Dr. Mark Vonnegut: On Creativity, Being ‘Crazy’ And Getting Help

By Mark Vonnegut, M.D.
Guest Contributor

Being related to a famous person is somewhere between a cruel joke and a minor distraction. My father was immensely talented and worked very hard at his writing, but the degree of his success was a fantastically unlikely bit of luck. There are lots of talented, hard-working artists who don’t make it.

The important thing in overcoming mental illness, whether or not you have a famous last name, is to want things to be better — and being willing to get help to make that happen.

Dr. Mark Vonnegut (Courtesy)

Dr. Mark Vonnegut (Courtesy)

Both of my parents’ families advised them to stay away from one another, as mental illness was rumored to be in each other’s family. The rumors were true, but it wasn’t like anyone then or now comes with any guarantees. It makes us feel more alive to be able to see, listen to and read great art, partly because great art is often the result of great struggle. The idea that artists and “the mentally ill” have inner demons while the rest of us do not is part of what has made it — and continues to make it — so hard to come to terms with mental illness.

The reason the arts and craziness run in families is because crazy people who can sing and dance and paint pictures and write well do a much better job of convincing others to have babies with them than if they’re just plain crazy. Thus has it ever been.

In my career as a mental patient, I started with schizophrenia, worked my way up through manic depression, and have now settled at bipolar disorder. I can joke about it because I recovered sufficiently to get into and through medical school, internship and residency, and have had the enormous honor and privilege of being trusted by parents to help them and their children. I make no bones about it; I make mistakes just like everyone else, but am very proud of how well I do my job.

I’m also very aware of how easily I could have ended up otherwise — a suicide statistic or just another broken young man who never got well enough to have a life. Continue reading

Report: Woman Wins $100M In Transvaginal Mesh Case Against Boston Scientific

A Delaware jury has ordered a medical device manufacturer to pay $100 million to a woman who, despite two surgeries, still has pieces of transvaginal mesh embedded inside her.

The News Journal of Wilmington reports the 51-year-old Newark woman was awarded damages Thursday following a two-week trial in Superior Court in Wilmington against Boston Scientific.

Court documents say the woman had transvaginal mesh inserts, a net-like product used to treat incontinence and sagging pelvic organs in women, implanted in May 2009. Since then, she has had complications, including urinary tract infections and pain during sex.

The jury found Boston Scientific, which is headquartered in Marlborough, Massachusetts, failed to warn doctors and patients of the risk of the poorly designed inserts.

Boston Scientific spokeswoman Kelly Leadem says the company dedicates significant resources to ensure products are safe.

Earlier:

Amnesia Undone: MIT Study In Mice Restores Lost Memories

mouse neurons1

3-D reconstruction of mouse neurons (Zeiss Microscopy/Flickr Creative Commons)

How’s this for a grabber?

“Memories that have been ‘lost’ as a result of amnesia can be recalled by activating brain cells with light. In a paper published today in the journal Science, researchers at MIT reveal that they were able to reactivate memories that could not otherwise be retrieved, using a technology known as optogenetics.”

Yes! Does this mean we can reclaim our long-forgotten halcyon childhood days with a bit of a laser boost to the right neurons? Um, no, not today. But it’s still fascinating. That MIT press release quoted above goes on to explain that the study explores the difference between how a memory is stored — in a group of brain cells called an engram — and how it is retrieved. It quotes Nobel Laureate Susumu Tonegawa, who leads the group that did the work, on the evolving concept of what a memory is, in our brains:

“We are proposing a new concept, in which there is an engram cell ensemble pathway, or circuit, for each memory,” he says. “This circuit encompasses multiple brain areas and the engram cell ensembles in these areas are connected specifically for a particular memory.”

WBUR’s Rachel Paiste spoke with Dheeraj Roy, a grad student in Tonegawa’s MIT lab who worked on the research. Their conversation, lightly edited:

RP: So what did you find?

DR: We wanted to look at mouse models of amnesia, for the simple reason that there’s very little done today in the field. So we attempted to look at individual memory traces, which we refer to as engram cells, which are sparse populations in several brain regions — the one we worked with is the hippocampus, which is widely known to be involved in memory. And we looked at: Do these memory traces, which we see in normal mice, do they still persist in amnesic mouse models? And if so, is there any way that we can restore or bring back these memories?

