Author Archives: Carey Goldberg

Brain Scientist: How Pixar’s ‘Inside Out’ Gets One Thing Deeply Wrong

By Lisa Feldman Barrett, PhD, with Daniel J. Barrett, PhD
Guest contributors

Pixar’s Inside Out is the latest in a long tradition of animated entertainment that teaches us about science.

Chemistry, as I learned from Saturday morning cartoons, is about mixing colorful, bubbling liquids in test tubes until they explode. “Roadrunner and Coyote” cartoons—those fine nature documentaries—taught me physics: if you run off a cliff, you’ll hang in mid-air until the unfortunate moment that you look down. Computer science is apparently about robots that kill you. And now, with Inside Out, we finally have cartoon neuroscience.

Your brain, it turns out, is populated with characters for each emotion, and they press buttons to control your expressions. This is all good fun and a sweet movie. What is surprising, however, is that some scientists have taken this model seriously for a century and actually search for these characters in the brain. Not as animated creatures, mind you, but as blobs of brain circuitry.

So happiness and fear are not brain blobs — they are whole-brain constructions.

This blob over here is your “fear circuit,” they say, or this other blob “computes anger.” And every time you experience an emotion, your corresponding blob of neurons supposedly leaps into action, triggering your face and body to respond in a consistent way. Your Fear blob makes you freeze with widened eyes. Your Anger blob makes you scowl and your heart speed up. And so on.

The thing is, this science of “blob-ology” is no more realistic than detonating test tubes and hovering coyotes. Today’s neuroscientists finally have the technology to peer into a living brain without harming its owner, and it’s clear that the brain doesn’t operate even remotely in this cartoonish fashion. We might perceive Joy, Fear, and Anger as separate entities — even gloriously rendered in 32-bit color — but the evidence from neuroscience is overwhelmingly against it.

For example, my lab has analyzed nearly 100 published brain-imaging studies by other scientists, involving nearly 1,300 test subjects across 15 years, and found that no brain region is the home for any single emotion. (We do have brain circuits for behaviors like freezing and fighting, as do other animals, but not for complex mental states like fear and anger.)

In another analysis covering 22,000 test subjects across more than 200 studies over 20 years, we demonstrated that anger, happiness, sadness, and other emotions don’t have consistent responses in the body either. And plenty of studies have shown that human facial expressions have tremendous variety, far more than would occur if they were automatically launched by “emotion blobs” in the brain. Continue reading

What If Your Doctor Really Listened Instead Of Just Telling You What To Do?

(Alex Proimos/Flickr)

(Alex Proimos/Flickr)

On many a Friday, Dr. Joji Suzuki goes trawling through the medical wards of Brigham and Women’s Hospital with trainees in tow, looking for smokers.

One recent Friday, he finds Thrasher West, a patient who’d had trouble breathing but now is about to go home, where a tempting half-a-pack of cigarettes awaits her.

Dragging in the smoke, blowing it out — smoking feels good to her, West tells Suzuki. But then, she thinks, “Damn. Why’d I do that? Because it’s not good for me –” (Here, her deep cough adds emphasis.) “It’s bad for my health…Aw, I’ll give it up when I finish the pack.”

Suzuki, the hospital’s director of addiction psychiatry, does not lecture her about the risks of smoking. He does not suggest nicotine patches or pills or any other aids for quitting. He just mostly listens, and thoughtfully echoes what she says, and draws her out — when, for example, she mentions that she once quit for five years.

Dr. Joji Suzuki (Courtesy)

Dr. Joji Suzuki (Courtesy)

“Something happened, and you made a decision to stop,” he probes.

Her sons begged her, West recalls. One said, “Mommy, please stop smoking, please stop smoking.”

“Pleading with you…” Suzuki reflects.

“He had tears in his eyes. And he’s my baby, that’s my baby boy.” She reassured her son that she would be around for a long time, she remembers, and he answered, “You keep smoking, no, you won’t!”

Suzuki interprets: “They love their mama so much, they don’t want to lose her.”

The conversation, lasting just a few minutes, may sound like a simple chat. But Suzuki is expertly following principles that have been hammered out over decades and studied in copious research. He listens — actively, empathetically — more than he talks. His comments and questions remind West of her reasons to quit, and bolster her confidence that she can do it. They tap into her values and goals — her love for her family, her desire to live.

By the end, West says she wants badly to stop smoking, and she urgently asks Suzuki to write her a prescription for nicotine patches.

She has just experienced the subtle power of a method that’s increasingly popular in medicine: It’s called motivational interviewing, often referred to just by its initials, MI.

