S2 Episode 4: What’s So Funny?

Phil Stieg: Welcome! Today I have with me Dr. Ori Amir, Dr. Amir is a neuroscientist at the University of California. He is a leading researcher on the way our brains create and understand humor. Probably equally important, he is a part-time stand-up comedian. He is here today to help us understand where humor originates in the brain. Ori, welcome.

Ori Amir: Hello!

Phil Stieg: Before we even get going or a can you explain to me what is a joke and what constitutes humor?

Ori Amir: Humor, I believe for something to be funny, it has to have a logical mechanism and in which there is some kind of a switch of perspective. So you have two scripts or two possible ways to interpret a situation and and you switch between one to another essentially. It doesn’t have to be the listener being surprised or switching. It could be somebody else that is being observed, you know, like in a practical joke, you know, what’s going to happen. But you still find it funny when somebody else is being surprised. And then there is the emotional mechanism by which the joke has to make you somehow happier. It could provide a relief, titillation, their schadenfreude, the switch of scripts somehow make the listener happier.

Phil Stieg: Is humor or a joke one of those things that a beauty is in the eye of the beholder. What you might find humorous, I don’t necessarily?

Ori Amir: For sure, although the you probably would recognize something as a joke even if you don’t find it funny. So there is a structure to it. There is a logical structure to it. If you at least understand the language and the reference, you would know it’s a joke.

Phil Stieg: Can you go to school? Can you go to a class and say, you know, all of a sudden I decide I think I have a sense of humor. I want to try to be a little bit funnier. Can you go take classes on how to construct the joke and be humorous?

Ori Amir: I’d say, yes. I mean, there definitely would be the people who would say, no, you’re born with it. And it’s a talent. And I think it’s a combination of both. And, you know, it could be helpful. It could help to an extent. I’ve seen people improving with comedy classes .

Phil Stieg: Yeah. So, do you personally – You get more satisfaction or equal satisfaction out of studying humor or being a standup comedian.

Ori Amir: It varies and I guess I guess an emotionally thrilling to a greater extent is is actually is performing comedy.

Phil Stieg: So, your research focuses on the brain’s function as it is involved in what creating humor is that the approach that you’re taking? You’re looking at process, function or the result in the brain?

Ori Amir: It’s a whole process. When you were exposed to a joke, for example, you know, there is that initial processing and then when you get the joke. And the same for comedy generation, I looked into what is the difference between, for example, professional comedians and amateurs and non-comedians that their brain activation during the process of coming up with a funny idea. So it’s a sequence. There’s a bunch of stages to it.

Phil Stieg: So, you’re, you’re fundamentally looking at a person’s process of writing a joke? Is what you’re looking at?

Ori Amir: Yes, sir.

Phil Stieg: Let’s break it down into a process, OK? So, what parts of the brain are activated when a comedian is creating a joke?

Ori Amir: The short answer is pretty much everything.


But there are areas where the unique things that have to do with writing jokes happen.

So in our experiment, what we did was we shove the those comedians and non-comedians into this tube, the MRI machine.

Voice Inside Comedian’s Head – “So this is an MRI Machine? Man! Who knew it was going to be so cramped … (noise starts) … cramped and really noisy! – This would be a bad time to learn I’m claustrophobic.

Ori Amir: And so basically they’re lying there, and they’re looking through some mirror were some New Yorker cartoons are being displayed. And they basically have to come up with captions in 15 seconds to those to those cartoons.

Voice Inside Comedian’s Head – Ok, so what have we got? A psychiatrist’s office – and there’s an elephant on the couch. Um… “Geez Doc, I wish I could forget sometimes”? No, no. How ‘bout “I’m in the room and NOBODY will acknowledge I’m here!” (rim shot sound effect) Yeah!

(music out)

Ori Amir: So, this is the task.

Phil Stieg: Now the assumption is that the caption is humorous. But in reality, how do you determine whether it is humorous?

Ori Amir: Well, first of all, I ask them to come up with a humorous caption. (laugh) Also we do have we do save those captions and we give them to some undergraduate students who have who have to do our experiments and they have to rank those captions for funniness. Each caption was rated by something like four undergraduate psychology students. And the average rating was the funniness of the joke.

Phil Stieg: Are your subjects willing? Is this a happy time for them to work with you?

