You know there's water and you really need water if you're going to survive another day or two right people's thirst mechanisms go off It's it's life threatening. Yeah yeah you know. I can see some hatless do article into the think about computers in for example so Brain has set of to at least hold. I don't know much about this Tests asset of expedients these Sticks and and because they are risks form it can just implemented pretty easily pretty quickly If if it is true then you can see. It's not wing really well. If you take the individual to a completely folded and one right past you agree with that one hundred percent so i think that is you know in some sense. That's what to do to that. You can actually because heuristic can be done or implemented you know pretty costly. That is what you want to do. We'll take a quick break out when we come back. We'll talk about your recent people. Sounds gracious influence pain. Thank you.
Scientific Sense
"neurology" Discussed on Scientific Sense
"One direction to costs in another direction to benefits. And there's a couple of places in the brain that through that. So you'll have a convergence of the inputs that are saying computing the value of a reward. You'll have another set of neurons that are feuding. The cost of a painful stimulus in terms of potential tissue damage and they converge in onto a single neuron that say excited by reward in inhibited by paint. So that would be. There's some evidence that a set of neurons in the mid brain. An area called the ventral take mental area. Which has dopamine neurons. You you may have heard of dopamine it's considered by many to be a critical neurotransmitter for encoding reinforcement or reward. And there's so these same neurons that are excited by reward are inhibited bite. Painful inputs but the coast benefit sort of decision is complex rates. So going back to the heat example there is sort of a short term cost and then if the akon lasting that requirement of food. There's no long term 'cause and bhutto. These are sort of dependent on the state of individual rights individuals for in the debt without sold a different different decision. So i just wonder even though there is a common currency. Cpr in terms of neural activity. It is still a brady beatty complex tradeoff decision. The brain has to make. I have to think about that What i would say instead. It's it's it's an equation with multiple variables in and so by that definition. You could use the word complex but you know there. There are things that are really complicated. So for example in a let's talk about dreaming or imagining are writing poetry or composing music Those are things you know to a certain extent we do not understand it all and they certainly don't make a whole lot of sense in terms of either cost or a benefit right whereas food. You know you could. You can do calculations about what a number of calories you need to sustain your body weight and you can do calculations on how much damage a stimulus of a given temperature can produce. And that's something that i would think over the course of four hundred million years of evolution of the nervous system the brain and pretty good at The other thing is that we know that the hypothalamus which is in the dining cephlon's not far from the reward site and it's highly connected to the reward site has neurons in it that are sensitive to food deprivation as milady of in terms of calculating. I you know. Oxygen blood has salt concentration in the blood. So there is a set of monitors in your hypothetical that can detect deviations from homeo- stasis. How stasis would be the ideal environment for the cells of your body that feel like those things are actually fairly well understood in.
Scientific Sense
"neurology" Discussed on Scientific Sense
"To help you survive. You have to have behavioral repertoire that allows you to react in a meaningful way to the particular stimulus. The particular change in your environment and so the system formed as you say For either to counteract threat or against some sort of reward lights correct and it is it is it is sort of instinctual soviet baby touch something heart Been deposed that hand The is the brain doing it. Consciously or something instinctually. Something is a different process on us. I would say that We if it's what we call a reflex a reflex as a motor response that's triggered on by particular sensory input so you don't need to be awake to pull your hand away from the hot save pan. You don't need to be conscious of it. In fact probably most people have had the experience of touching something hot pulling their hand away and then only after they pulled their hanaway. You know feeling the burn. So i think if you have to wait till you actually have the subjective experience to react to it it would be too slow to protect your hand from burn. You have to be able to do it quickly. Intermissions doesn't need the even need to get to your brain just needs to get to your spinal cord. Yes let's announcement at so somebody that call. Mom would do that too. Yes it yes Most people in a coma will respond to pain in a you can be at least slightly anesthetized instill have a pain response when an anesthesiologist is trying to gauge your depth of anesthesia. What they do is they raise the concentration of the anesthetic to the point where you just stop responding to pain. I'm so since a you talked about the circuit that gets information to the brain terrace. I think that is something else that sort of inhibits that. So that's that's a very important point That it's in the paper that we're talking about the motivation decision model so it turns out that the.
Scientific Sense
"neurology" Discussed on Scientific Sense
"Half a millisecond to two or three milliseconds. You have an inward rush of sodium and you have than an outward rush of tahseen so you have a deep colors ation in a reporters asian we call that the action potential missed the same all neurons in so at than that action. Potentials conducted down the axe on. To what we call the accent add if polarize the terminals in those terminals release a chemical signal which goes across a gap called synapse and then acts on the next sell. It could be either excited tori or in the vittori effect. So what you have with a painful stimulus. Is you evoke a pattern of expectations in addition in a set of interconnected neurons and win that set of interconnected neurons fires in a certain way. You get the perception of pain. That's how it happens. Now as i said before how that gets converted from the objective chemical changes that we can measure to the subjective experience of pain. That's a complete mystery. So i can't tell you i can tell you what you need to make it happen. But i can't tell you how it happens. Yes so Intuitively this should have caused the benefits esther sort of helping homo sapiens wide. So to speak like the pain as a pain process. Do we know of any biological systems any animals who don't feel pain. yes well. This is a really great question. Kill can you guilt okay. So it turns out that There are animals that don't have nerves. Sponges that whole file them. They are animals but they don't have nerves and if you don't have nerves than you can't feel pain right The most primitive animals that have a nervous system are in the filing a nigerian and those like sea. anemones are nigerians They have they don't have a brain but they have a nerve net and they do two things they can rapidly respond to threats by escaping or they can rapidly respond to a food source by moving toward it. So those are the two things that can do. And and that illustrates the general principle. You can ask yourself well. What is the nervous system for. How does it help animals to have a nervous system. It helps them by allowing them to change rapidly and move rapidly in response to rapid changes in the environment that either threaten. Their survival are necessary for their survival. So animals need a source of food to survive all animals. It's almost the definition of animal plants. Don't need a source of food. They can make their own food from minerals and sunlight but animals need to find food and having a nervous system helps them move quickly to acquire it and if there's a threat of damage or destruction a predator for example they need to rapidly escape and respond to that in one way or another so in order for your sensory.
Scientific Sense
"neurology" Discussed on Scientific Sense
"Chemical pulses in the neurons that they use to communicate with other neurons. How does that activity translate into a subjective experience. That's completely mysterious and anti suggestion. Expedience is different for different people. That makes it a more complicated right. I don't know if i agree with that. it's it's hard to know what somebody else's subjective experiences so would re difficult to compare it in different people. That said what i do agree with is if you apply a given painful stimulus to different people they will report. Different levels of pain perhaps different qualities of paint. So it's true that there's a highly variable relationships between the tissue damaging stimulus and what different people report. That's for sure troop. Maybe that's what you were driving. Yeah that's what. I was driving outside a number this longtime ago Slicer company was something medications and obviously one of the difficulties in clinical trials in pain is to get a consistent with sponsors consistent said over sponsors from from the correct and this august measurement problem. That's obvious speed it difficult part right. Well you can you can constrain The situation individuals and they can be trained to give very reliable reports. And if you're using a thermal stimulus so you can accurately control the temperature. There's a fear elite reproducible relationship between the intensity of the stimulus and the numerical rating scale. So that you would use something like a zero to ten scale. Where zero is no pain. Ten is the worst pain you've ever seen. Few wrath forty forty three forty four degrees. Most people say yes. That's moderately painful. I'd give a five as you go up higher and higher however you know in the real world. It's very variable. You never predict what somebody's gonna tell you. say after. They've in like sprained ankle. Or even a broken bone The clinical situation is incredibly variable. So i want to go back to the mechanism And so You hit your leg against something Some sort of tissue damage happens on site and From dat site Information is sent to the frame right that that is the mechanism by which we know something bad as direct and at that point the brains converting that information into some. What exactly happens great. Yeah that's a good question. Well we know we know the physics and chemistry of it. We know how nerve cells work. We even know how they talk to each other right so every nerve cell pretty much is the same in the sense that it has what we call an action potential in action. Potential is a rapid in other words anywhere from.
Scientific Sense
"neurology" Discussed on Scientific Sense
"Welcome to the site of accents. Podcast where we.
The Essential Oil Revolution
Lifetime Longevity With Dr. Chalmers
"I'm here with dr matt. Chalmers who has specialties. And certifications in sports neurology nutrition and spinal decompression for disc damage. He's a holistic wellness concierge provider that specializes in bringing eastern and western medicine together to eliminate current issues and prevent future conditions. His book pillars of wellness is published as of this april. Congratulations on that dr chalmers. Welcome to the show. Thank you great to be here so dr travelers. You've you've come to take a bit of a different approach to health then many of your colleagues. Let's say what i love about your work. Is you really strive for bringing the highest quality of life as well as the longest quantity and you have this focus on looking for issues before they become too big to fix so. I'm just curious. How have you sort of come to this. Methodology this way of work You know compared to some of your some of the other doctors who may not take that same approach. We'll it's actually kind of a interesting story. It's a little bit of a selfish story. I was working on a guy who was early sixties And he just sold his company for twenty twenty two million dollars at the time. That was the biggest amount of money ever heard anybody making. And i thought oh my gosh i asked him. I said what are you gonna do. I would go to italy. There's this whole big world war. Two trail i would take and he has stopped. My knees hurt so bad. When i get to top of the stairs up to sit down and rest. He said when i walk my dog around the block. I've gotta sit and rest. I'm not going to italy there. Some restaurants i want some tv shows. I'm gonna catch up on. And so i thought to myself. This man is young. he's sixty. He's got twenty million dollars at least and his life is over. He's just going to sit there and do nothing. And you know whatever. And i thought that cannot be me.