“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it,” says Dr. Allan Zuckoff of The University of Pittsburgh, a national leader in the field and author of a new self-guided book, “Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Motivational interviewing goes back decades in the field of addiction counseling, Zuckoff says, but in medicine, it’s been really taking off in the last few years.

Hundreds of studies have been published on using it in health care, from diabetes control to reducing the risk of heart disease. It’s being tried for patients with incontinence, psoriasis, hepatitis C, Parkinson’s — virtually any disease in which the patient’s behavior — taking medication, choosing food — affects the outcome. And of course, it can be used for the lifestyle issues that are the biggest driver of American chronic illness: overeating, smoking and drinking and drugs, lack of exercise.

Continue reading

The Key To Gardening Without Blowing Out Your Back? It’s Not What You Think


Say you love gardening, like Boston-based landscape designer Barbara Quartier in the video above. Say you, like her, find that your happy toil is tinged with dread, with the foreknowledge that one of these days, you’ll be pulling at a recalcitrant weed or hefting a heavy pot and boing: There goes your back. Or your knee. Or your neck. But you get carried away in the absorbing process of earthly beautification. You take chances you know you shouldn’t. What’s a gardener to do?

I asked Dr. Sharon Bassi of New England Baptist Hospital, which specializes in orthopedics and spine care, and she responded with evidence- and experience-based wisdom that diverges surprisingly from the usual folk wisdom. You know the usual maxims: Above all, bend your knees when you lift. Avoid prolonged repetitive movement without breaks. Know your weight limits.

All good pointers, Dr. Bassi says, but her central message, based on research and countless encounters with injured patients, is this: Strengthen your core, particularly your back muscles. Studies and experience suggest that matters more than specific postures.

Her advice, lightly edited:

“Many people feel that they have to lift a certain way or bend a certain way or not carry excess amounts of loads. But the reality is that it’s different for each individual, and a lot depends on how strong you are at baseline. One of the key pieces of our bodies that we fail to strengthen is the spine.

We talk about core strengthening a lot, about getting the abdominal muscles strong. But in parallel, the muscles that are less often talked about are the para-spinal muscles, and there are many of them: There are very tiny ones that hold the joints together, and there are larger ones that really help stabilize your back. And those are the muscles that we need to focus on a lot. In people who present with back strain or pain, we talk about core but we talk equally about getting the para-spinals in the back very, very strong, because that’s what helps holds you erect, that’s what helps to prevent sprain and strain injuries.

(Flickr Creative Commons)

(Flickr Creative Commons)

It’s especially important in people who are doing prolonged periods of gardening, or any type of prolonged activity — almost every activity involves your spine to a certain degree — that in parallel, those individuals strengthen those two key components. That will help prevent a lot of injuries and allow you to do almost anything in any comfortable posture and lift many pounds of weight without worrying about injuring your back.

So I think this whole notion of correct biomechanics — like bending from the knees — is really a little bit over-rated, and a little bit over-talked-about. We see plenty of people who have injuries having lifted in what is considered an ergonomically correct posture. And we don’t have great studies that show that by lifting in that manner you’re going to prevent an injury. We have more studies telling us that if we strengthen, that we can pretty much lift however we want, however it feels comfortable, because we will inherently be engaging the right muscles.”

(Here both Barbara Quartier — who goes by Barbara Peterson in her landscape design business — and I expressed some shock. We’d heard forever about bending our knees, but never a word about our para-spinals.)

“It really is a common misbelief,” Dr. Bassi responded. “We see patients who say, ‘I knew I lifted this wrong, and that’s why this happened,’ but that’s not necessarily true.”

So the question instantly arises, of course: How to strengthen those para-spinal muscles? Continue reading

Having A Baby? Big Differences In Hospital Quality Across Massachusetts

If you’re one of the roughly 70,000 women who will give birth in Massachusetts this year, you may be planning to deliver at a hospital close to home or where your OB practices. But what you might not realize is that when it comes to childbirth, there are big differences in hospital quality across the state.

For example:

  • Your chance of having a Cesarean section is almost three times higher at some hospitals
  • While some hospitals allow you to schedule an early delivery even when it’s not medically necessary, other hospitals have stopped this practice because a baby’s brain, lungs and liver need the full 39 weeks to develop
  • Your chance of having an episiotomy — a surgical cut to enlarge the vaginal opening — ranges from 0 to 31 percent
  • Trying for a natural delivery after having had a C-section is encouraged at some hospitals but not offered at others
  • Three times as many women breastfeed their babies at some hospitals as compared to others

“The door you walk in will have a big impact” on what happens during and after childbirth, says Carol Sakala, director of programs at the nonprofit maternity quality group Childbirth Connection.