Ori Amir: And it beats the alternative, some of the other experiments they could have done.

Phil Stieg: (laughs) You’re gonna start with painful electrical stimuli and see if they can crack a joke under those circumstances, huh?

Ori Amir: If you’re taking introduction to psychology, you participate in some experiments and ours. Our experiment was not one of the more boring ones.

Phil Stieg: So, did you see the parietal lobe light up ?

Ori Amir: Obviously you would see areas in the brain involved in vision like, you know, processing the image in areas involving in language in, you know, just just crafting the sentence that that makes up the caption. But we try to see what is unique to humor creation. And we think that there and certain areas in the temporal cortex like the area next to your ears, this is sort of a high level area where information from all over where the brain converges which allows you to essentially put together remote associations. Many jokes are about the surprise. I f you want to surprise somebody, it has to be a remote association, but it also has to be something that is not completely unrelated. For information from remote areas of the brain to to converge and to be become meaningful as a joke, and it has to be in an area where in terms of the architecture of the brain, this is possible. And this area next to the ears is where this kind of action is possible.

Phil Stieg: What difference did you see between trained comedians and, as you call it, amateurs, you know, did different parts of their brains light up?

Ori Amir: The same brain areas are activated, so it’s not completely different for them. But you have a difference in magnitude. So and the temporal area that we described has been activated more in amateurs compared to non-comedians, and more in professional comedians compared to amateurs. But at the same time, at the prefrontal cortex, the area in the front of the of the head, and that is involved in in control of the thought process. So essentially, it’s kind of like the conductor of the orchestra. The creative ideas don’t come from it, but it’s kind of directing the creative process. So it’s less activated the more experience you have. And you need less of a conductor to an orchestra when you when you have that professional musicians, essentially.

Phil Stieg: Or you’re less inhibited. I mean, since this is the executive function of the brain, probably, I would suspect, tamps down some of our zanier ideas.

Ori Amir Absolutely.

Phil Stieg And to be a comedian you don’t want to tamp it down. Right?

Ori Amir: And that is what I think one of the more common advice that, you know, improv teachers give students is “get out of your head” , meaning you want to disinhibit your thought process. And so I guess the translation to neuroscience language would be, you know, “Reduce the activity of your prefrontal cortex!”

Phil Stieg: Well, I would presume that that’s true in all of the creative forms of, you know, art, music, other things. You want to be more expansive. Correct?

Ori Amir: Yeah, I mean, in the end of the day, you do want to have some and some direction and some logic to the composition. You don’t want to be completely random. And this is why perhaps like the one common factor or the one common area that is activated in all kinds of creative processes like rap improvisation to jazz improvisation, to painting all seem to activate this pre-frontal cortex area. But the magnitude apparently is smaller for the more experienced.

Phil Stieg: Was there any major surprise as you were going through all this? You went, oh, my God, I didn’t expect that at all.

Ori Amir: One thing that we found was that… The striatum is a reward region, so essentially anything that you do that is rewarding, so you eat sugar, you look at a picture of a loved one, also when you enjoy comedy, you would see activation in this area and the striatum. So, what we found that that activity in the striatum before you even come up with the joke at the very beginning, predicted to some extent how funny the joke is going to be that you write.


Phil Stieg: I’m sure there’s differences between being a neuroscientist and being a comedian. Are they both equally difficult?

Ori Amir: Funny enough, I feel like in neuroscience, you know, it ends up losing its challenge at some point, whereas comedy keeps being challenging. But that might be just because I haven’t worked on it enough. You can take your skill and intelligence to to its limits and with both with both pursuits.

Phil Stieg: So may I ask you to combine both and do you have any good neuroscience jokes?

Announcer: Ladies and Gentlemen, put your hands together for the comedy stylings of Dr. Ori Amir, PhD!

Ori Amir (on stage in a comedy club)
So, as you can tell by my accent, I am a neuroscientist.

Well, I just got my PhD. And if you’re all wondering what’s the difference between a Ph.D. and an M.D.? Em, it’s about 10 times less women.

When I told my friend that I am going to LA to pursue a Ph.D. at USC. They said, “Wow, you must love learning!” No, I just really like acronyms!

My dream is to become a professional comedian and an amateur neurosurgeon. If you all want to have a PhD like me, here’s what you gotta do. It’s going to take seven years. In the first five and a half years you’re going to work very hard on developing a silly accent.