The Rich Roll Podcast
Optimize Your Brain: Fighting Cognitive Decline With Nutrition & Lifestyle
"What is it about age or maybe neurology that makes people set in their ways as they get older. It is a weird thing right. It really is more difficult to entertain new ideas. I think it varies from person to person but in my experience just comfort you know when once you set a path in. You're comfortable with it. Your brain doesn't really allow you to change that math. It's like walking on a snow track. It's so deeply set in the walls or sol-solid that it's difficult for you to actually make a new pathogens and it requires a lot of reflection and judgment and being okay to make mistakes and the discomfort in being uncomfortable the comfort in being uncomfortable. They can help you set noise but it does seem like that becomes much more of a challenge. It does it does We the whole idea of change is not normal. I'm talking about chronic change acute chain. We're good at it because an acute change we had to for millions of years. There's a tree there's a lion you know. Better make change in my decision making. I'm not going to go down. This stop long-term change were not designed for that were not our brains are not designed for long term change. That's a completely different mechanism. And and if we and if we don't address that i mean to be honest i know that it's not be recalled. Our political stances. Everything is around this concept of being with change. I always say about. Five percent of population is future seekers. Another ninety five percent is passed protectors And you have to be pass protector in many ways because protection has worked. Whatever has gotten you here as you depending on the past patterns right but all the change in society in the world around us is by those five percent. Whatever i'm using arbitrary number that are comfortable. This is weird. People comfortable with change with the unknown. The three hundred sixty degrees of are known. You're willing to go there and yet this house. that's comfortable you're willing to leave it to go to the next place. That's an unusual concept Were which comes with the frontal lobe but but That's why as we get older. We become more set on all the strings that connects us to the past. You want us. To sever sever sever suffers to go to a new path. That is unknown at a time. Where i'm already vulnerable. Yeah that's too much risk. Yeah yeah is there a genetic piece to that when you look at that five percent can you isolate out what it is that distinguishes them neurologically from very early. You can tell there. There's a genetic component environmental component that genetic anxiety is at the core of all this stuff or term that is like anxiety we using anxiety as a just as a word. That's as filler. But it's a little more than that. Our ability to deal with the world around us for the most part for at the beginning is genetically you can see children. We have two children both trust me. We're gonna talk about them. But they're very precocious. Yeah incredibly but the understatement of the century go ahead make very different very different. Alex is what you could see when you when you I'm not putting him down. Because this is not a weakness this is just our proclivities. We can change you when you put him on the sand when he was six months. Old us som- do this. He hated sand. Sofi would crawl to the ocean. Having right away. I mean that's a threat. Why are you not threatened. By very thing you're supposed to be threatened by north right so that threat aversion versus not the river part of it is intrinsically ingrained in us part of it is actually data shows part of. It's actually program how your mother reacts to anxiety provoking moments mother because the is there all the time wherever you're around the most and how they react know how they promote challenging situations and anxiety provok- situation how they react with it and how they deal with it is the forget about leadership masters. I got a phd. Forget about that ends and starts there. Yeah you create situations that are a little bit anxiety provoking. You fail nothing. My parents didn't react badly. You succeed great how you react. And how does micro environments of threat version threat response. Threat creation and response is the foundation of all leadership. Yeah i would think from an environmental perspective or i mean an evolutionary perspective that You know maintaining your membership in good standing with your community is paramount right. So if that community is welcoming to people who pushed the boundaries and try new things. That's one thing but if that sort of thinking outside the box is gonna alienate you than You there's gonna be some pushback right there's a disincentive. That's that's butting up against somebody's willingness to entertain new ideas or try new things always an and the culture that's been set in place that creates an aversion to change the language the micro languages that anything that somebody brings that his little threatening to the status quo. You have things out. This is a this is arrogant. The word arrogant to push away. People who have new ideas is universe. It's it's such a ubiquitous silencing technique and When you look at when you look at the main reason why people are not willing to change his the fear of being ostracized like you said. Nobody wants to get out of that comfortable zone. Because it's really difficult to be alone in your way of life in your new methodology in your new habits and that's that's the first step that people have to challenge themselves to take over right given that though it's interesting that most environments are not really that permissive when it comes to free thinking and creative expression and most are pretty regimented around. What's okay and what's not but it would. It would seem like we should be more encouraging to that permissive environments. And why is that. Why are we not able to make that more. The case as opposed to you know the slim five percent or whatever it is. Yeah well we have ghanistan and with taliban around us yet. That same mentality exists here in the medical community and by the way this is me not bashing dramatic medical community like part of the only the medical community here to know about just their mentality. that's all know. But but the stagnant comfort with the status quo. Right is the same thing. I mean the hallways of your limbic system are the same You might have put it better clothes and better beards and you know my beard was a little better here than that but if the mentality is i must maintain it's not always over. I must maintain the status. And i don't know even why because it makes me uncomfortable. It's a satan. yeah. I mean to In two thousand two before we met two months earlier. I'm an experimental therapeutics branch. That's as wonky as as experimental as it gets speaking with nobel prize winners two months later. I'm in afghanistan. Speaking with taliban leaders. Both places trying to bring change. And i can promise you. The the the language was much more sophisticated But the blockades same protection of the status quo. That's why i mean when we talk about. Dementia we talk about stroke. We talk about mental health. Even now that repetition of the same patterns over and over again. I'm now some other. Studies are starting with clinical trial with hundred people. Fifty people six. We're done. We know what works.
Broken Brain with Dhru Purohit
Could This Simple Hack Reduce Anxiety and Panic Attacks? with Dr. Kristen Allott
"Dr analogy welcome to the broken brain podcast. It's an honor and a privilege to have you here. Thank you so much drew. I am so excited for this conversation. I think it'll be just fine Back and forth to share information. Yeah i love what. You're bringing to the world in this topic of anxiety and i think that we zoom out in the context of the current world even prior to cove nineteen pandemic anxiety. You could see that. The instances and usage of the word in just general language newspaper social media is skyrocketing and you know languages so powerful and sometimes we really have to parse apart a word to really understand like what do we really mean when we're saying that because sometimes we say anxiety and we actually could be meaning something else when you talk about this world of anxiety and your new book which we're going to get into in a little bit. What do you really want people to help understand. What exactly is anxiety. Yeah so i think that's a great question. And i will just tell you how i approach that When i started in practice about fifteen years ago Because i'm a naturopathic physician acupuncturist decided to specialize in mental health. And people were coming in. And saying i'm anxious and and i just didn't think it was like so. How does that apply. Physiology was really the question that i was interested in and because some for some people it's stress for some people. It's i'm afraid to move forward and take a step forward for some people. It's a i'm overwhelmed like there's all sorts you know. It's a catch word as you say. And but there's also a curious about what the physiology of depression or anxiety or whatever these words were saying. And and so i. When i started in practice i literally in my on my living room floor. I had stock physiology textbooks a stack of neurology. Textbooks and the dsm and the dsm is the diagnostic statistical manual. It just describes. What the diagnosis categories for anxiety are and i was just like will. I think it's more than just an emotion like a candy but like the people were coming in with panic. Attacks like that is not an emotion that is a full embodied experience right. And and so i started just parsing out like what are the. What are the fizzy. What physiology causes these physical symptoms of shaky and racing thoughts and your heart racine. And maybe you're sweating and and all those symptoms that you know sometimes it starts small and Escalates to really big asu started to parse that out and then was like well. Once once i started to understand the physiology in the neuro physiology will. Where do we. Where can we intervene to help. People feel better and so answering your questions kind of copying out. But it's like. That's that's the approach that i took because so many people were using words and i was like i want a grounded in something concrete. Absolutely i mean if we look at the history and evolution of just anxiety and a lot of mental health. A lot of these things in early medicine were considered to be They're kind of in your head right like nothing else is going on right. We made a documentary a few years ago. Which then led to the name of this podcast. Broken brain my business partner. Dear friend dr mark hyman. We made a documentary called broken brain and the underlying premise. That documentary was what you do to your body you do to your brain. Your brain is not in. This isolated eight oregon that just as floating on top of your head. That's completely disconnected than the rest of everything. That's going on there actually an intertwined system and we have to understand that yes there can be. Let's call for lack of a better term emotional factors that are there right. Stressor is the complete driver of so many different things that we feel but let's also look at the physiology of what's happening underneath so when it comes to that topic of anxiety and the physiology gonna ask you a question which is a question that i came across a few years ago in a book by peter thiel little bit of a controversial character. But i really love this question that he had inside of this book. I think the book is called zero to one and he said what truth do you believe is true that other people disagree with in that category. So when you look at right what do you believe is true when you think about anxiety and physiology that people maybe traditional western medicine will say like. I don't know if that's true. Yeah so The one truth. That i see time and time again is it is really hard to have a panic attack. If you just ate. And i don't see panic. Attacks occur unless people are five hours from food or more at or they may have eaten some really sugary substance to at two hours ago. But if you had a real meal. It is really hard to have a panic attack. That's powerful right. There and people like that is not true and and the same applies to suicidal Which is know just part of the spectrum of people keep doing doing panic attacks they can get there and and and and the reason for that is that are i mean i can go into the physiology but but people don't believe that until they start looking mental health professionals or physicians and then when they want start looking at the pattern it holds true. Now there's always an exception to the rule ways but it holds like ninety five percent true
Serial Killers
Killer Couple, Ray Fernandez And Martha Beck
"Based on his seemingly idyllic childhood raymond martinez fernandez's family never imagined what he would someday become born in hawaii in nineteen fourteen. Raymond spent his first three years there before relocating with his family to the seaport town of bridgeport connecticut. We don't know much about raymond's childhood. But by all indications he and his family lived a peaceful life at seventeen. Raymond moved to spain where he spent time working on his uncle's farm and fell in love with a local girl. The couple were married by nineteen thirty five when raymond was twenty and had four children together but raymond was restless. A young man with ambitions that didn't include raising a family and so by nineteen thirty nine. Raymond abandoned his wife and children and embarked on a military career during world war. Two raymond made a name for himself. Serving i in the spanish merchant marines and later the british intelligence service officials saw him as loyal and diligent noting that he carried out his difficult and dangerous duties. Well raymond had a bright future an after the war he decided it was time to seek his fortune back in america but the trip home was a fateful one onboard. The ship raymond suffered a terrible accident. A steel hatch fell directly onto his head fracturing his skull and causing damage to his frontal lobe when he recovered. Raymond was different. Vince is going to take over on the psychology here and throughout the episode. Please note vanessa is not a licensed psychologist or psychiatrist. But she has done a lot of research for this show. Thanks greg true crime fans. May well be familiar. With the body of evidence linking childhood head trauma to homicidal behavior later in life it specifically damage to the frontal lobe the area of the brain responsible for memory formation impulse control and even empathy that has been associated with violent crime but two thousand one overview in the journal of neurology. Neurosurgery psychiatry noted that the strongest evidence was foreign association between prefrontal lobe damage and quote an impulsive subtype of aggressive behavior. In other words the head trauma raymond suffered could have made him less cautious and more reckless raymond's reported personality change following the head trauma suggests that he may have suffered the kind of frontal lobe damage described in these studies and along with this shift in his nature. His career ambitions seemed to evaporate too soon after he was released from hospital in the us. Raymond was arrested for petty theft and sentenced to a year in prison. If the head injury had pushed him toward darkness his time behind bars was the straw. That broke the camel's back. Raymond cellmate was into the occult and only too happy to share his knowledge of voodoo and other black magic. Raymond saw this as an opportunity. He believed that he could use his new supernatural skill set to seduce women but his intentions were anything but romantic once a respected intelligence officer thirty one year old. Raymond was now a conman in the he emerged from prison in nineteen forty six with a fully formed him. Oh after moving to new york city. He wasted no time putting it into action. Raymond's plan was simple a nineteen forties ancestor of what we now might call cat fishing. He scoured personal ads in local newspapers looking for women who seemed lonely and vulnerable. He responded to their ads with charming thoughtful letters describing his military service and his deep desire to settle down. He reportedly started wearing a toupee. Which hit the conspicuous scar from his accident and made him just a little bit more handsome. After sweeping his target offer feet and gaining her trust raymond would steal money jewelry and anything else of value he could find before disappearing into the night most of raymond's victims realizing that they had been conned. Were likely to embarrassed to report him. Raymond knew this only too well in fact his scheme relied upon it. It was thanks to this sense of shame that he managed to go undetected for at least a year during which he conned and knowing number of women
Sounds of Science
A Father's Fight