The hospital where women choose to deliver “absolutely matters,” says Dr. Neel Shah, an assistant professor of obstetrics at Harvard Medical School. Take C-section rates, Shah says. “In many ways, which hospital you go to is a bigger predictor of whether or not you’re going to get a C-section than your own risk or your own preferences.”

Continue reading

Related:

Transgender Patients Create Their Own Networks Of ‘Safe’ Providers

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT organizations. (Jesse Costa/WBUR)

RAD Remedy pools and vets referral lists of doctors, nurses, dentists from LGBT groups. (Jesse Costa/WBUR)

A nurse looked at the couple: a man of medium height with a large belly and a tall, thin woman. The nurse handed the woman a small paper cup and asked for a urine sample.

“Well, that’s not really going to work because my husband is the one who’s pregnant,” the woman said. Then Karl Surkan, a transgender man who teaches gender studies at MIT, took the cup.

“Well, then I guess I need a urine sample from you,” Surkan remembered the nurse saying to him.

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Jonathan Pauli, left and Karl Surkan are the co-founders of TransRecord. (Martha Bebinger/WBUR)

Other nurses and doctors might make the same mistake. Transgender men are pretty unusual in OB offices and maternity wards. The nurse in this case wasn’t hostile, Surkan said, just “not knowledgeable about the existence of masculine-looking people who are pregnant.”

Still, Surkan would give the nurse a low score on an online provider rating system he co-founded late last year — TransRecord.com. Transgender and genderfluid patients log in, name a provider, and respond to eight questions that identify a doctor, nurse or counselor as transgender friendly — or not.

“This is a population that is heavily medicalized,” Surkan said. From the pre-transition period, through a gender change, to potentially decades of hormone therapy, these patients will be frequent users of health care. Continue reading

Related:

Mass. AG Shifts Health Care Costs Conversation To Behavioral Health

If you have ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy.

Now, that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. It takes stock of behavioral health benefits and the low health insurance pay rate for these services in Massachusetts. Healey is shifting the focus of her office’s health care cost report after several, under former Attorney General Martha Coakley, that highlighted the wide gaps between payments made to high- and low-cost hospitals.

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Attorney General Maura Healey speaks during a press conference at the State House in June. (Jesse Costa/WBUR)

Healey says she’s changing gears because “it’s really important to look at the whole health of the patient.”

“We need to get to a place where we treat people who’ve got mental health, substance abuse issues in the same way we treat patients with diabetes or with cancer or with broken bones,” Healey says.

Seventy-nine percent of Massachusetts residents enrolled in MassHealth or ConnectorCare have coverage that separates general medical care from mental health and substance abuse. For members of commercial health plans. that number is much lower but still significant: 31 percent.  Healey’s report does not say that the separation is necessarily bad, but that the state needs a better system of sharing patient information between medical and behavioral health providers, and more coordination of care.

Continue reading

Study: Jolt Of Java Before Exercise Makes Legs Stronger But Not Arms

(Wikimedia Commons)

(Wikimedia Commons)

By Marina Renton
CommonHealth intern

Wondering whether you should forgo your Starbucks run in favor of a cross-country run before work? According to a study just out in the June issue of the journal Medicine & Science in Sports & Exercise, no need to give up your morning cup (or two) of coffee for a trip to the gym. In fact, the caffeine could enhance your performance — particularly your legwork.

The study is titled “Caffeine’s Ergogenic Effects on Cycling: Neuromuscular and Perceptual Factors.” (Vocabulary note: “Ergogenic” means “enhancing physical performance.”) It consisted of two experiments in which young adults consumed caffeine — equivalent to between two and three cups of coffee — and then cycled using their legs and arms.

The researchers found that caffeine improved leg muscle performance but not arm muscle performance, and it decreased sensations of pain and perceived effort in both legs and arms when the exercise was at a moderate intensity level.

The takeaway? Barring any special circumstances — like being adversely affected by caffeine or having heart trouble — you needn’t hesitate to caffeinate before you exercise.

I spoke with Christopher Black, assistant professor of Health and Exercise Science at the University of Oklahoma and lead author of the study. Our conversation, lightly edited:

Could you summarize the study’s results?

There are multiple parts to the study but, in general, here’s what we found: Consumption of a 5-milligram-per-kilogram body weight dose of caffeine — which is the equivalent of maybe two to three cups of coffee depending upon how much you weigh and what kind of coffee it is — improves cycling performance if you ride the bike with your legs. But, that same dose does not improve cycling performance if you ride the bike with your arms. And that’s the big, real-world performance measure of things.

We ascribe that difference of effect to the fact that caffeine improved people’s strength in their legs but not in their arms. And it improved that strength by allowing them to turn on more of their muscle.