And this is actually stemming from a debate in the field: Neuroscientists weren’t sure, when a mouse or a rat or a human can’t remember a memory, is it because the memories are no longer stored or is it because for some reason they can no longer be accessed? So our study really started with that goal: Can we try to tease apart storage problems, where the memory is gone, or retrieval problems, where the memory is there but just needs to be retrieved somehow?

So our findings, I think for the first time, tell us that in certain models of amnesia, memories do persist and, very importantly, at levels similar to what we see in control mice. And that’s actually what was most exciting for us: not just that memories persist — that’s been known for a while — but the fact that we can bring back memories to equivalent levels as control animals is very unexpected.

So the first thing I thought of here, knowing more about pop culture than brain science, is “Eternal Sunshine of the Spotless Mind.” As far as retrieval of memories, is this something that could somehow become used for humans? Continue reading

From The Eating Lab: Diets Don’t Work, But Why?

By Jean Fain
Guest Contributor

As soon as Traci Mann’s new book, “Secrets From The Eating Lab,” hit bookstores shelves, I ordered my copy. Not only because the University of Minnesota psychology professor is one of the leading researchers on the psychology of eating, dieting and self-control, but her 2007 Medicare study on effective obesity treatments was the irrefutable evidence I needed in writing about how diets don’t work — at least not as dieters expect — in my own book on eating with self-compassion.

Diets fail to facilitate significant or sustainable weight loss, Mann argues. What’s more, diets are unnecessary for optimal health.

Diets don’t work for a variety of reasons, from biology to psychology. After two decades of studying the scientific literature as well as her own diet subjects, Mann points the finger, first and foremost, at human biology. “Genes,” she argues, “play an indisputable role in regulating an individual’s weight: most of us have a genetically set weight range. When we try to live above or below that range, our body struggles mightily to adapt.”

Second to biology, Mann blames a combination of neuroscience and psychology. Our brains are hardwired to want food for survival, she explains, so restricting calories creates a psychological stress response, which facilitates weight gain, not loss. Also, she adds: “Studies show that willpower, the thing we all blame ourselves for not having enough of, is in many ways a mythical quality and certainly not something that can be relied upon for weight loss.”

Whether you’re interested in boosting your health or losing weight, Mann’s best advice is to ditch the diet and adopt her 12 “Smart Regulation Strategies,” her proven mental strategies for reaching your “leanest, livable weight.” Instead of counting calories, for example, she advocates penalizing yourself for succumbing to temptation as well as thinking about tempting foods in the abstract. So instead of thinking about the specific qualities of a glazed donut with chocolate icing, think of a donut as a generic dessert or just one of many breakfast foods.

Mann’s views come as no surprise to me, a therapist who specializes in eating disorders. The big surprise for me in her new book is that I only loved the first half — the half that pinpoints the problem with dieting. The other half, which focuses on her “no-diet” plan, well, I liked it only half as much. Turns out, a good bit of Mann’s plan calls for external changes, like using smaller plates and taking smaller portions, a la Brian Wansink’s Mindless Eating. Mann prescribes internal changes, too, but none are what I’d describe as truly mindful.

I was tempted to dismiss Mann’s plan as a collection of mental tricks, then I thought better of it. Instead, I set up a mini-interview via email with the professor turned author and I’m glad I did. Not only did Mann have some interesting things to say about dieting — her own experience and that of determined dieters –- but her answers reminded me that there’s no right way to address eating problems. In fact, there are many ways to go. To see if Mann’s way of reaching your leanest livable weight is a way you might want to go, read on.

JF: You’re pretty unusual in that you ditched dieting after just one diet. And yet, you’ve devoted your career to proving diets don’t work. Why is that?

TM: I ditched dieting because the diet I went on made me miserable, and I watched both of my parents cycle through diets and re-gain, diets and re-gain, ad nauseam. Continue reading

Asthma, Lyme Disease, Salmonella: How Climate Change May Worsen Your Health

EPA Administrator Gina McCarthy speaks  in Washington in 2014. (Manuel Balce Ceneta/AP/File)

EPA Administrator Gina McCarthy speaks in Washington in 2014. (Manuel Balce Ceneta/AP/File)

The link between climate change and extreme weather is widely known. But as the planet warms, what about the risks to your own personal health?