"Spastic paraplegia fifty or spg. Fifty is a neurodegenerative disorder that progresses slowly from infancy patients experienced developmental delays specificity and paralysis in the lower and upper limbs and microcephaly among other symptoms. It's an autosomal recessive disorder. Which means that. The child inherits the disease causing genetic mutation from both parents. I'm joined today by terry. Pure volek s whose son. Michael was diagnosed. This ultra rare condition. Terry and his wife georgia founded the organization cure. Pg fifty in order to find gene therapy treatment for michael and all other children affected by this disease. He will tell us his family's story and give us an update on how research is going for his son. Welcome terry thank you so much for being here. We really appreciate being able to share your journey with you. So can you tell us about your family's journey with this disease. So on december seventeen two thousand seventeen michael. Our youngest son was born. It was pretty much uneventful. We went to the hospital mill the night. My wife said her you know her. Water broke our third child so we were prepared. We got there. The midwife is there and michael came out in pretty much like an hour and a half. We were home within three hours so it was. It was very quick. It was completely uneventful and he was a perfect little kid he was you know he was quiet. He was the perfect child. Around six months of age we noticed that he wasn't raising his hands and he wasn't following the milestones are other children. Were following in. My wife said know. Something's up so he brought him to the doctor in the noticed that his head was starting to fall off. The charter wasn't growing as expected. And he he had something called low muscle tone to that kind of fell into the odyssey of finding out what was wrong with him. And i think it's important to note here especially for any parents that have gone through this themselves. How agonizing this step can be especially when it turns out that it's this sort of rare disease. I imagine there were all kinds of tests and all kinds of doctors. Who were just telling you that. They didn't know what it was. And how heartbreaking. That can be for parents obviously are. I thought you know what he has. Low muscle tone as you know. It looks like he's head is smaller but don't worry about it. He'll he'll catch up. And then you know that kind of lasted three months and then we were like okay. Will he still not progressing therapies and he is improving but you know his head still isn't growing. What's going on so then we went to sick. It's hospital in toronto. And we went to infectious disease. Because i was traveling at the time to latin america and he thought maybe he adds zeka so we went down the path of siyavizy ca testing. And all the other infectious diseases. What you didn't have any of them obviously and then we moved into neurology. Team did an ira. And they found that they they saw few. You know things that were not normal but nothing major. And that's when they started doing you know the panel testing which came back all negative and then finally let. We were very lucky that they did the genetic testing and then on april second of of twenty nine thousand nine. He was diagnosed with this. You know terrible disease. And how did you find doctors that were able to tell you more information about this disease. We were really lucky. That won't april second. We were told to go home. Love michael that there was nothing really the can do for him that he will most likely be completely paralyzed with limited brain function and As parents we were absolutely devastated by drove home that night. And i honestly i don't remember how even got home. Allie member his crying on the street in the car. But we found a family 'cause we're hearing the paper. I don't know what happened. I think i lost it but denied the emailed us what the disease was in the diagnosis and we found a family that had spg forty seven out of boston and call them up that night in a panic and the as she walked us through the disease and and who are the specialists and they took care of us for the next two weeks while we mourned this significance piece of our lives. It was almost like a while. It is like a piece of our soul was taken away from us. That's a really amazingly lucky to be able to find a family and have them be so willing to help you out especially in those early days will not just not the lucky that there are. She already going in the path of gene therapy. So not only do they tell us what the disease prognosis was. But they were telling us what they were doing for their disease and for their gene therapy program and spg. Forty-seven is part of a protein complex called ap four and under that ap four there's four genes their ap for eight before and one s one g one and be one in ours was the same essence. We all have the same disease so we were very fortunate. Karachi went on that path and and and kind of guided us for the next two weeks on what we should be doing and we took it on and did it ourselves from
77WABC Radio
"neurology" Discussed on 77WABC Radio
"That's the official the omega three fatty acids. So we've been talking about this for a long time. Your brain is like a sponge that will suck up all sorts of things. Vitamins, minerals hormones glucose. And if the blood flow to the brain has been compromised, you're getting less of those things. If there's plaque in the blood vessels, you may be delivering less. If you're not absorbing nutrients that you're taking, which happens as everybody gets older. Or if you're not taking the right combinations of nutrients, your brain function will be affected. So this is a great study published in journal Neurology Curve You journal Talking about individual 65 years of age. And older, those that had the omega three fatty acids on board. 2 to 3 capsules a day had a significant Correlation with lower atrophy of the gray matter in the brain. They were measuring the fatty acid levels of baseline before taking supplements. Then while they were taking the sufferance and over the course of four years, so Pretty interesting to see that EPA can help slow kind of client. Now, of course, is I see a patient of cognitive decline. We're looking at all their vitamins. They're all important. Older minerals all the hormones because hormone decline the H E. A. Thyroid, testosterone. Estrogen progesterone idea if one all of these Are important for your body to function as you have in the past. So correction. There makes a great deal of sense. Heavy metals play a very direct role with damage of, nor logic and brain tissues. Of course you want to test the blood. And more so more importantly, the urine For having medals to see what your body storing and get them out of the system. For those individuals that have significant dysfunction. We also talk about doing stem cell therapy. Because that will significantly improve new cell. Development, new cell production, new cell existence and the tissues, including your brain. And that could help dramatically improve memory focus concentration. So important to look at all of these. Concerns. Once again from lines were open 1 804 8 w A. B C 1 804 89222 You can call now and ask a question We love to hear from you. Vitamin D supplementation may improve cardiovascular outcomes for patients that are on hemodialysis. Now, if a person's on hemodialysis, they obviously have a long term history. Progression of kidney decline. And the dialysis is taking out the waste products of metabolism. So that your body can function without that when your kidneys are not working. Your body doesn't survive so adding nutrients onboard is always important for patients on hemodialysis. You know, this is a study just looking at vitamin E helping with cardiovascular outcomes. The journal Nephrology Period of your journal. Important, understand that even just a vitamin E could help to protect your heart and decrease cardiac decline. What if we talk about cookie 10? Vitamin C All the B vitamins lowering homocysteine Lawrence C reactive protein pulling out heavy metals. So That's how I look at the studies. It's another great Adam. To the comprehensive approach. That I talk about. So looking at each of these studies and then putting them all together. Can give you far greater benefit and, of course for those people that have declined organ decline. Once again we talked about doing stem cell therapy. So there are many people who are Exhibiting or experiencing decline in organs don't really feel that different. One of the conversations I have with patients every day. Is that behind the scenes, we're losing cells as we age. So visibly and functionally we're changing because we're not making new cells. As we did when we were younger number one. Number two outside. Issues or agents. Heavy metals, of course, can damage our tissues and make it harder to make hormones and cause cellular decline. So there are things that you don't realize that you don't see you don't feel that are causing the change. That's why we look, it. Someone get from parameters of function. In your blood test. That's why we'll correct vitamins will get people to eat right exercise correct hormones and then retest those things. Well, look to see if we see improvement in other secondary markers. So if you're B vitamins are low and home assistance, Hi, and that's gonna cause plaque or this already causing plaque. As we correct your vitamin levels rechecked those levels rechecked the homocysteine to see that it's down. You also do circulatory testing looking at for plaque in your head, your neck, your heart, your legs. Abdominal Vessels. Because you want to make sure that you don't already have existing plaque that would create Much more risk of more of a problem. Okay. Phone lines are open. 1 808 for eight W A. B. C. Let's go. Our first caller. It's Elena in Carmel. How are you? High doctor's caliphate. I'm fine. And thanks for taking my call. You want him quite a bit and I've done suddenly starts as you suggested. You know, in terms of the floor, the Forbes off Already. Yeah, well, anyway, I'm hoping that they don't mandate a vaccine on the rough. Well, what? What Recourse do we have other anything? Don't know. All right. I don't know. They're different companies, you know, producing vaccine so there may be other companies after Senate comma Derma. Besides visor, but you have to really look at the science. Yeah. What happened? So only time and research, which has been skipped, apparently. I don't think there have been studies on animals over. Ah, you're too with the vaccines that are coming out. So we don't really know what to expect. That's why I want people to research. I want people to look a lot of people that I understand. Look at literature from other countries. Look at what's going on to see if that's something that you want to do. Well, e don't want to do it. But if they mandated what recourse do we have? I don't think you have much recourse it all What do you mean? What recourse is there? If it's a man date where you can fly, you can put your kids in school. I can't whatever. I don't know what recourse you would have. Like, you know, Right now there is a system in place that is forcing people to do things and I think this you know, changing in our liberty and changes in our freedom are already happening. Behind the scenes, etcetera, So you know You have to be diligent..
Scientific Sense
Dr. Mark Hoffman, Research Associate Professor at the University of Missouri, Kansas City - burst 01
"Welcome to the site of accents podcast. Where we explore emerging ideas from signs, policy economics, and technology. My name is Gill eappen. We talk with woods leading academics and experts about the recent research or generally of topical interest. Scientific senses at unstructured conversation with no agenda or preparation. Be Color a wide variety of domains red new discoveries are made. and New Technologies are developed on a daily basis. The most interested in how new Ideas Affect Society? And, help educate the world how to pursue rewarding and enjoyable life rooted in signs logic at inflammation. V seek knowledge without boundaries or constraints and provide unaided content of conversations bit researchers and leaders who low what they do. A companion blog to this podcast can be found at scientific sense dot com. And displayed guest is available on over a dozen platforms and directly at scientific sense. Dot? Net. If you have suggestions for topics, guests at other ideas. Please send up to info at scientific sense dot com. And I can be reached at Gil at eappen Dot Info. Mike yesterday's Dr Mark Hoffman, who is a research associate professor in the University of Minnesota Against City. He is also chief research inflammation officer in the children's Mussa hospital in Kansas City. Kiss research interests include health data delayed indication sharing initialisation Boca Mark. Thank you for inviting me. Absolutely. So I start with one of your papers Kato you need the use by our system implementation in defy date data resource from hundred known athlete off my seasons. So Michio inflicted. Data aggregated for marketable sources provide an important resource for my medical research including digital feel typing. On. Like. Todd beat to from a single organization. Guitar data introduces a number of analysis challengers. So. So you've worked with some augmentation log and in almost all cases be used. Data coming from that single macy's listen primary care behavioral. Or specialty hospitals and I always wondered you know wouldn't be nice. Get a data set. That sort of abrogates data from the radio on-ice. Asians but a lot of different challenges around that. So you wanted to talk a bit about that. I'd be happy to the resource that we've worked with. Is primarily a called health fax data resource. It's been in operation for almost twenty years. And the the the model is that organizations who are. Using these Turner Electronic. Health. Record. Enter into an agreement was turner they agreed to provide data rights to sern are. The identifies the date of affords aggregated into this resource. And certner provides data mapping, which is really critical to this type of work. It also the aggregate the data. And for the past probably six years. Then, they provide the full data set to especially academic contributors who want to do research with that resource. And I've been on both sides of that equation Lead that group during my career there, and then now I have the opportunity to really focus research on that type of data. So before we get into the details smog so e Itar Systems. So this is. Essentially patient records. So he gets dated like demographics out family history, surgical history hats, medications, lab solves it could have physician nodes no snow. So it's it's a combination of a variety of different types of data, right? A couple of things on the examples you gave it includes demographics. Discreet Laboratory results Medication orders. Many vitals so If access the blood pressure and pulse data. It does not include text notes because those can't be. Automatically identified consistently. So. We don't have access currently to TEX notes. Out of an abundance of caution. That his Hobby Stephen, physician writes something down they could use names they could use inflammation that could then point back to their. Patients Makita Perspective been the data's aggregated, the primary issue shoe that date has completely the identified, right? Correct. So. So yeah. So the data that we receive there's eighteen identifiers. Hip requires be removed from data. And those include obvious things like name address email addresses are another example One of the. Things. That is also part of the benefit of working with this particular resource. The. Dates of clinical service are not allowed to be provided under hip. White is done with this resource that allows us to still have a longitudinal view is. For any given patient in the data set the dates are shifted by A. Consistent. Pattern that for any given patient it can be. One two three four five weeks forward or one, two, three, four or five weeks backward. But that preserves things like day of the week effect. So for example, you see -nificant increase in emergency department encounters over weekends and you don't WanNa lose. Visibility to that. but it also allows us to receive. Very, granular early time stamped events in so. We can gain visibility into the time that a blood specimen was collected, and then the time that the result was reported back. And so we're able to do very detailed analyses with this type of resource. Right right and I don't know the audience our market is fragmented. Tau himself e Amorebieta providers out there. and so two issues. One is sort of. Standardization as to how these databases are designed and structured and others even that standardization that the actual collection of the data. In itself is not standardized played. So vk CAV vk potentially lot inability coming from different systems. Correct and that's part of what the paper that you mentioned Evaluates so. Often, night you out in the field