And then you do some original research, and it all culminates in a dissertation defense in which you present your work in front of five important neuroscientists. And if you fail, they eat your brains.

Yes. Thank you very much ladies and gentlemen. (applause)

(Music under & fade)
Phil Stieg Which came first for you. Was it being a humorist – or was it being a neuroscientist and then you got interested in humor?

Ori Amir: Well, I was I was a neuroscientist first you know, I was studying it and the university I was at, USC in Los Angeles. They had a comedy group which I just accidentally ran into. And I was like, “Oh, that is fun”. You know, I tried it and I was I was hooked. And Los Angeles has a lot of open mics and a lot of comedy clubs. So I just got involved in the scene. And I was actually feeling guilty that I was like, oh, I’m wasting too much time on comedy or I’m wasting too much time on neuroscience, depending on what I was like thinking I’m going to be in the end at the time. But then I figured I can potentially combine those two, and especially since I was in Los Angeles. And, you know, we’re not far from half of the famous comedians in the world and we have a fancy brain imaging machine. I guess I was lucky. I was just in the right place for comedy, in the right place for brain imaging. And it just I didn’t even I didn’t plan any of this, but I realized the potential of the situation.

Phil Stieg: So is there something about nighttime and humor? Because, I mean, if you think about it, the nighttime shows – Johnny Carson, Jay Leno, of all the stuff, Saturday Night Live, all that’s at night. You never hear of a mid-afternoon comedy show.

Ori Amir: I don’t know what it is. I think something about darkness and you feel less inhibited to laugh. You want the room to be dark. You want the people to sit close together. You want the ceiling to be low. All of those those elements appear to make people laugh more.

Phil Stieg: I just don’t know whether at night, I’d have to look, as to whether, you know, more serotonin or dopamine is released when we’re getting ready for bed. So it puts you in a happier mood to appreciate a good joke.

Ori Amir: You know, that is very possible. I actually don’t know it myself. But it also the darkness itself plays plays a role. I’ve been performing in the evening in some countries where the sun goes down at 11 p.m. and it’s not it’s not a very easy place to perform.

Phil Stieg: Really? OK. That’s amazing.

Phil Stieg: Ori, when you’re performing, is there a high that occurs and how long does it last?

Ori Amir: Em – not as often or as long as I want it, but — being nervous. I rarely am nervous recently before performances, but if I am, it’s usually results in a better performance and a better high.

Phil Stieg: So question to you is, what about, you know, taking this into the therapeutic realm? What about humor, therapy? You know, in this day and age with Covid, how can we just get people to lighten up a little bit and stop worrying so much?

Ori Amir: I feel I feel like our major aim of the field is the field is to make people people keep worrying.

Phil Stieg: You want to keep people worrying?

Ori Amir: It seems like if you watch any of like those comedy shows, like The Daily Show or whatever – it’s all about getting people to stay worried.

Phil Stieg: Yeah. (laugh)

Ori Amir: You can you can consider comedy clubs for comedians to be humor therapy.

Phil Stieg: The comedians themselves.


Phil Stieg: So the take home message from from all of your research is — question mark?

Ori Amir: We’re still working on the question.

Phil Stieg: And yeah, you never have the perfect question. Right?

Ori Amir: I mean, if we had the take home message, we could have retired.

Phil Stieg: So where do you go next with this? What’s your goal with the research?

Ori Amir: Well, currently I’m playing around with artificial intelligence. I want to sort of try to mimic to see to what extent you can mimic the process that the human brain does when writing jokes. I don’t think that AI will be as good as humans in generating jokes until it will be as good as humans in pretty much everything else. But being good as humans in pretty much everything else, I believe is around the corner.

Phil Stieg: Well Ori, it’s a pleasure. I truly appreciate you taking the time to explain to us what humor is about, how it’s constructed and where it’s located in our brain. And even though you haven’t found my funny bone, you at least give me kind of map to start thinking about where it is. Thank you for being here.

Ori Amir: Of course. And everybody who listened to it would is now guaranteed to be twice as funny.

Phil Stieg: We can only hope, right? We need more. Trust me. I think we need more humor in the world right now.

S2 Episode 3: Are You Smarter Than A Teenage Neuroscientist?