I asked U.S. Environmental Protection Agency Administrator Gina McCarthy, a Boston native in town to deliver the commencement address at UMass Boston (her alma mater), to give some specific examples of how climate change can impact human health. Here, edited, is our conversation.

RZ: So, feel free to get scary here, what should people know about climate change and their own health?

GM: As temperatures rise, smog gets worse and allergy seasons get longer, which makes it harder for our kids to breathe. We know that increasing the ozone, the ground level smog, makes it difficult for kids — and also the elderly — to breathe, it impacts their lung function. So, you’re going to see a dramatic rise in the number of kids with asthma who experience bad air days.

So, the allergy season gets longer, and this is related to the warmer temperatures as well as the later fall frosts, which means plants produce pollen later in the year. The length of the ragweed pollen season has increased in 10 of 11 locations studied in the Central U.S. and Canada.

This season is awful: I have a little allergy this year for the first time. I found myself sneezing, my eyes watering. Even the dog went on some kind of antihistamine. I felt sorry for her.

You also mentioned ticks, what will happen in their world?

Warmer temperatures also bring increases in vector-borne diseases — Lyme disease, mosquito and tick-borne diseases, and expanded seasons. What we see is that the Lyme disease areas are expanding and the number of cases is increasing. Among the states where Lyme disease is most common [New Hampshire, Delaware, Maine, Vermont, and Massachusetts], on average, these five states now report 50 to 90 more cases per 100,000 people than they did in 1991.

You can clearly see the geographic region expand. Also, West Nile Virus is expanding. Our climate assessment tracks geography and seasons getting longer, expanding. As temperatures get higher, the entire ecosystem changes. I was in Aspen, the winters are getting shorter.

Screen shot 2015-05-28 at 1.11.33 PM

Are there any other diseases we should brace for?

There are also water and food borne diseases: salmonella, that relates to food potentially sitting out, the higher the temperature the more salmonella outbreaks. The same with water — anything that’s a bacteria — it’s going to increase in warmer weather. Continue reading

Latest Checkup Podcast: Teen Zombies, From Sleep To Porn To Impulsive Choices

(Photo: Hypnotica Studios Infinite, Flickr Creative Commons)

(Photo: Hypnotica Studios Infinite, Flickr Creative Commons)

News bulletin: Teens are … different. They’re caught betwixt childhood and adulthood, but they’re no simple hybrid of the two — they can sometimes seem more like a separate species.

In the latest episode of The Checkup podcast, we explore three important aspects of the adolescent mind:

• Do you beg your teenager to go to sleep earlier so he or she can function? Well, it turns out they physically can’t do that, explains Dr. Marvin Wang, a pediatrician at Massachusetts General Hospital on a mission to make school start times later.

• Also, why adolescent brain development is the culprit behind so much bad (and sometimes law-breaking) decision-making and reckless behavior.

• And, a sex therapist talks about how Internet porn can sabotage a teenager’s ability to have a normal romantic relationship.

In case you missed other recent episodes: “Power to the Patient” looked at ways we can all feel in more control of our health care; “High Anxiety” explored hormones, parenting and fear of flying; and “Sexual Reality Checks” examined penis size, female desire and aging.

But lists get tedious — why not just subscribe?

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at podcasts@slate.com.

Public Pay: UMass Med School Chief Now Earning Nearly $900K

Infographic by Reuben Fischer-Baum at Deadspin.com, reposted with permission.

Infographic by Reuben Fischer-Baum at Deadspin.com, reposted with permission.

This time around, I’m feeling about a hundred grand more like an appalled taxpayer than a proud Bay Stater.

A couple of years ago, we posted the map above under the headline, “Highest Public Pay: Coaches In Most States, Med School Chief In Mass.” The map — which we re-posted with permission from Deadspin.com — had earlier been titled “”Everything Wrong With America In One Simple Image.” I expressed my pride that I live in a blue state where the highest-paid public employee is not a football coach but a medical school chancellor.