in conferences you hear. Comparisons kind of lumping all organizations using one. Vendor lumping all using another together but as you get closer to it, you quickly learn that. It's not even clear. It's within those. Vendor markets. There's variation from organization to organization in how they use the e Hr and so. Because the identities of the. Contributing organizations are blinded to those of us who work with the data. We have to be creative about how we. Infer those implementation details, and so with this paper, we describe a couple of methods that We think move things forward towards that goal. Yes. So I'm not really familiar with that. So you mentioned a couple of things here. One is the the merge network. So this initiative including electric medical records and genomics network and pc off net the national patient, centered clinical research network support. Decentralized analyses that goes disparate systems by distributing standardized quotas to site. So this is a situation where you have multiple systems sort of. Communicating with each other and this net folks at allowing to sort of quickly them In some standardized fashion. So In this type of technology, there's janitorial core models. One is the. Federated or distributed model, the other is a centralized data aggregation. So there are examples including those that are mentioned in the paper where. Queries are pushed to the organization and. They need to do significant work upfront to ensure that there are standardizing their terminologies the same way. And once they do that upfront work than they're able to perform the types of queries that are distributed through those. Federated Networks. With. Okay. So that just one click on so that the police have standardized. So all on the at Josh site, then they have like some sort of a plan slater from from Stan Day squatty do all the data structure. And in many cases, they work through an intermediate technology. that would be. In general, consider it like a data warehouse. And so the queries are running against the production electric. Health record. That has all kinds of implications on patient care where you don't want to slow down performance. By using these intermediaries They can receive queries and then Follow that mapping has occurred. Than, they're able to to run those distributed queries. Okay. And the other model is You know. You say the g through the medical quality, improvement consortium and sooner to the health facts initiative. So this says in Sodas case, for example, in swags. This is essentially picking up data from the right deals, clients and Dan standardizing and centralizing data in a single database is that that is correct. One benefit of that model is that Organizations who for example, may not be academic and don't have the. Resources to do that data mapping themselves by handing out over that task over to the vendor you get a broader diversity of the types of organizations so you can have. A safety net hospitals you can have. Critical access rural hospitals, and other venues of care that are probably under represented in some of those. More academically driven models. And clearly the focus on healthcare about I would imagine applications in pharmaceutical out indeed to right I. Don't know if it s use and bad direction there has been some were performed with these data resources to. Characterize different aspects of medications, and so it does have utility in value. In a variety of. Analytical contexts. I was thinking about you know a lot of randomized clinical trials going on into Kuwait context and One of the issues of dispatch seem development toils that are going on that one could argue the population there are not really well to percents. it may be number by Auditees, men, people that deputy existing conditions. and. So he will serve at my come out of facedly trial. granted might work for the population. Tried it minority have sufficient? more largely. So I wanted this type of well I guess we don't really have an ID there right. So clearly, you don't know who these people are but they could be some clustering type analysis that might be interesting weight from It's very useful for Health Services Research and for outcomes research for you know what I characterize digital phenotype being. they can then guide. More, more formal research. you know you can use this type of resource to. Make sure. You're asking a useful question and make sure that there's likely to be. Enough patients who qualify for given study. Maybe you're working on a clinical trial in your casting your net to narrow you can. Determine that with this type of data resource. And is the eight tiff date who has access to it typically. So for this data resource on, it's through the vendor so. You need to have some level of footprint with them. which is the case with our organization. They're definitely a broadening their strategies. So they're. Gaining access into health systems that aren't exclusively using their electronic health records so. It's exciting to be a part of that that process. and to again work with them to. Analyze the data. I think. To the example you gave a formal randomized trials. In key part of what were growing our research to focus on is because this is real world data. You learn what's happening in practice whether or not it's well aligned with guidelines or formal protocols. And doing that there's many opportunities for near-term interventions that can improve health outcomes simply by. Identifying where providers may be deviating more from. Best Practices in than taking steps through training and education to kind of get them back towards those best practices. This data is a fresh on a daily basis. It's not. It's because it's so large and bulky? Typically we've received it on a quarterly basis in since it's retrospective analysis that's not been a major barrier. But. mechanistically, on onto soon aside is data getting sort of picked up from this system that it's harvested every day and then it's aggregated bundled and distributed on A. On a different timescale. Okay okay. So. From again, going to the, it's our system designed issue and implementation You say many HR systems comprised of more news at specific clinical processes or unit such as Pharmacy Laboratory or surgery talked about that. But then then people implement them this of fashion right they they implement modules by that can be a factor or sometimes they may want. One vendor for their primary electronic health record, but another vendor for their laboratory system. and so that's where you don't see a hundred percent usage of every module and every organization. And detailed number of different you know sort of noise creating issues in data one. This is icy speech over from ICT denied ten. and I don't know history of this but this was supposed to be speech with sometime in twenty fifteen. That's correct. So there is A. You know. There's a date in October of Twenty fifteen where most organizations were expected to have completed that transition. When I see with researchers who aren't as familiar with the you know the whole policy landscape around `electronic health records that? you can imagine researchers who assumed that all data before that date in October is is nine and all data after that date would be icy the ten. While we demonstrate in this paper, is that that transition was not Nearly, that clean and it was a much more, you know there are some organizations who just It the bullet and completed in twenty fourteen, and there are other organizations that were still lagging. In. Two Thousand Sixteen. Potentially because they weren't as exposed to those incentives in other things that you know stipulated the transition so. Part of why were demonstrating with that particular part of that work was that. you know these transitions aren't always abrupt. Yeah and and and so that is one issue and then you know a lot of consistency inconsistency issues fade. So we see that in in single systems and one of the items note here as you know if you think about the disposition code for death. you could have a right your race supercenter, right? It's a death expire expedite at home hospice, and so on. if this is a problem for a single system, but then many think about aggregating data from multiple sources this this problem sort of increased exponentially. Absolutely. So one of the challenges with documenting and and finding where you know if a patient has A deceased that. There's just multiple places to put that documentation in the clinical record. The Location in the record that. We have found to be the most consistent is what's called discharge disposition. By as we show in that analysis, that field is not always used document that and so if you're doing outcomes research and one of your key. Outcome metrics is death. And there are organizations that. Aren't documenting death in a place that successful. You should filter those out of your analysis before moving forward. And so part of what we wanted to promote is the realization that. That's the type of consideration that needs to be made The four. Publishing. Your data about an outcome metrics like death that. You're not. If you're never gonNA see that outcome it doesn't mean that people are. Dying in that particular facility, it just means it's not documented in the place that successful. Right. Yeah. So you know you on your expedience. Unique Position Mark because you you look at it from the from the vendor's perspective you're in an academic setting you're also in practice in a hospital. What's your sense of these things improving the on a track of getting getting this more standardize or it's camping in the other direction I think in general there is improvement I think The. Over the past eleven years through various federal mandates, including meaningful use and so forth. Those of all incentive organizations to utilize. Standard terminologies more consistently than was the case beforehand. I think there's still plenty of room for improvement and You know it's it's a journey, not a destination, but I think things have improved substantially. I was wondering there could be some applications of artificial intelligence here to In a clearly TATECO systems and you'd like the most them pity human resource intensive Yvonne to get it completely right. So one question would be you know, could be actually used a Dick needs to get it maybe ninety nine percent white. And that the human deal with exceptions I definitely think that that's an exciting direction that You want those a algorithms to be trained with good data, and that's a big part of what's motivated us to. Put this focus on data quality and Understanding these strange nuances that are underpinning that date has so that. As we move towards a in machine learning and so forth. We have a high level of confidence in the data that's training those algorithms. Right. Yeah. I think that a huge opportunity here because it's not quite as broad as NFL, not natural language processing it is somewhat constrained. that is a good part of it. The back part of it is that is highly technical. and so. you know some of the techniques you know you can have a fault tolerance in certain dimensions such as you know, misspellings lack of gambling and things like that. But as you have Heidi technical data, you cannot apply those principles because he could have misspelling the system may not be able to. Get, sometimes, and that's where you know I think. It's totally feasible to use. Resources to you know when you're dealing with. Tens of millions of patients and billions of detailed records. Using a I'd even identify those patterns of either. Inconsistent data or missing data it's also very powerful just to. kind of flag in identified. Areas that need to be focused on to lead to a better analysis. Greg Wait Be Hefty. Use that information somehow did is a belt of information that you know and so it just filtering into decision processes that the are really losing it. So hopefully getting improving in that dimension I've jumping to another paper bittersweet interesting. So it's entitled rates and predictors of using opioids in the Emergency Department Katrina Treat Mike Dean in Young Otto's and so so this is sort of a machine learning exercise you have gone through to locate you know coup is getting prescribed. OPIOIDS water the conditions for the Democrat not Nestle demographics but different different maybe age and things like that gender. and and then ask the question desert has some effect on addiction. In the long term rights. So that project To great example of team science though. We. Assembled a team of subject matter experts in neurology pain management. And Data Science and. The neurologist and pain management experts. Identified an intriguing question that we decided to pursue with data. In their question was. Based on anecdotal observation and so we thought it'd be interesting to see how well the data supported that. Observation is that. for youth and young adults Treated or admitted into the emergency. Department. With a migraine headache that. All too often they were treated with an opioid. And so we Use the same day to resource that we were discussing earlier. To explore that. Question. And using data from a hundred and eighty distinct emergency departments. We found that on average twenty, three percent of those youth and young adults were treated with. An opioid medication while they were in the emergency department. In general, it should be almost zero percent in general. There's really Better medications to us, four people presenting with a migraine. and. So this fits into obviously the OPIOID crisis it. it demonstrates the. Scenario describing that. You know using real world data. You can identify patterns of clinical behavior that. Don't match guideline. And the good news is that the? correctable and so through. Training and communication there's great opportunity to. To, manage this. Really. Striking. So fifteen thousand or so inevitably the encounters. And nearly a quarter of this encounters you say involved inoculate. and these are not just Misha and Congress right. It is not filtered down to migraine encounters. Okay. Okay. So these fifteen thousand just might in encounters might vein being repeating disease So once you. If you make a statement and. This or not Easter conditioning issue here. So you get your pain, you go to an emergency department and you get treated with an opioid you get quick tactical relief. From pain. auditing condition expect that in the next episode. So you can say we didn't pursue that particular question, but that is Definitely key part of. Managing the OPIOID crisis is that drug seeking behavior and so Part of our goal was to quantify that and use this as an opportunity to educate providers that. You really shouldn't be treating migraines with an opioid in there are better alternatives and. So we we felt that this was an important contribution to that national dialogue, but we didn't specifically pursue the question of whether the patients we analyzed. Within. Encounter show up Subsequently. With the same symptoms. Right right. Yeah you it develop into period when problematic patterns of drug use comedy. FEST MERGE THE PREVALENCE RATE OF OPIOID misuse estimated to be two to four percent and debts in each goofy just young adult drew from overdoses are rising. and. You say that literally prescribe IOS has been slumping loose future opioid misuse by thirty three percent. Betas Mehta say really huge number. I think just validates the importance of this of this work. Interesting mark. I don't know you exploded on data. Last the question if you look at the aggregate data, it'd be flying opioid. Misuse. what percentage of the total number. Actually started from. You know some sort of medical encounter has mike or some sort of. related encounter that could be completed otherwise was three a bit opioid. in that encounter documented resulted in that misuse. So what so If you look at the active misuse problem that we have today. do you have a sense of what percentage of that goal is actually started I? Think the exciting thing about this type of research is for everyone questioned that you pursue you have. You have ten new that you can pursue. We haven't. Delved into that specific area, but it's It's very ripe for further analysis and A considerable part of where I end my colleagues and our time as. We do this type of work to get an initial analysis published. And then You know in my leadership role I just WANNA. support people like my colleagues on this paper Mark Connelly Jennifer Bickel. in in using data to. Support their research into identify those follow. I mean, he tests policy implications. So it's sweet important work. and. If you find it direct relationship here than you have to ask you know from from a medical perspective what is right intervention? maybe is not just added of care just best practice but clearly should be the bay You know things should be looked at you say you're American Academy of Neurology has included avoidance of using opioid to treat gain one of stop top flight choosing wisely