Phil Stieg: I’m excited to welcome Dr. Norbert Myslinski, founder of the U.S. Brain Bee, a program designed to help motivate teenagers and inspire interest in the neurosciences. In addition, he founded the International Youth Neuroscience Association. He is a professor at the University of Maryland. I’ve invited him today to make us aware of these amazing programs. He has grown the brain into an international phenomenon with over 250 chapters in countries throughout the world. Norbert, congratulations on your success and welcome.

Norbert Myslinski: It’s a delight to be here. Thank you for inviting me.

Phil Stieg: So tell everybody what the International Brain Bee is.

Norbert Myslinski: The Brain Bee is a competition in neuroscience for teenagers.  And what we want to do is to inspire these young men and women to study the human brain.

Phil Stieg: Just in thinking about this, you know, just the function of the brain is overwhelming.  You know, having done this for 40 years now, I’m still daily amazed at what I don’t know. And if I’m a 13-year-old person, it would seem to me a little bit daunting.  What do you do to help them prepare for and guide them for the competition.

Norbert Myslinski: First of all, these young men and women are very smart, they’re very well motivated,

Phil Stieg: Smarter than you and me, right?

Norbert Myslinski: Absolutely! It gives me a lot of faith in the future knowing that these individuals would be leaders in days and years to come. You know, initially I tried to make it relatively simple. Like you said, neuroscience is complex. It’s not open ended. There are some resources that we provide for these men, women around the world that the question has come from. And these resources are translated into many languages and they are available free of charge. We don’t charge anything for the students to compete.  And so we help them that way. And then there are, in the local chapters, have their own ways of preparing the students. They have Brain Bee preparation courses and classes. Some of the competitors are invited into universities, cadaver labs to look and examine the brains. There are organizations that help to prepare the students like the International Youth Neuroscience Association

Phil Stieg: How many students are we talking about on an annual basis? 

Norbert Myslinski: We’re talking about, oh, about thirty thousand students.

Phil Stieg: Wow, and that’s worldwide?

Norbert Myslinski: That’s worldwide. We have about two hundred and fifty chapters (actually more than that) Two hundred fifty chapters in about 50 countries in six continents all around the world. 

Now, the actual competition itself, at the chapter level, is relatively simple. It’s usually questions and answers. The students that win at the chapter level, they are then invited to their respective national championship 

Audio from Kansas City Brain Bee 2011

You’ll have 30 seconds to answer.  If you’re correct I’ll let you know.  If not, that’ll be counted as a strike.  

Electro Convulsive Therapy is used to treat what brain disorder…

What lobe of the cerebral cortex is the hippocampus located in…

Huntington’s Chorea is characterized by lesions in what …  

What do you call brain peptides that block pain and cause sleepiness…

What do you call the chemicals that support the survival of distant groups of neurons.  Optifactors is correct.

Norbert Myslinski: And then those that win their national championship get to compete at the world championship, which is in a different city every year.

Phil Stieg: Does each level have a similar format or a different format?

Norbert Myslinski: Yes and no.  We’ve added on since it started maybe four additional components to the competition. One is the neuroanatomy practical, where the students actually go into the cadaver labs of medical schools and they are at different stations that have 20, 30 different human brains, real human brains or brain parts, and they’re asked to identify parts of the brains.  And this portion actually is comparable to the neuroanatomy exams that medical students take.   Another component is called patient diagnosis, where we have actors who sit down with each individual student individually and they converse.  And the student has to diagnose what that actor with that patient has. By listening to the patient, looking at the patient, the individual can ask three questions of the patient. The student can ask two different laboratory or clinical tests and from a long list of neurological disorders and have to decide what condition this individual has.

Phil Stieg: This is really amazing in the sense that you go from a student’s ability to memorize, ability to integrate that memorization into a clinical setting. And now you’re starting to work on their emotional IQ so that they can integrate science into society and communicate it and maybe try to affect health care policies. So you really cover the full spectrum of the human personality using neuroscience.

Norbert Myslinski: We have to keep up with the students. (laugh)

Phil Stieg: So why do you think so many students want to compete in this thing? What is it about it that they like? Do they win anything?  Do they get a big prize or…

Norbert Myslinski: They get a big trophy. That’s called the Norby Trophy. (It’s named after me.) They get a scholarship, small scholarship. They get an opportunity to work summer-long in a neuroscience laboratory with a famous neuroscientist. And it’s not just what they get. I mean, they are so interested in this science, but they do not get it in high school.  In the United States, you can’t find neuroscience at high schools.