At that point, the Boston Globe reported, “At $784,468, the top 2012 salary ­belonged to Michael F. Collins, who holds dual roles in the University [of Massachusetts], as chancellor of the medical school and ­senior vice president for health sciences at the university. He was also the state’s highest paid employee in 2011.”

Now, according to a post by David Art of MASSterList, the latest numbers are in on salaries in Massachusetts state higher ed, and the top spot holder is once again Michael F. Collins, but with, by my count, $113,010 more a year:

“Michael F. Collins, Chancellor of UMass Medical School, with salary of $897,478, topped the list of the highest-paid educators in the state higher education system in 2014.”

I can only repeat the plaintive question I asked in 2013, with $113,000 more emphasis:

“Of course, public employees’ salaries need to be comparable to private-sector salaries if we want to attract good people to public service. But is there not also something called ‘enough’? At what point does a taxpayer-paid or nonprofit salary become unseemly?”

What You Really Need To Know About Dense Breasts

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

From left: 1) a breast of normal density showing fat (white), fibrous tissue (pink) and glands within the rectangle, while a cancer is present (circle). This illustrates the fact that cancer can occur in breasts of any density; 2) an extremely dense benign breast without any fat, composed of pink fibrous tissue and minimal amounts of glands; 3) an extremely dense breast involved by cancer (infiltrating haphazard small glands), in contrast to Fig 2, but very similar in appearance, demonstrating the subtle similarities. (Courtesy Michael Misialek)

By Michael Misialek, M.D.
Guest Contributor

Reading the pathology request on my next patient, I saw she was a 55-year-old with an abnormality on her mammogram. Upon further investigation I discovered she had dense breasts and a concerning “radiographic opacity.” The suspicion of cancer was high based on these findings and so, a breast biopsy had been recommended. As I placed the slide on my microscope and brought the tissues into focus, I immediately recognized the patterns of an invasive cancer. Unfortunately the suspicion had proven correct.

Just a few patients earlier, an almost identical history had prompted another breast biopsy. This time the results were far different, a benign finding and obviously a sense of relief for the woman. Every day these stories unfold; the never ending workup of abnormal mammogram findings. Both radiographically and microscopically, it can be challenging at times sorting out these diagnoses, particularly in the face of dense breasts.

But what, exactly, are dense breasts and why are they suddenly in the news?

Breast Tissue 101

Breast tissue is actually made up of three tissue types when viewed under the microscope. The percentage of each varies between patients. There is fat, fibrous tissue (the supporting framework) and glandular tissue (the functional component). This is what I actually see under the microscope. Cancer can occur in fatty or dense breasts. It can be toughest to assess when the background is dense.

Biopsy, considered the gold standard in diagnosis, may even prove difficult to interpret when in the background of dense breasts. Dense breasts can hide a cancer, making it more difficult to detect both by mammogram and under the microscope.

Breast density has taken a lot of heat recently. A new study published in the Annals of Internal Medicine found that not all women with dense breasts and a normal mammogram warranted additional screening, as was previously thought. Understandably this report has received much attention. The authors found nearly half of all women had dense breasts. This alone should not be the sole criterion by which additional imaging tests are ordered since these women do not all go on to have a cancer. Clearly other risk factors are at play.

Confusion All Around

This is confusing for patients and doctors alike, especially when it seems as if screening guidelines are a moving target. Recently, the American College of Physicians issued new cancer screening guidelines: among these was mammograms, being recommended every two years. This too is getting a lot of press.

The American College of Radiology, American Cancer Society, Society of Breast Imaging and American College of Obstetricians and Gynecologists recommend yearly mammograms beginning at age 40. Continue reading

Why We Need To Talk Now About The Brave New World Of Editing Genes

Screen shot 2015-05-21 at 7.48.44 PM

(Image: NIH)

It was standing room only in the Harvard Medical School auditorium last week, the atmosphere electric as an audience of hundreds hummed with anticipation — for a highly technical talk by a visiting scientist, Dr. Jennifer Doudna of Berkeley. Near the front sat the medical school’s dean, Dr. Jeffrey Flier.

Dr. Jennifer Doudna (Vimeo screenshot)

Dr. Jennifer Doudna (Vimeo screenshot)

“I don’t believe in my years at Harvard Medical School I’ve ever seen a crowd of this magnitude for a lecture of this kind,” he said.