recommendations. For high-value duck in this gives Really evidence to to support that. The other thing that's really intriguing is this level of variation from site to site in. Some Sun facilities are very much aligned with the guidelines. Others are at the you know well, above twenty three percent. And that gives an opportunity for a really precision. conversations about you know, where does our organization stand on that spectrum? Yeah that's a that's an interesting avenue to right. So you know one could ask he says some sort of push sliced Intervention if we can fly goal of patients who who had gone an opioid sexually don't have an addiction problem. that as you know Anna, the kofoed does. if you can fly those type of patterns than you can think about. A customized within electronic health record systems. There's. The ability to provide decisions poor. There's certainly phenomena called pop up fatigue were physicians. You know they don't like having so many pop up windows but at the same time. It's Within the capability of an e e Hr to do that if then logic if patient has. migraine medication order equals opioid. encourage the provider to pause and reconsider that. Right, right and so this is supervised machine learning type analysis where so you have. you have number features that comes directly from each else. So each sex race ethnicity. insurance type. Encounter prostate suggest duration. time of the year and so on. and you have labeled data in this case I guess you have able tater because you would know if op- inscribed on trade. Okay and so are the two questions here. One is to ask the question given a new patient and those features. you could assign a probability that that patient will be prescribed will. Definitely. Impress the data from that predictive Minds. Right and then can you so that data definitely tell you if the patient is going to progress into some sort of an addiction issue. So. Earn Predicting Substance Abuse. So. Yeah. Yeah. Yeah. There's additional diagnosis codes that document. whether a patient has a history of substance abuse disorder. and. So it would be feasible to. Identify the with those diagnosis codes in than really look at their prior history. Of What other conditions were they treated for? What medications were they give in? to develop that model. One of the things in this case that helped with this study is that just in general, it's not advised get. So there are other things that are much more of a gray area. Or whether opioid is as useful, but in this case. The really not. Considered. To be helpful for migraines compared to other options and so that help us have a fairly clear cut scenario to do this work. Yeah. This this won't be the data like you say once you do something like this, you have been other things you could. You could stop asking. So unquestioned that that been to my mind as you know, how did they hugged the actually prescribing opioids? Is it the patient asking for it all so? Off that was another scoping thing with this project is focused on what happens within the emergency. Room. So it's it's. Really, medication order in administration that happens. In that emergency room setting. Whether or not the patient. was. Requesting that you know if they came in and said, this has worked for me before. Can I have it again? we don't have visibility to that. Right. Right. And so from a practical perspective So the the analysis that you did slightly ended up with the Family Clyde power we think it is. Compelling. Pretty compelling. So as as a new patient gets into e D either high. and what I mean by that probably is if there is a history of substance abuse property. the physician has really think twice about. The use of may be the well, and in this case, even without that history. Just because it's not considered to be an effective treatment. You know encouraging them to pause in that decision making. In this particular case is as effective as wall. Right. So looking forward. In if you think about both of these issues, one is the data quality data aggregation data standardized recent problem in the the right of Utah Systems have did that the talked about? And then if we can get to a level that we can look at cross a large data set. Beacon, ask. More. US specific questions, treatment. Optimum treatment type questions. subpoenaed. US The mark big think B be hunting. Certainly, the volume and variety of data that we're able to work with will be even greater I, think the. Opportunity To. Look, holistically at how upstream data capture. Effects Downstream data. Analysis. example I frequently give is if we have a Aggregate Data said we identify. Ten patients whose way in that data such shows up as being. Something that's completely infeasible. let's say they're documented is being. Fifty year old person who weighs two pounds. Clearly air. What's important is? Creating the process to communicate that back upstream. Because that clinical decision. Support. Many drug dosing things are evaluated using weight based logic and so. That same logic that's Evaluating the appropriateness of dosage. It's going to be running against an incorrect value in that may or may not always be visible. So I really am intrigued with that holistic opportunity. In it I am I remain just we have three or four additional papers coming out. About other examples where Provider behaviors not aligned with Best Practices and I'm just excited about you know when you compare that to how long it takes to develop a new drug or how long it takes to. To a really long term research. This research has the opportunity for a pretty quick turnaround on an effective intervention. A really that. Other so much that right. Providers. been taught in a no, but they're. Not always using that in practice and so to help them. Identify, those topics in just modifying behaviors is. In the scheme of things, it's a very straightforward way to improve. So. You know the entire spectrum from essentially getting the data. Right or cleaner like you know Missa mischaracterized or miss input data like wait or something like that. To to get. Better diagnosis better treatment modalities. policies there and from a femme perspective clearly inflammation therefore clinical trials. I was even thinking about drug interaction type. Inflammation. I haven't been involved in the former de for awhile but. Typically, this type of data doesn't get back into automatic processes that fast but I think that is all I know there's strong interest in Pharma in. Working with this type of data there a again looking at real world behavior. This is an excellent resource for off label medication use at. you know where Pharma's Always interested in repurposing existing medications the. Regulatory Processes, much more straightforward for that because the safety is already been. Evaluated and so. The. Significant Opportunity With this, there's also just exciting. Patterns of you know. What are those unrecognised correlations? That's where the machine learning opportunities are really exciting where. You know we're not always asking the right question. And the data can show us what we should be. Yeah exactly. So if the machine a sort of red flags something or create hypotheses. that Cubans have missed sometimes, those types of things are extremely powerful. because maybe that sometimes it's countering tutor. and so we all look at data with an Incan bias. The beauty of machines that at least on the surface began deploy Michigan. This volume of data. Techniques like machine deep learning can recognize those subtle but consistent associations. Wait quite. Excellent. Idea this has been great mark Thanks so much time with me. I enjoyed it very much. Thank you. But
Scientific Sense
Dr. Mark Hoffman, Research Associate Professor at the University of Missouri, Kansas City - burst 01
"Welcome to the site of accents podcast. Where we explore emerging ideas from signs, policy economics, and technology. My name is Gill eappen. We talk with woods leading academics and experts about the recent research or generally of topical interest. Scientific senses at unstructured conversation with no agenda or preparation. Be Color a wide variety of domains red new discoveries are made. and New Technologies are developed on a daily basis. The most interested in how new Ideas Affect Society? And, help educate the world how to pursue rewarding and enjoyable life rooted in signs logic at inflammation. V seek knowledge without boundaries or constraints and provide unaided content of conversations bit researchers and leaders who low what they do. A companion blog to this podcast can be found at scientific sense dot com. And displayed guest is available on over a dozen platforms and directly at scientific sense. Dot? Net. If you have suggestions for topics, guests at other ideas. Please send up to info at scientific sense dot com. And I can be reached at Gil at eappen Dot Info. Mike yesterday's Dr Mark Hoffman, who is a research associate professor in the University of Minnesota Against City. He is also chief research inflammation officer in the children's Mussa hospital in Kansas City. Kiss research interests include health data delayed indication sharing initialisation Boca Mark. Thank you for inviting me. Absolutely. So I start with one of your papers Kato you need the use by our system implementation in defy date data resource from hundred known athlete off my seasons. So Michio inflicted. Data aggregated for marketable sources provide an important resource for my medical research including digital feel typing. On. Like. Todd beat to from a single organization. Guitar data introduces a number of analysis challengers. So. So you've worked with some augmentation log and in almost all cases be used. Data coming from that single macy's listen primary care behavioral. Or specialty hospitals and I always wondered you know wouldn't be nice. Get a data set. That sort of abrogates data from the radio on-ice. Asians but a lot of different challenges around that. So you wanted to talk a bit about that. I'd be happy to the resource that we've worked with. Is primarily a called health fax data resource. It's been in operation for almost twenty years. And the the the model is that organizations who are. Using these Turner Electronic. Health. Record. Enter into an agreement was turner they agreed to provide data rights to sern are. The identifies the date of affords aggregated into this resource. And certner provides data mapping, which is really critical to this type of work. It also the aggregate the data. And for the past probably six years. Then, they provide the full data set to especially academic contributors who want to do research with that resource. And I've been on both sides of that equation Lead that group during my career there, and then now I have the opportunity to really focus research on that type of data. So before we get into the details smog so e Itar Systems. So this is. Essentially patient records. So he gets dated like demographics out family history, surgical history hats, medications, lab solves it could have physician nodes no snow. So it's it's a combination of a variety of different types of data, right? A couple of things on the examples you gave it includes demographics. Discreet Laboratory results Medication orders. Many vitals so If access the blood pressure and pulse data. It does not include text notes because those can't be. Automatically identified consistently. So. We don't have access currently to TEX notes. Out of an abundance of caution. That his Hobby Stephen, physician writes something down they could use names they could use inflammation that could then point back to their. Patients Makita Perspective been the data's aggregated, the primary issue shoe that date has completely the identified, right? Correct. So. So yeah. So the data that we receive there's eighteen identifiers. Hip requires be removed from data. And those include obvious things like name address email addresses are another example One of the. Things. That is also part of the benefit of working with this particular resource. The. Dates of clinical service are not allowed to be provided under hip. White is done with this resource that allows us to still have a longitudinal view is. For any given patient in the data set the dates are shifted by A. Consistent. Pattern that for any given patient it can be. One two three four five weeks forward or one, two, three, four or five weeks backward. But that preserves things like day of the week effect. So for example, you see -nificant increase in emergency department encounters over weekends and you don't WanNa lose. Visibility to that. but it also allows us to receive. Very, granular early time stamped events in so. We can gain visibility into the time that a blood specimen was collected, and then the time that the result was reported back. And so we're able to do very detailed analyses with this type of resource. Right right and I don't know the audience our market is fragmented. Tau himself e Amorebieta providers out there. and so two issues. One is sort of. Standardization as to how these databases are designed and structured and others even that standardization that the actual collection of the data. In itself is not standardized played. So vk CAV vk potentially lot inability coming from different systems. Correct and that's part of what the paper that you mentioned Evaluates so. Often, night you out in the field in conferences you hear. Comparisons kind of lumping all organizations using one. Vendor lumping all using another together but as you get closer to it, you quickly learn that. It's not even clear. It's within those. Vendor markets. There's variation from organization to organization in how they use the e Hr and so. Because the identities of the. Contributing organizations are blinded to those of us who work with the data. We have to be creative about how we. Infer those implementation details, and so with this paper, we describe a couple of methods that We think move things forward towards that goal. Yes. So I'm not really familiar with that. So you mentioned a couple of things here. One is the the merge network. So this initiative including electric medical records and genomics network and pc off net the national patient, centered clinical research network support. Decentralized analyses that goes disparate systems by distributing standardized quotas to site. So this is a situation where you have multiple systems sort of. Communicating with each other and this net folks at allowing to sort of quickly them In some standardized fashion. So In this type of technology, there's janitorial core models. One is the. Federated or distributed model, the other is a centralized data aggregation. So there are examples including those that are mentioned in the paper where. Queries are pushed to the organization and. They need to do significant work upfront to ensure that there are standardizing their terminologies the same way. And once they do that upfront work than they're able to perform the types of queries that are distributed through those. Federated Networks. With. Okay. So that just one click on so that the police have standardized. So all on the at Josh site, then they have like some sort of a plan slater from from Stan Day squatty do all the data structure. And in many cases, they work through an intermediate technology. that would be. In general, consider it like a data warehouse. And so the queries are running against the production electric. Health record. That has all kinds of implications on patient care where you don't want to slow down performance. By using these intermediaries They can receive queries and then Follow that mapping has occurred. Than, they're able to to run those distributed queries. Okay. And the other model is You know. You say the g through the medical quality, improvement consortium and sooner to the health facts initiative. So this says in Sodas case, for example, in swags. This is essentially picking up data from the right deals, clients and Dan standardizing and centralizing data in a single database is that that is correct. One benefit of that model is that Organizations who for example, may not be academic and don't have the. Resources to do that data mapping themselves by handing out over that task over to the vendor you get a broader diversity of the types of organizations so you can have. A safety net hospitals you can have. Critical access rural hospitals, and other venues of care that are probably under represented in some of those. More academically driven models. And clearly the focus on healthcare about I would imagine applications in pharmaceutical out indeed to right I. Don't know if it s use and bad direction there has been some were performed with these data resources to. Characterize different aspects of medications, and so it does have utility in value. In a variety of. Analytical contexts. I was thinking about you know a lot of randomized clinical trials going on into Kuwait context and One of the issues of dispatch seem development toils that are going on that one could argue the population there are