Phil Stieg: The students that win the competition. They’re the best competitors. Have you found that they go on to actually become the best scientists?

Norbert Myslinski: We did some surveys in the past.  The vast majority of them, 67 percent said that it’s a very worthwhile experience, that it helped direct them toward science. And, you know, around 40 percent said that they went into careers where science is involved. And about 30 percent of that said that they actually went into the neuroscience field, Yes.  So so they are very, very successful.  Look at Julieanne McCall.  

She was in the United States brain when she was in high school. She got third place and she inspired her so much that she went on to her hometown in the Midwest and started another chapter.  And she went to college and started a chapter there. Her adviser went to Germany. So she followed him there and made a whole German country, a Brain Bee country. She was there. She was helping out. She was very enthusiastic.  And she was a very good role model because she was young not that old like me.

Phil Stieg: We took Dr. Myslinski’s advice and reached out to former Brain Bee competitor (and now PhD Neuroscientist) Dr. Julianne McCall.  Dr. McCall is a staff scientist in the Office of Planning and Research for the Governor of California.

Julianne, welcome.  It’s really a pleasure to talk with you. I would like you to tell me a little bit about what your experiences were with the Brain Bee.

Jullianne McCall: Oh, I could go on and on, Dr. Stieg. I first participated as a high school student myself in northeast Ohio in 2002. So almost 20 years ago now. My principal at the time knew that I was fascinated by neuroscience.  So the Brain Be was just a natural, you know, after school activity for a 17 year old in 2002.

Phil Stieg: So, tell me what that experience was like as a 13 to 19 year old. I mean, what did you have to go through to be part of this Brain Bee? 

Jullianne McCall: You know, you would hardly recognize the brain be of 18 years ago compared to what it is now. It was an exciting one for sure. But, you know, much like an academic competition rather than a time to come together as a group and learn from one another.

Phil Stieg: In terms of the competition, what did you personally find to be the most difficult portion?   

Jullianne McCall: Oh, by far it’s being asked very complicated questions from a panel of intimidating scientists. As a as a young kid, you don’t know.  You’ve never met a scientist before. And in your mind, you picture, you know, people reading textbooks over dinner and talking about philosophical intellectual questions over breakfast. So I was deadly nervous when I had to get on that stage. I loved the neuroanatomy part. I just I could have stayed in that room with the cadavers for hours.

Phil Stieg: Well, what I find amazing is when I looked at what they test you on the competition, it ranges from intelligence to memory to emotions, stress, sleep, degenerative disorders like Alzheimer’s, autism, addictions. I mean, what 13-year-old walks into this of being facile at answering complex questions by prominent scientists?

Jullianne McCall: You would be delightfully surprised by how many young teenagers are already into this kind of stuff. For example, the 2013 International Brain Bee. It was my first time directing the International Brain Bee, and the young man from Italy had already set up a neuroanatomy station in his garage.  He would take take animals and literally go through those dissections with a textbook open next to him. So there’s hope for the world yet.

Phil Stieg: You’re bringing back memories of both me and my cousins. We all got PhDs and some of us went on to medicine and we created our own laboratory with microscopes, dissections…  Yeah, the bug gets you very early in life, that’s for sure…

Jullianne McCall: Especially with the brain that’s, you know, with such low hanging fruit to bring people into science and the wonders we still have yet to discover

(Music up)

Phil Stieg: We’ll return to our guests in a moment.  During the break, you’ll have a chance to see what it’s like to train for your own Brain Bee. 

Phil Stieg; We continue with our conversation with Dr. Julianne McCall, former Brain Bee contestant and now a science advisor in the office of the Governor of California.   I had asked if she could tell me what originally sparked her interest in neurosciences.

Jullianne McCall: Gladly. So my kid sister was born when I was nine years old and she was diagnosed in utero with hydrocephalus. The condition was so extreme that the doctors didn’t even expect her to survive to birth.  And she is now twenty-seven years old and breaking all sorts of expectations going above and beyond what we had ever hoped and dreamed for her. She’s capable of so much love and joy and has a vivacious appreciation for nearly every day. And the magic that took place that allowed – that granted her that opportunity to experience happiness and love in the way that she does and share it with the rest of the world continues to be an inspiration. And neuroscience is a core part of that.