The draw?

“The draw is, this is one of the most exciting topics in the scene of biology today.”

That buzzworthy biology topic is a revolutionary new method to “edit” DNA that has spread to thousands of labs around the world just in the last couple of years.

Suddenly, it’s no longer purely science fiction that humankind will have the ability to tinker with its own gene pool. But should it?

Learn This Acronym: CRISPR

The hot new gene-editing tool is known by the acronym CRISPR, for “clustered regularly interspaced palindromic repeats.” It acts as a sort of molecular scissors that can be easily targeted to cut and modify specific genes.

(Source: NIH)

(Source: NIH)

CRISPR occurs naturally in bacteria, but scientists are now learning to harness its power to alter DNA for research across the board — cancer, HIV, brain disease — even to make better potatoes. Just this week, the journal Science published a paper on possibly using CRISPR to try to stop female mosquitoes from spreading deadly diseases.

CRISPR looks particularly promising for human diseases that hinge on just one gene, like sickle-cell anemia or cystic fibrosis. Someday, the hope is, CRISPR and gene-editing tools like it will let us cure what are now lifelong diseases by simply deleting and replacing a baby’s “broken” gene. Continue reading

Q&A: A Taste Of The Looming Ethical Debate On Gene-Editing Humans

Boston University bio-ethicist George Annas discusses the ethical issues raised by new gene-editing tools that may eventually allow humankind to control its own genetic legacy. (Courtesy)

Boston University bio-ethicist George Annas discusses the ethical issues raised by new gene-editing tools that may eventually allow humankind to control its own genetic legacy. (Courtesy)

The powerful new gene-editing tool CRISPR is sparking excitement in biology labs — but also calls for a broad discussion about limits, and whether we should ever meddle with the human gene pool. I asked Boston University bio-ethicist Prof. George Annas for his take. Our conversation, edited:

CG: So scientists are saying we should start talking about using CRISPR to alter the human gene pool. What would a conversation like that even sound like?

GA: The conversation is not about CRISPR per se. It’s about: Now that we have techniques to edit the human genome, should we edit the human genome, and if so, for what purposes?

We’ve had this conversation around cloning in the mid-1990s. Most but not all scientists, and almost everyone in the public, agreed we should not try to clone a human being, use our genetic knowledge to make a genetic duplicate human being. And we’ve had very good luck: it’s turned out not to be possible to clone a human being. At least, we don’t know how to do it yet.

But with CRISPR, it seems much more likely that sometime in the not-too-distant future — though it may be decades, this gene editing technology will be dependable enough that someone is likely to try to use it on a human embryo.

This will be a big and dangerous step—dangerous for sure to the resulting child. Many people have no trouble with using genome editing on animals and plants, so long as you’re not harming the animal in a way that makes it suffer. But children do suffer. So the first question is: Should we ever try to edit the genomes of human embryos that are destined to become children? I think the answer is no.

I agree with the scientists who say that it’s definitely not safe to do it now because we can’t predict what other things CRISPR will do to the rest of the genome. We know very little about the genome, and what impact taking out one or a series of base pairs — with CRISPR, you can take a series out — is going to do to the rest of the genome, and hence to the whole organism as it develops.

And the problem with germ-line genetic engineering at the level of the embryo —

— Making genetic changes that will be passed on forever —

Potentially, yes. First they will be passed on to this baby, and this baby will become an adult. And if this “engineered” baby has children, the new traits will be passed on to the next generation, and so on.

So an initial question — and scientists agree with this — is, how many generations do you need to prove that a particular method of genome editing is safe? I would guess most scientists would say, at least four or five. Well, we can do four or five generations in zebrafish or in rats or in fruit flies pretty quickly.. In humans, however, it’s going to take you probably 100 years. So, how many children would you want to follow, and their offspring, for 100 years before you are ready to conclude that editing the human genome is safe for children?

That strikes me as a question that we can’t answer. Because we cannot prove it safe without putting human children at terrible risk of harm, we can’t subject any human child to this experiment. That’s because children can’t consent, and their consent is necessary as a matter of ethics because there are good reasons to anticipate that something will go horribly wrong.

And more broadly, there are potential implications for the whole human race, if we start engineering evolution — ? Continue reading