not really well to percents. it may be number by Auditees, men, people that deputy existing conditions. and. So he will serve at my come out of facedly trial. granted might work for the population. Tried it minority have sufficient? more largely. So I wanted this type of well I guess we don't really have an ID there right. So clearly, you don't know who these people are but they could be some clustering type analysis that might be interesting weight from It's very useful for Health Services Research and for outcomes research for you know what I characterize digital phenotype being. they can then guide. More, more formal research. you know you can use this type of resource to. Make sure. You're asking a useful question and make sure that there's likely to be. Enough patients who qualify for given study. Maybe you're working on a clinical trial in your casting your net to narrow you can. Determine that with this type of data resource. And is the eight tiff date who has access to it typically. So for this data resource on, it's through the vendor so. You need to have some level of footprint with them. which is the case with our organization. They're definitely a broadening their strategies. So they're. Gaining access into health systems that aren't exclusively using their electronic health records so. It's exciting to be a part of that that process. and to again work with them to. Analyze the data. I think. To the example you gave a formal randomized trials. In key part of what were growing our research to focus on is because this is real world data. You learn what's happening in practice whether or not it's well aligned with guidelines or formal protocols. And doing that there's many opportunities for near-term interventions that can improve health outcomes simply by. Identifying where providers may be deviating more from. Best Practices in than taking steps through training and education to kind of get them back towards those best practices. This data is a fresh on a daily basis. It's not. It's because it's so large and bulky? Typically we've received it on a quarterly basis in since it's retrospective analysis that's not been a major barrier. But. mechanistically, on onto soon aside is data getting sort of picked up from this system that it's harvested every day and then it's aggregated bundled and distributed on A. On a different timescale. Okay okay. So. From again, going to the, it's our system designed issue and implementation You say many HR systems comprised of more news at specific clinical processes or unit such as Pharmacy Laboratory or surgery talked about that. But then then people implement them this of fashion right they they implement modules by that can be a factor or sometimes they may want. One vendor for their primary electronic health record, but another vendor for their laboratory system. and so that's where you don't see a hundred percent usage of every module and every organization. And detailed number of different you know sort of noise creating issues in data one. This is icy speech over from ICT denied ten. and I don't know history of this but this was supposed to be speech with sometime in twenty fifteen. That's correct. So there is A. You know. There's a date in October of Twenty fifteen where most organizations were expected to have completed that transition. When I see with researchers who aren't as familiar with the you know the whole policy landscape around `electronic health records that? you can imagine researchers who assumed that all data before that date in October is is nine and all data after that date would be icy the ten. While we demonstrate in this paper, is that that transition was not Nearly, that clean and it was a much more, you know there are some organizations who just It the bullet and completed in twenty fourteen, and there are other organizations that were still lagging. In. Two Thousand Sixteen. Potentially because they weren't as exposed to those incentives in other things that you know stipulated the transition so. Part of why were demonstrating with that particular part of that work was that. you know these transitions aren't always abrupt. Yeah and and and so that is one issue and then you know a lot of consistency inconsistency issues fade. So we see that in in single systems and one of the items note here as you know if you think about the disposition code for death. you could have a right your race supercenter, right? It's a death expire expedite at home hospice, and so on. if this is a problem for a single system, but then many think about aggregating data from multiple sources this this problem sort of increased exponentially. Absolutely. So one of the challenges with documenting and and finding where you know if a patient has A deceased that. There's just multiple places to put that documentation in the clinical record. The Location in the record that. We have found to be the most consistent is what's called discharge disposition. By as we show in that analysis, that field is not always used document that and so if you're doing outcomes research and one of your key. Outcome metrics is death. And there are organizations that. Aren't documenting death in a place that successful. You should filter those out of your analysis before moving forward. And so part of what we wanted to promote is the realization that. That's the type of consideration that needs to be made The four. Publishing. Your data about an outcome metrics like death that. You're not. If you're never gonNA see that outcome it doesn't mean that people are. Dying in that particular facility, it just means it's not documented in the place that successful. Right. Yeah. So you know you on your expedience. Unique Position Mark because you you look at it from the from the vendor's perspective you're in an academic setting you're also in practice in a hospital. What's your sense of these things improving the on a track of getting getting this more standardize or it's camping in the other direction I think in general there is improvement I think The. Over the past eleven years through various federal mandates, including meaningful use and so forth. Those of all incentive organizations to utilize. Standard terminologies more consistently than was the case beforehand. I think there's still plenty of room for improvement and You know it's it's a journey, not a destination, but I think things have improved substantially. I was wondering there could be some applications of artificial intelligence here to In a clearly TATECO systems and you'd like the most them pity human resource intensive Yvonne to get it completely right. So one question would be you know, could be actually used a Dick needs to get it maybe ninety nine percent white. And that the human deal with exceptions I definitely think that that's an exciting direction that You want those a algorithms to be trained with good data, and that's a big part of what's motivated us to. Put this focus on data quality and Understanding these strange nuances that are underpinning that date has so that. As we move towards a in machine learning and so forth. We have a high level of confidence in the data that's training those algorithms. Right. Yeah. I think that a huge opportunity here because it's not quite as broad as NFL, not natural language processing it is somewhat constrained. that is a good part of it. The back part of it is that is highly technical. and so. you know some of the techniques you know you can have a fault tolerance in certain dimensions such as you know, misspellings lack of gambling and things like that. But as you have Heidi technical data, you cannot apply those principles because he could have misspelling the system may not be able to. Get, sometimes, and that's where you know I think. It's totally feasible to use. Resources to you know when you're dealing with. Tens of millions of patients and billions of detailed records. Using a I'd even identify those patterns of either. Inconsistent data or missing data it's also very powerful just to. kind of flag in identified. Areas that need to be focused on to lead to a better analysis. Greg Wait Be Hefty. Use that information somehow did is a belt of information that you know and so it just filtering into decision processes that the are really losing it. So hopefully getting improving in that dimension I've jumping to another paper bittersweet interesting. So it's entitled rates and predictors of using opioids in the Emergency Department Katrina Treat Mike Dean in Young Otto's and so so this is sort of a machine learning exercise you have gone through to locate you know coup is getting prescribed. OPIOIDS water the conditions for the Democrat not Nestle demographics but different different maybe age and things like that gender. and and then ask the question desert has some effect on addiction. In the long term rights. So that project To great example of team science though. We. Assembled a team of subject matter experts in neurology pain management. And Data Science and. The neurologist and pain management experts. Identified an intriguing question that we decided to pursue with data. In their question was. Based on anecdotal observation and so we thought it'd be interesting to see how well the data supported that. Observation is that. for youth and young adults Treated or admitted into the emergency. Department. With a migraine headache that. All too often they were treated with an opioid. And so we Use the same day to resource that we were discussing earlier. To explore that. Question. And using data from a hundred and eighty distinct emergency departments. We found that on average twenty, three percent of those youth and young adults were treated with. An opioid medication while they were in the emergency department. In general, it should be almost zero percent in general. There's really Better medications to us, four people presenting with a migraine. and. So this fits into obviously the OPIOID crisis it. it demonstrates the. Scenario describing that. You know using real world data. You can identify patterns of clinical behavior that. Don't match guideline. And the good news is that the? correctable and so through. Training and communication there's great opportunity to. To, manage this. Really. Striking. So fifteen thousand or so inevitably the encounters. And nearly a quarter of this encounters you say involved inoculate. and these are not just Misha and Congress right. It is not filtered down to migraine encounters. Okay. Okay. So these fifteen thousand just might in encounters might vein being repeating disease So once you. If you make a statement and. This or not Easter conditioning issue here. So you get your pain, you go to an emergency department and you get treated with an opioid you get quick tactical relief. From pain. auditing condition expect that in the next episode. So you can say we didn't pursue that particular question, but that is Definitely key part of. Managing the OPIOID crisis is that drug seeking behavior and so Part of our goal was to quantify that and use this as an opportunity to educate providers that. You really shouldn't be treating migraines with an opioid in there are better alternatives and. So we we felt that this was an important contribution to that national dialogue, but we didn't specifically pursue the question of whether the patients we analyzed. Within. Encounter show up Subsequently. With the same symptoms. Right right. Yeah you it develop into period when problematic patterns of drug use comedy. FEST MERGE THE PREVALENCE RATE OF OPIOID misuse estimated to be two to four percent and debts in each goofy just young adult drew from overdoses are rising. and. You say that literally prescribe IOS has been slumping loose future opioid misuse by thirty three percent. Betas Mehta say really huge number. I think just validates the importance of this of this work. Interesting mark. I don't know you exploded on data. Last the question if you look at the aggregate data, it'd be flying opioid. Misuse. what percentage of the total number. Actually started from. You know some sort of medical encounter has mike or some sort of. related encounter that could be completed otherwise was three a bit opioid. in that encounter documented resulted in that misuse. So what so If you look at the active misuse problem that we have today. do you have a sense of what percentage of that goal is actually started I? Think the exciting thing about this type of research is for everyone questioned that you pursue you have. You have ten new that you can pursue. We haven't. Delved into that specific area, but it's It's very ripe for further analysis and A considerable part of where I end my colleagues and our time as. We do this type of work to get an initial analysis published. And then You know in my leadership role I just WANNA. support people like my colleagues on this paper Mark Connelly Jennifer Bickel. in in using data to. Support their research into identify those follow. I mean, he tests policy implications. So it's sweet important work. and. If you find it direct relationship here than you have to ask you know from from a medical perspective what is right intervention? maybe is not just added of care just best practice but clearly should be the bay You know things should be looked at you say you're American Academy of Neurology has included avoidance of using opioid to treat gain one of stop top flight choosing wisely recommendations. For high-value duck in this gives Really evidence to to support that. The other thing that's really intriguing is this level of variation from site to site in. Some Sun facilities are very much aligned with the guidelines. Others are at the you know well, above twenty three percent. And that gives an opportunity for a really precision. conversations about you know, where does our organization stand on that spectrum? Yeah that's a that's an interesting avenue to right. So you know one could ask he says some sort of push sliced Intervention if we can fly goal of patients who who had gone an opioid sexually don't have an addiction problem. that as you know Anna, the kofoed does. if you can fly those type of patterns than you can think about. A customized within electronic health record systems. There's. The ability to provide decisions poor. There's certainly phenomena called pop up fatigue were physicians. You know they don't like having so many pop up windows but at the same time. It's Within the capability of an e e Hr to do that if then logic if patient has. migraine medication order equals opioid. encourage the provider to pause and reconsider that. Right, right and so this is supervised machine learning type analysis where so you have. you have number features that comes directly from each else. So each sex race ethnicity. insurance type. Encounter prostate suggest duration. time of the year and so on. and you have labeled data in this case I guess you have able tater because you would know if op- inscribed on trade. Okay and so are the two questions here. One is to ask the question given a new patient and those features. you could assign a probability that that patient will be prescribed will. Definitely. Impress the data from that predictive Minds. Right and then can you so that data definitely tell you if the patient is going to progress into some sort of an addiction issue. So. Earn Predicting Substance Abuse. So. Yeah. Yeah. Yeah. There's additional diagnosis codes that document. whether a patient has a history of substance abuse disorder. and. So it would be feasible to. Identify the with those diagnosis codes in than really look at their prior history. Of What other conditions were they treated for? What medications were they give in? to develop that model. One of the things in this case that helped with this study is that just in general, it's not advised get. So there are other things that are much more of a gray area. Or whether opioid is as useful, but in this case. The really not. Considered. To be helpful for migraines compared to other options and so that help us have a fairly clear cut scenario to do this work. Yeah. This this won't be the data like you say once you do something like this, you have been other things you could. You could stop asking. So unquestioned that that been to my mind as you know, how did they hugged the actually prescribing opioids? Is it the patient asking for it all so? Off that was another scoping thing with this project is focused on what happens within the emergency. Room. So it's it's. Really, medication order in administration that happens. In that emergency room setting. Whether or not the patient. was. Requesting that you know if they came in and said, this has worked for me before. Can I have it again? we don't have visibility to that. Right. Right. And so from a practical perspective So the the analysis that you did slightly ended up with the Family Clyde power we think it is. Compelling. Pretty compelling. So as as a new patient gets into e D either high. and what I mean by that probably is if there is a history of substance abuse property. the physician has really think twice