In what form were people given the caffeine? Continue reading

More Health Coverage, And Perhaps More Health, For Same-Sex Couples

A crowd waves rainbow flags during the Heritage Pride March in New York on Sunday, June 28. (AP)

A crowd waves rainbow flags during the Heritage Pride March in New York on Sunday, June 28. (AP)

You know how it goes: You have the great joy of the wedding — or of the gay pride celebrations that followed the Supreme Court’s marriage decision — and then the honeymoon’s over and it’s time to talk about the mundanities of stuff like (sigh) health insurance.

But still, it can be at least quietly pleasing to contemplate the many a newlywed who’ll now qualify for insurance offered by their new spouse’s employer. (And that on top of the several million people whose health insurance subsidies were just saved by the previous Supreme Court decision, on Obamacare.)

Not to rain on the weddings, but it’s also likely that many employers’ “domestic partner” benefits will go away. The picture is complex, but a study just out in JAMA finds that legalizing gay marriage does indeed increase employer-based health insurance coverage for same-sex partners. It looked at New York after gay marriage was legalized there in 2011, and more than 12,000 same-sex couples wed. From the press release:

Compared with men in opposite-sex relationships, same-sex marriage was associated with a 6.3 percentage point increase in ESI [employer-sponsored health insurance] and a 2.2 percentage point reduction in Medicaid coverage for men in same-sex relationships. Same-sex marriage was also associated with an 8.9 percentage point increase in ESI and a 3.9 percentage point reduction in Medicaid coverage for women in same-sex relationships vs women in opposite-sex relationships.

I asked the study’s author, Gilbert Gonzales of the University of Minnesota, whether anyone had done a similar study in Massachusetts after our own pioneering legalization of gay marriage more than a decade ago. He replied by email:

The only Massachusetts study I’m familiar with is an American Journal of Public Health study that found potential improvements in gay and bisexual men’s health after MA enacted same-sex marriage in 2003. There were significant reductions in mental health care visits and expenditures in the year after MA enacted same-sex marriage, which suggests broad public health benefits for LGBT people when states recognize same-sex marriage.

Another related study on health insurance coverage looked at the 2005 domestic partnership law in California, and found the law increased health insurance coverage among lesbian women relative to heterosexual women. There was no similar finding for gay men. The JAMA study suggests that legal same-sex marriage–rather than domestic partnerships–may improve coverage options for both men and women in same-sex relationships.

How many people in all may gain employer health insurance thanks to the Supreme Court ruling? Continue reading

Further Reading:

Why Your Doctor Might Want To Track Your Tweets

The little digital breadcrumbs you blithely leave in your wake — the tweets, the online searches, and communities you join, the wearables that account for every step and bite — are beginning to coalesce into what could ultimately become a critically important portrait of your true physical and mental state.

At least that’s what John Brownstein of Children’s Hospital Boston and his colleagues argue as they analyze and collect these “breadcrumbs” amassing a wide spectrum of data to support a broad new concept of personal and public health that they call the “digital phenotype.” It’s like a contemporary extension of the more traditional phenotype — one’s observable characteristics based on a mix of genetics and the environment.

(Medisoft via Compfight/Flickr)

(Medisoft via Compfight/Flickr)

In a sort of digital phenotype manifesto published earlier this year in the journal Nature Biotechnology, Brownstein, an epidemiologist and associate professor at Harvard Medical School and chief innovation officer of Children’s Informatics program, and others, explain the idea like this:

…there is a growing body of health-related data that can shape our assessment of human illness. Such data have substantial value above and beyond the physical exam, laboratory values and clinical imaging data — our traditional approaches to characterizing a disease phenotype. When gathered and analyzed appropriately, these data have the potential to fundamentally alter our notion of the manifestations of disease by providing a more comprehensive and nuanced view of the experience of illness. Through the lens of the digital phenotype, an individual’s interaction with digital technologies affects the full spectrum of human disease from diagnosis, to treatment, to chronic disease management.

Or, put another way: the digital phenotype adds a unique, more fine-grained look at the way people actually live each day.

Here’s one real-world example: Michael Docktor, a gastroenterologist and director of clinical innovation at Children’s Hospital Boston, treats many patients with Irritable Bowel Syndrome and one thing he usually requests is a detailed food diary. “Sometimes teenagers dump a 50-page food diary on me, and it’s hard for me as a human being to comb through that and, perhaps, find that milk, for instance, is a problem.” But, he says, “if we had that information digitally, tracked by software that used algorithms and machine learning to figure out the meaningful correlations and serve it up in an easily digestible format — that could be transformative.” Continue reading