Phil Stieg: I find that true in many of our neurosurgical applicants. They’ve had family members that have had some neurologic disorder that they’ve overcome, and it motivated them to get involved in the science.

Jullianne McCall: Yeah, I would never wish it on my worst enemy.  But truly, it’s been the key motivating factor in my life

Interstitial – This Is Your Brain: The Guided Tour

Phil Stieg: I’d like you to think about applying what you’ve done with Brain Bee and how you’ve used neuroscience in your life to affect other people.  Are there lessons that you’ve learned that are applicable for other areas in life where we can work with teenagers to expand and get them involved in things?

Jullianne McCall: Oh, absolutely, yeah.  Teenagers, they just thrive on that social connection. I wish you could join us for an International Brain Bee. We’ve created a feeling of it being a festival, right. Where we bring them together in the same hotel for four days and they can’t stop talking to one another. They fall in love with the opportunity to connect over distances and cultures around a fascination and an excitement for science.  And so I take that model and I try to replicate it in everything I do, whether it’s organizing TEDx conferences or coordinating science policy conferences now, in my role in the governor’s Office of Planning and Research and bringing people together around public good missions. That was definitely part of the Brain Bee inspiration.

Phil Stieg: Julianne, that was fantastic. I hope that the 13-year-old is listening to this and gets motivated to follow your path.

Jullianne McCall: It would be such a privilege to know that that that’s an outcome of this interview.

Music up and under

Norbert Myslinski: But you know, it really does me good when I see these students working together and playing together and interacting and developing friendships. you know, We have like 50 different countries involved I mean, we set them up alphabetically and right next to each other. You have a young man from Iran and a young lady from Israel, and they talk together.  And I tell you, I’m saying to myself, these are the leaders of the future. And right now they are going to remember these experiences. And I’m saying that “gee, the international brain is an instrument of peace”.

Phil Stieg Dr. Norbert Myslinski, it has been an honor, a pleasure your vibrancy is palpable and what you’ve done with the brain be and the International Youth Neuroscience Association and the world impact that you’ve had is essentially immeasurable. I hope and pray for more individuals like you. And I hope that Julianne McCall continues your work in the future, since she’s much younger than both of us. 

Norbert Myslinski: (laugh) Okay Dr. Stieg! 

S2 Episode 2: The Change Is Gonna Come: Menopause and the Brain

Menopause can wreak havoc on mood and body temperature as it signals the end of fertility, but some of the biggest changes it causes are in the brain. Emily Jacobs, assistant professor in the department of psychological and brain sciences at UC Santa Barbara, explains how the precipitous decline in estrogen during the “change of life” disrupts the endocrine system, and why menopause makes some women feel like they’re going crazy while others sail through unscathed. Plus: Hear from real women describing the wide range of effects they experienced.

Phil Stieg: Hello, today, I have with me Dr. Emily Jacobs. Emily is a neuroscientist at the University of California, Santa Barbara, in psychological and brain sciences. Currently, she focuses on sex hormones and their influences on brain function, in particular brain changes that occur around menopause,
Emily, thanks so much for being with us.

Emily Jacobs: Thank you so much for having me.

Phil Stieg: How long is the typical menopause period? And as I understand it, there are specific stages in menopause. Can you describe that for me?

Emily Jacobs: Menopause is a transition. It starts with, you know, a fully reproductively capable woman with regular menstrual cycles. And we enter sort of a late reproductive stage and then perimenopause where we start to see infrequent cycles. They may grow shorter or longer in length. And this is where we get a lot of kind of turbulence, where hormone levels can have a much greater dynamic range. But eventually it starts to fall down. And by post menopause, which is defined as 12 months, one year without any cycle, ovarian hormone levels have declined by about 90 percent. That’s estrogen and progesterone from your ovaries. Those levels have really plummeted.

Phil Stieg: Can you tell me what kind of emotional and physiologic changes women experience when going through menopause, and then why do others not experience any of those at all?

Emily Jacobs: When we talk about these hormonal changes where you have this 90 percent decline in the production of ovarian hormones, those hormones are going to act on a lot of different bodily systems, not just the brain. And that’s the power of hormones. Hormones do not have targeted effects. You know, they have sweeping effects across an organism. But from a brain perspective, we know that about 40 percent of women will experience brain fog—

Phil Stieg: Permanent or temporary?