about. The use of may be the well, and in this case, even without that history. Just because it's not considered to be an effective treatment. You know encouraging them to pause in that decision making. In this particular case is as effective as wall. Right. So looking forward. In if you think about both of these issues, one is the data quality data aggregation data standardized recent problem in the the right of Utah Systems have did that the talked about? And then if we can get to a level that we can look at cross a large data set. Beacon, ask. More. US specific questions, treatment. Optimum treatment type questions. subpoenaed. US The mark big think B be hunting. Certainly, the volume and variety of data that we're able to work with will be even greater I, think the. Opportunity To. Look, holistically at how upstream data capture. Effects Downstream data. Analysis. example I frequently give is if we have a Aggregate Data said we identify. Ten patients whose way in that data such shows up as being. Something that's completely infeasible. let's say they're documented is being. Fifty year old person who weighs two pounds. Clearly air. What's important is? Creating the process to communicate that back upstream. Because that clinical decision. Support. Many drug dosing things are evaluated using weight based logic and so. That same logic that's Evaluating the appropriateness of dosage. It's going to be running against an incorrect value in that may or may not always be visible. So I really am intrigued with that holistic opportunity. In it I am I remain just we have three or four additional papers coming out. About other examples where Provider behaviors not aligned with Best Practices and I'm just excited about you know when you compare that to how long it takes to develop a new drug or how long it takes to. To a really long term research. This research has the opportunity for a pretty quick turnaround on an effective intervention. A really that. Other so much that right. Providers. been taught in a no, but they're. Not always using that in practice and so to help them. Identify, those topics in just modifying behaviors is. In the scheme of things, it's a very straightforward way to improve. So. You know the entire spectrum from essentially getting the data. Right or cleaner like you know Missa mischaracterized or miss input data like wait or something like that. To to get. Better diagnosis better treatment modalities. policies there and from a femme perspective clearly inflammation therefore clinical trials. I was even thinking about drug interaction type. Inflammation. I haven't been involved in the former de for awhile but. Typically, this type of data doesn't get back into automatic processes that fast but I think that is all I know there's strong interest in Pharma in. Working with this type of data there a again looking at real world behavior. This is an excellent resource for off label medication use at. you know where Pharma's Always interested in repurposing existing medications the. Regulatory Processes, much more straightforward for that because the safety is already been. Evaluated and so. The. Significant Opportunity With this, there's also just exciting. Patterns of you know. What are those unrecognised correlations? That's where the machine learning opportunities are really exciting where. You know we're not always asking the right question. And the data can show us what we should be. Yeah exactly. So if the machine a sort of red flags something or create hypotheses. that Cubans have missed sometimes, those types of things are extremely powerful. because maybe that sometimes it's countering tutor. and so we all look at data with an Incan bias. The beauty of machines that at least on the surface began deploy Michigan. This volume of data. Techniques like machine deep learning can recognize those subtle but consistent associations. Wait quite. Excellent. Idea this has been great mark Thanks so much time with me. I enjoyed it very much. Thank you. But
Daily Breath with Deepak Chopra
Conscious and Unconscious Impulses
"I'm debugging show. This is. A new series is called total mention. The brain isn't like an automobile which runs only if you turn the ignition on. The brain runs unduly control. Which means that it obeys both conscious. And unconscious impulses. So who's in control? Is it your conscious mind Oreo your unconscious mind? We all experience, unconscious impulses and these keep going on without instruction. For example, your blood pressure, your heart rate, your digestion, your immune system, your hormones. They're happening right now self-regulating feedback loops, loops all of that who misses self-regulation is happening right now without your conscious awareness. In. Sleep particularly in deep we awareness all together. When we're awake? We have thoughts without awareness of how neurons operate. Nobody needs know neurology to experience thought. Without medical knowledge, you wouldn't even know that you have a brain. Of course these days everyone knows they have a brain because they've seen a picture or a cat scan of the being told. But without actually having. An experience of looking at the brain. Are It's. Our photo. You actually don't even know that you have a brain. Dual control as seen by the nervous system is always happy. So for example, breathing his automatic and yet we can intervene by taking a deep breath. By banking a yawn or the side, here's another example tried to stop a sneeze. Both sides of the breathing mechanism. By An inventory will battle it out. You will be trying to stop the sneeze which is voluntary and this needs will keep trying to occur which is in biology that's the battle. The body mind is so seemless that we often cannot tell who's in control. For example when you have an outburst of anger all when you have obsessive thoughts are when you panic or when you have depression anxiety phobias addictions when you experience these. Symptoms the involuntary part of your nervous system has overtaken you. And at that moment, it seems that all these emotions anger obsessive thoughts, Banik Depression. They have a mind and a life of their own. And yet, there are a HA moments creative breakthrough, sudden insights which are unexpectedly or seemingly. By the way when that happens, your brain shows completely different. Pre Quincy Raves Call Gamma spikes. Somewhere in our ancestry and evolutionary leap occurred when Homo sapiens species crossed over the gap from
Broken Brain with Dhru Purohit
Protecting Your Brain from Alzheimers Disease and Cognitive Decline
"In this mini episode, I speak with Dr David Perimeter Dr, Lisa, Mosconi Dr Dale, Br Edison about why Alzheimer's is a preventable disease and the lifestyle factors that can set the stage for Alzheimer's years from. Now, we also talk about this disticts of Alzheimer's disease and its impact on women, and what you can do today today to prevent cognitive decline in the future. Let's listen in starting with interview with Dr. David Pearl Mutter, a board certified neurologist and four-time New York. Times bestselling author, we do know that a for the most part Alzheimer's is a preventable disease. This is a disease costing Americans two hundred and thirty billion dollars affecting five point four million of us. That is dramatically exploding in terms of its incidence and prevalence globally, and yet you know the notion that our lifestyle choices are not relevant is it does take my breath away. You know it's all about living a life that is less inflammatory and that certainly transcends are narrative as it relates to Alzheimer's but. Involves Parkinson's and involves coronary artery disease diabetes and cancer, and all of the chronic degenerative conditions, and you know what really is so very important and I think sort of stands in our way of getting this information to really have traction is the time table that this is effective over for example, you tell somebody wear your seatbelt that'll be good for you. They get in a car accident they're wearing their seat belt and they say, Hey, I get it that worked yesterday I was in that accident worked. But the inflammation issues that are relevant in terms of causing the brain to degenerate or narrowing the coronary arteries. These are issues that are beginning to take shape ten, twenty, thirty years prior to actual disease manifestation, and therefore it makes it very challenging for the consumer to connect those dots. Let me give you an example. In the journal Neurology, which is arguably one of our most well respected neurology journals on the planet period viewed. There was an interesting study that was published and it measured in a group of several thousand individuals who were in their forties and fifties. At the time it measured markers in their blood of inflammation and the study then came back and looked at the same group of individuals twenty four years later, the study again was just. And what it found was really quite remarkable. There was very direct relationship between risk for developing Alzheimer's disease and having had higher measurement of blood inflammatory markers twenty four years ago. So what does it say? It says that if you? Elevated Markers of inflammation in your blood today, you are setting the stage for Alzheimer's years from now and so that your lifestyle choices today whether you choose to eat low carb high carb high fat low-fat whether you choose said integrity vs physical activity the amount of sleep that you get. Hopefully that is restorative the amount of stress in your life, etc. these are all extremely important variables. Which you have control that clearly are connected to your brains Dini. This is not live your life come what may and we have a pill for you. If you're suddenly cognitively impaired is the other story. The story is that you make lifestyle choices today that will dramatically impact how your brain works to three decades from now
The Carlat Psychiatry Podcast
New Schizophrenia Guidelines
"Lot has changed since 2004 when the APA the last road practice guidelines on schizophrenia this September and twenty-twenty. They updated those guidelines and here's a few of the key changes. There's less emphasis on divorce pushing between the conventional or first generation antipsychotics and the second generation or a typical perhaps because the Katy Trail put an end to the notion that the newer ones are better tolerate or the older ones are more effective, but the guidelines do Place greater emphasis on clozapine. They recommend clozapine after a patient has failed to respond to two trials of a guy psychotics and they Define failure of response meaning less than a 20% response and unlike the 2004 guidelines. They don't require that one of those trucks. Else be with the first-generation antipsychotic. They also recommend clozapine first line for a number of patients, which when you think of it is a lot of people with schizophrenia, those are people with suicidality problematic aggression and potentially with tardive dyskinesia. That doesn't respond to other options. The guidelines do go into great detail on how to treat side effects to antipsychotics. They list metformin as first-line for weight gain and metabolic syndrome and they list the vmat2 Inhibitors two of which are like ft approved and one of which are not all is first line for tardive dyskinesia. That's one area where I might differ from the guidelines they seem to emphasize these FDA-approved treatments, which actually have a fairly poor number needed to treat and not-so-great tolerability and are extremely expensive at $80,000 a year and they give real short shrift wage. Other options for tardive dyskinesia things like ginkgo biloba extract Keppra and amantadine which were actually given more emphasis in the neurology guidelines wage in several places. The guidelines give Credence to the idea of checking blood levels on antipsychotics to see if the patient is actually taking them a lot of authors of advocated for this and the fact here is that you just don't know if the patient is taking it even though the blood levels of most antipsychotics don't correlate with any therapeutic level except for clozapine where the therapeutic effects are greater above blood levels of 350. It's still useful to check them before moving to clozapine because you don't know if the patient even took the medication that you gave them too often. They don't and perhaps the biggest and most welcome change here is the emphasis on psychosocial therapies while they were recommended in a more generic form in 2004 here they recognized A whole host of specific psychosocial programs for people with schizophrenia so they can get their lives back. Here's one that was striking to me. They recommend that all first episode page be treated and something called a coordinated Specialty Care Program. These are things that have been researched since 2004 and shown to improve outcomes. They are team based programs incorporate both medications along with education resiliency training family therapy and vocational rehab sounds like a full pallet of what people need when they're going through them first episode too bad. These programs are hard to find but they're starting to Institute the more public Mental Health Centers and some academic centers have them but helpfully the guidelines do give you a reference to free resources where you can train your staff to start one locally
Parenting: Difficult Conversations
Kids Know How To Occupy Themselves. We Need To Let Them Do It
"One of our own NPR colleagues Mike Lean decline. was actually feeling this stress big time she's been working quarantined with her husband and her daughter Rosie. WHO has four? She is like a firecracker, right? She is strong willed. Through life with this intensity, which is fantastic, she learns really fast, and she's fearless, but you know it's like when she wants something. There is like no giving in, and it was these constant demand demands to draw neurology. Video, Mama, make a Sandwich Mama set up. My Zoom Circle Time Mama you know all those little interruptions that completely obliterate your concentration I would lock the door. I slid down the back of it and I just cried I. was like what am I going to do like I have this book deadline in July and it was just really like this is. This is not going to be good for any of us. Like things are going to deteriorate really quickly in this House Mike Lee and actually wrote about this moment in a new. York Times. OP, ed recently, and it's related to the. The book that she's working on, so it's called. Hunt gathered parent, and it's coming out in March twenty twenty one, and it's all about what American parents can learn from other cultures including traditional cultures, because the pressure to keep kids constantly entertained well. Mike, Ian says that's really specific to American parents and culture. There is huge amount of pressure like I have been fighting it and I still feel it. You know I still wake up in the morning I'm like. What are we GONNA do today. What are we going to do this morning, right? You're like per child entertainer part event planner. I mean it is like we're planners. If you think about it, right, it is late. They are little tech CEO's that have like a day planned for them, and we are there to usher them in, and not only just usher them, but make sure they enjoy it or something out of it or like. There's feedback afterwards, right? There's a cruise director like there's hustler service aspect to it. It's having a good time. Did you find your except my kids are those trolls on Yelp that always give the two stars, the One star now, not good enough, not good enough. Maybe they're trying to tell you something so in this episode of Life Kit. It's all about turning kids from customers. You have to please into good coworkers Mike. Leeann is gonNA share what she's learned from her reporting on other cultures to help our kids learn to entertain themselves. Michelina Club says that she got this idea from her reporting that she could sort of retrain her daughter. Yes, she was thinking about a scene. She had read about in an anthropology book by Jean Briggs who studied the inuit in the Arctic in the sixties, the anyway still lived in pneumatic lifestyle, and in the winter they build Igloos to stay warm, and the mother had two young children I think that the time they were about three and six. Six, so this is a part of the world. That's one of the coldest parts of the world in so there were many days where like the little girls couldn't go outside there. They had nothing to do right. There were no videos legos, no children's books and there's these scenes in the book where the children literally spend like an hour or two in the morning under a blanket playing without bothering anyone yet. That sounds like a real dream culture. I cannot wait to get to that point and so looking at these cultures to do this. You see striking similarity, and that is that they do not feel the need to constantly entertain, educate or stimulate. However, you want to think about it children. It's a very different approach to the way they treat a child's time. And I. Think because they don't demand the child's attention. You do this now now. You're doing this now. You're doing this I. Think in return. The child stops demanding the parents attention, and so that's what I really wanted to test out to walk us through. What did you do? I stopped trying to demand Rosie's attention. Right I stopped trying to say now. It's nine o'clock. You're going to watch this video or we're gonNA. Read a book right? I stopped being the event manager for her. And I started doing the things. I needed to do and expect her to come along with me. And welcomed her right so another thing that like these other cultures do that? We tend not to do is welcomed the children into our worlds right? There's a very separate world child world. And I think in order for this to work. You have to welcome them into your world, so hey, we're cooking now. Come over here and you know probably stir these eggs or now we're cleaning. Help back you. It's not forced. It's not like you have to do it, but I'm not gonNA. Draw you a Narwhal right now. I'm cleaning and they do this with all of their work. It's not just cleaning and domestic chores, but also you know their businesses. The children are there. The children are welcome into the world of and so so I started doing that, too. I said well. You know what I need to write. I need to write like four hours a day. And Yeah me. Sitting on a computer writing is not very interesting, but neither is like sewing and an Igloo and so I said okay. I'm going to write I. Need Quiet. And you are welcome to sit here with me the first time we did it, I started small like thirty minutes, and if she really was upset at the beginning, I would stop I'm not trying to like force anything and make a lot of chaos in their house. It's really the opposite like if she was really like in the beginning, if she was really escalating with you and getting really upset, you would would give her some time. Yeah like I. I would really try to ignore her. Because I was really teaching her like this is quiet time and it's not time for me to give you attention. But? But if it got really bad and then I'd be like okay. Let's go outside. Let's take a break you know. But you guys the first time I did it. She was kind of stunned. She actually said to me. I can do anything I want as like. Yeah, you can do anything you want as long as you don't damage the house. Like you know she just couldn't believe it, so started sma- and after about a week we had worked up to lake. Hour hour and a half chunks in by like two weeks. She wants to do it even she'll be like. Are you going to write a? Show. Ask Me and so you built up to it and her main thing that she does. Being is what she will sit here in color with me for an hour or so, and then she kind of runs around the house in desert. Thing she can go outside she cooks quote unquote, which means like mixing different things in the kitchen and she makes them S. There's no doubt there's a message. To be honest, she latched onto it quicker and better than I thought it was going to be I mean. It is one child in one house, but it's backed up by all these other families right that I that we've seen in these cultures
Coronavirus Daily Briefing
How the Pandemic Has Changed the Way We Sleep
"According to preliminary results of a study of sixteen hundred people from sixty countries, forty six percents of people reported poor sleep during the pandemic. That's up from just twenty five percent before the pandemic insomnia and vivid weird dreams, both caused by the increased stress of the time we're living through has been evident anecdotally and as indicated by a fourteen percent uptick in sleep. Medication Prescriptions Melatonin sales in over the counter supplement for the natural hormone that induces sleepiness are up forty four percents. Philip Musket a professor of Psychiatry at Columbia University Medical Center said he's avoiding prescribing medications to patients preferring to offer sleep hygiene tips. He's seen that actually staying asleep is the biggest problem for most people and says some of the primary factors causing that is that people are lacking in structure and exercise. Stain active can help you sleep more soundly and boost your immune system Dr Musk's also advises sticking to a regular sleep schedule and avoiding naps during the day. The good news according to Kathy Goldstein physician at the University of Michigan and an associate professor of neurology at the Schools Sleep Disorders Center is that what most people are experiencing is acute insomnia or quitting the Wall Street Journal having difficulty for or staying asleep a few times a week for three months or less and quotes, the third of people will experience acute insomnia at some point in their lives usually caused by some stressor. stressor in their life like say a pandemic the key doctor. Goldstein says though is not letting the issue. Become a chronic one quote. It's important to avoid associating your bed or bedroom with a place where you were awake. Experts recommend that if you can't fall asleep or wake up in the middle of the night and are unable to go back to sleep after twenty minutes get out of bed and do something, relaxing and quotes. Natasha Bouillon a Phoenix based family physician at one medical, says most people's sleep problems right now either stem from a lack of normal schedule or general anxiety about the pandemic. Some tips she recommends mindfulness through meditation, exercise or cognitive behavioral therapy. To maintain a consistent sleep schedule, turn devices off an hour before going to sleep and make your sleeping space a device free zone, consider even ditching your smartphones alarm and getting an actual alarm clock, as for anyone, experiencing vivid dreams or nightmares Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, says quote. During Times of stress, there's a release of narrow chemicals that can trigger these vivid dreams and nightmares in some people end quotes. And, Dearly Barrett a dream researcher at Harvard Medical School notes that waking up frequently throughout the night can also cause people to remember their dreams better. Contribute to the sense that your dreams are more vivid than usual. guardless of how? Your sleep has been disrupted. Or why here are a few more sleep? Hygiene tips to leave with quoting the Wall Street Journal eat at regular times than snacking day. Avoid, napping or compensating for poor night of sleep by going to bed, unusually early limit caffeine and avoid alcohol avoid electronic devices one to two hours before going to sleep, but if you do use a blue light filter and try to look at content that is not stressful. Get Bright Light in the morning. Try to find a workspace that isn't in your bedroom and stop working at a specific our and make time for relaxing activities end quote.
VINTAGE Podcast
Confronting 'madness' A K Benjamin
"Tell me a little bit I I kind of want to hear your journey to writing the book. Like how takes your right. What can spark the idea in the first is place like what did it come from? So I'm I was I've been working for me ten years in a large hospital. A large urban hospital and I got a sabbatical to go to Asia to look at Different approaches to neurological problems. uh-huh And it was it was in Asia The I started to journal I was pretty exhausted from working in the H S and I started off the journaling Because that's what everyone else seemed to be doing All these kids gap years But after a week or so I got really bored of the sound of my own voice and I wanted to Turn this sort of emotional raw material into something The how to reader in mind rather than rather than just I myself am an kind of led to a process of elaboration first of all taking real incidents from my life and giving them a spin and then on sort of adding to that Bits from the imagination and fusing the two together so quite quickly. I became a little confused. Where the line between what really happened to me and what might have happened to me? In if I'd much things to two degrees to the West where where that line was and I'm from that over over over the course of a year year and a half I produced this book and the and the sort of I am yeah and uh almost with each pass with each going over it. I wanted to elaborate it more and make it a bit more juicy. Make the chronology different tune into a thrilla Ella then have a as a As a sort of as a romance and then as a quest and Cetera et cetera gave it different incarnations. Yeah 'cause that's kind of what I like about. The book was kind of remembered how I think about neurology and the science of the body and the kind of like I thought it was very straightforward. You you know I think especially it's going to be somebody who would just be patient you kind of think. Oh you know the the psychologist the doctors. The the the science on the paper knows everything and actually it's kind of this shame. Shame with John Thing like Oh this book and actually you can kind of liked leading us in different directions shows that. It's not just a linear. Yeah I hang I yeah I think I suppose the moment of implosion came for me when I was thinking you know. Maybe it was the thousandth time I was diagnosing. A patient with a A brain disorder. And I there was something about that Particular Day whereby I just the Became suddenly and strangely aware of the expectations that the patient had of me the expectations of of being sober of being experts of being in control of my feelings and then the difference between those expectations. And what might actually be taking place in mine nine or any doctor's mind at that particular time and then the flip side the other side of the mirror is what all of this sort of rehearsed. Propriety let's see and good manners and decorum in the face of this other person suffering the the suffering on that morning of this particular woman who was a little bit younger perhaps than than an average patient of mine who was a little bit messier in some ways who was who didn't recognize the bounded. It was enough to nudge me towards thinking about a her suffering. In a way that I become used to in a way that I'd armored myself against and I'm not particularly when I find it very hard to keep it together the to get to keep my own feelings in check because her suffering was so alive that this woman was going to be maybe in three or four years in her life from this moment. I'm an honor life that was dense dense with family And complication was just going to unravel and there was nothing I could do about it other than to diagnose it So so that this integration on both sides of of me the doctor but also the sense of the patient disintegrating a me not having professional boundaries in that moment in to guard myself against that sense. Do you think that it's there's a kind of mythology around the The history of your profession. And maybe there's always he's been kind of a bit more self reflective than we thought and so there there there there are a few but not many strains of medicine that really consider the presence of the doctor and the interaction of the doctor in the dialogue and how that might affect the way that decisions are made about the patient. Most I often. It's a very taken for granted process with no real subtlety. And I I suppose the starting point for me in the book is we we we. We see We see maybe forty percent of patients whereby we can't help them because we don't understand what's going on on what we tend to do is put those patients agents in in different types of boxes that constrain them and because of the way that we constrain them appears that problems get worse and worse because we have found ways of not listening to them of not allowing them to be heard and that includes the impact that we have on these people on the way that that constrains them and makes them go into their shell because they don't seem to fit particularly well into the frameworks. We have for understanding and I think there are different ways of thinking about ourselves and our presence in the room and how that interacts with the patient that may allow for certain kinds of curiosity and openness to problems that don't immediately mmediately fit into neurological taxonomy or diagnostic categories. Yes I suppose the diagnosis quite fluid like feeling that you might be diagnosed with now. Might have been a different diagnosis ten years ago. And having that kind of those that this is the fluidity the diagnosis. And there's also this sort of fluidity of these this major diagnostic interface interface between. What is neurological? What is psychological psychological tends in a medical setting to get put in some sort of casual Ben for a AH on a and Bonnard difficult patient or time-waster even worse I yet as things become more subtle? Take something like pain. Gene where there's obviously a psychological as well as neurological component than those two are a very fluid the crossover between the two and therefore the way that we interact with the psychic. If the patient is having an outcome on then urology in some subtle ways and crossover between science and literature. I think is something this is really interesting. Have you always been a reader. Have you always GonNa and do you think a lot of people in your profession are well I'll answer the second part. I I did Study of doctor-patient interactions which required a kind of Iq test full junior doctors junior neurologists and of course they do spectacularly accurately well on things like perceptual reasoning verbal reasoning. But when it comes to general knowledge people didn't know who Lewis Carroll was people don't know People can't name Shakespearean comedies. People didn't know who Martin Luther King Junior was so there are definite limits to their intelligence and they'll literate nece. I don't my background. I had a career in something that was more literary before I was doctor. Always always found An important autoparts understanding it literature contribution understand into how I understand. Other people My capacity to empathize is based to some extent on on how I've groner Rita so it's been crucial to my Clinical work and I think I hope it's led to kind of depth to how I and you you know my my sense of anthropology in the subjectivity of the people When it came to writing I think often I found the Literary influences more than clinical theoretical influences Medical theoretical influences can't afford because I was trying to write about about interactions that were a bit juicier a bit more alive a bit more dynamic and complicated and messy than what you normally get in case studies and this this convention in case studies is often to just dry out interactions and make them A little bit more algorithm make a bit of a bit more. He said she said he said he said she said so. He did this and this and then she responded in this way the things that feel quite dead on the page and I think literature allow if you allow only to infuse those sorts of conversations. Little bit then you bring something to life more. And that's what case did he should be. There should be an attempt to bring something to life rather than to just to to to To Map for success story or a failure. Do you think that's something to do with. Potentially the way we educate ourselves were very segmented in the boxes that will the the rates will go down as children. Do you think. And I think you've you've managed to have like a breadth of both the I think I think I'm in my my. My education was certainly very very box. Then it wasn't until I was seventeen and there was one teacher. He was just a bit chaotic embroidery and like to talk about different subjects. That the the idea of the syllabus was cracked open for me and from there on I didn't really low I want I. I studied literature at University but I spent a lot of time. Reading philosophy and reading work in translation and then reading on for apology I and found ways of sort of crow boring that into a syllabus back with into this elaborate requirements similarly when I was doing the clinical training I always tried to find and ways of bringing existing interests that apparently marginal into the central ground. And I think I think as long as you've as long as you meeting the basic requirements of your subjects for good practice then. I think it's helpful to have your because I really liked to identify the The Guardian very very well and they said it's as Yom redefining wakeup call for book when when they described as a wake up call. This is the kind of thing you're kind of going for. Obviously it's an exploration in general. Well if you're waking people up from something what would it be well. I think one thing that I'd be wanting to wake up. People from is is these are these narrow classifications occasions of what it is to be a doctor and how it how to interact of what it is to have a mental health diagnosis and how to understand that and how to treat that A A of what it is in the Culture Lodge which is supposedly there to serve us? The actually drives us to different states of distraction and