Emily Jacobs: Well, that is the question. And for most women, it’s likely temporary, that it’s driven by the perimenopausal state where these hormones are really kind of showing these large dynamic changes. But by post-menopause, you know, there are very … These are self-described cognitive changes, which are real. But when we put them, you know, when we bring women into the lab and give them a whole battery of cognitive tests, there are very few that are going to pick up these sorts of subtle cognitive differences.  It’s we know women don’t go crazy through the menopausal transition. We’ve got plenty of evidence that’s not the case. But but that’s not to say that these changes that they’re experiencing aren’t real. And one of the goals of my lab and many others who are focusing on this is to try to understand kind of what’s going on under the hood in terms of their brain structure and function that might make some women more susceptible to those cognitive changes.

Phil Stieg: Emily, I don’t think most of the population really understands how much of an endocrine organ the brain really is. Can you clarify that for us?

Emily Jacobs: Sure. When we say that the brain is an endocrine organ, we mean that in a couple of different ways. So the brain, and particularly a region called the hypothalamus, which sits right at the base of your brain, produces hormones. It guides the production of hormones from other organs, other peripheral endocrine glands in your body. So there’s this tightly coordinated, what we call a neuroendocrine cascade, where your brain, through the production of hormones in the brain itself, can guide the production of hormones in places like your testes or your ovaries.  And then the loop comes back full circle where those hormones, like estrogens and progesterone and testosterone that are produced by these endocrine glands, travel through your bloodstream and those hormones can bind to receptors that are also in your brain.

Documentary Voice: A lot of my friends who’ve never experienced menopause symptoms have asked me what it feels like and the only thing I can compare it to is like being in on a Coney Island roller coaster. So my brain and body feels like it’s climbing towards some sort of the top of something. And then the heat is the ride down.
(music out)

Phil Stieg: So I don’t think we touched clearly upon why some women have brain fog and others don’t.

Emily Jacobs: You know, the spectrum goes through from women who experience no symptoms whatsoever. In fact, don’t even kw that they’ve gone through menopause. If you know they’re not tracking their cycles, I mean, really, truly just sail through to women who become debilitated and experience, you know, what can be quite severe forms of perimenopausal depression, severe vasomotor hot flashes, brain fog. And it is a complete spectrum from one end to the other. Most women will not experience these sort of severe outcomes, but some will, and we need to be able to speak to the entire population and understand what may be driving those individual differences. And, of course, consider these women, you know, in a nuanced way that appreciates that full spectrum.

One of my favorite statistics, is that in the prefrontal cortex, 50 percent of your neurons pyramidal three neurons, 50 percent of them contain estrogen receptors. Half of the neurons in your frontal lobe express estrogen receptors—

Phil Stieg: Men and women?

Emily Jacobs: To the best of our knowledge.  And this suggests that this hormonal signal of estrogen is like a major organizing principle of how this region of the brain operates.  So a critical question is for women. When you go through menopause and you lose ovarian production of this hormone, how do these regions of the brain respond? And that is exactly the question that my lab is trying to answer.

Phil Stieg: As I was listening to you, I was thinking about, you know my Mother. She   was going through menopause and she had a hysterectomy. That’s the way they treated it back then. They put them on hormonal replacement.

Emily Jacobs: Estradiol, the major form of estrogen in mammals is neuroprotective. And you can do you can—remove the animal’s ovaries and show that it causes havoc on these regions of the brain that contain estrogen receptors. You give estrogen back and you know, all is right with the world… in a sort of simplistic way.

Phil Stieg: Mm hmm.

Emily Jacobs: So, the first female director of the NIH was Bernadine Healy. And her major initiative was something called the Women’s Health Initiative. And just to give you insight into the thinking at the time, this is going to be the gold standard – a randomized clinical controlled trial on a huge population, the first one  to really test in women whether HRT was neuroprotective,

Phil Stieg: HRT?

Emily Jacobs: Hormone Replacement Therapy.  And the Institute of Medicine at the time came out with a position statement that said, we think running this randomized clinical trial is unethical because the benefits of estrogen are so obvious. OK, so that’s just to clue you into thinking. At the time, they didn’t want to run the study. Fast forward several years later and that clinical trial ended early because of the opposite effects — adverse effects on stroke and in other outcomes. So, you know, the field, you could just hear the screech brakes, right, of people of doctors around the world taking women off HRT.   The number of prescriptions for hormone replacement therapy plummeted in the months after that report came out. The is that they threw the baby out with the bathwater. That study enrolled women who were on average age 75. Right? Decades after they’ve gone through the menopausal transition! And the brain is going to be different.  And you’re suddenly reintroducing this now foreign hormone to a brain that has gotten used to being without it. So it was not answering the question of whether hormone replacement therapy in sort of a critical window of this transition state might be beneficial. And we’re really kind of still trying to pick up the pieces and understand the potential utility of hormone therapy.

Phil Stieg: So It’s amazing. In 2021, we’re still in kind of a primitive level in terms of understanding all of this stuff.

Emily Jacobs: We really are.



Voice 1: When I was in menopause, I would wake up every night at four o’clock in the morning, stressed and  anxious, stare out my window and not be able to fall back to sleep. But the good news is it doesn’t last forever.

Voice 2: Couldn’t sleep, couldn’t think. Head in a fog the whole time. It was like an endless hangover with no liquor.

Voice 3: I love menopause because I stopped having migraine headaches. I wasn’t having to plan my life around monthly migraines.

Voice 4: Actually, the biggest changes were…all of a sudden, I’m putting on weight in places where I never have before.  I am I am much rounder and squishier without changing anything else about my diet or habits.

Voice 5: Hot flashes interrupt my sleep. And so I’ll wake up several times at night and … that affects how I am during the day. I’m groggy I can’t remember things. I’m not top of my game at all.

Voice 6: Perhaps because my periods were difficult and intense when menopause hit, I felt a burst of creative energy and alertness in my body and mind.

Voice 7: I went to see so many different doctors and gynecologists because…this was really something that was actually pretty debilitating during certain stages. And it’s I guess what frustrates me the most or strikes me the most is how varied and inconsistent medical response is.

Part 2
Phil Stieg: What can women do, you know, when they’re 30 to ease the impact of menopause?

Emily Jacobs: First, let’s just normalize menopause instead of making this taboo topic, let’s talk about it even just from a sort of cultural perspective, because a lot of women will experience these brain fog changes and be terrified that this means they’re on the route to Alzheimer’s disease. And in most cases, that’s not true. So what we can do as scientists is to try to help figure out what each of those sort of subpopulation of women is vulnerable. And we’re not there yet.  We don’t have the answer. But let’s start by investing in women’s health research from a national federal funding perspective, because these questions should have answers already – and they don’t. You know, one of the benefits that just happened a few years ago was just getting a taxonomy of menopause, and so there was something of a stages of reproductive aging workshop which convened endocrinologists to get together so that we could have a  working definition of menopause.

Phil Stieg: And you’re telling me this is recent?

Emily Jacobs: Probably in the last 10 years.

Phil Stieg: Really? That amazes me that it took that long.

Emily Jacobs: It is. You know, it is an insight into how often women’s health is just swept under the rug, which we can get into later…


Phil Stieg: What do we know about a woman that has one child versus a woman that has six children? Does that have an impact on menopause?

Emily Jacobs: That’s an interesting question. So a friend and colleague of mine, Anne-Marie Delonge, who’s in Europe, she just published a really interesting paper.  And she shows that the more that have more children actually show younger brain age post menopause. So there does seem to be this kind of protective role of maybe because of the brain has been bathed in estrogen during each of those pregnancies to kind of create these more neuroprotective effects. We don’t know the mechanism.

Phil Stieg: People that have more babies. Do they have more of these estrogen receptors in their brain that’s beneficial?

Emily Jacobs: We don’t know. We do not know at the receptor level. But she used data from 12,000 middle aged women and found that women who had multiple children showed younger looking brains relative to women who didn’t have children.

Phil Stieg: What’s a younger looking brain mean?

Emily Jacobs: So these are sort of a great question. And these are kind of statistical tricks where we can anticipate what—so she’s using brain structure.

Phil Stieg: She’s looking at cell counts and…

Emily Jacobs: Well, sure – volume of different regions. And we would expect a certain amount of, say, atrophy or changes. And in women that had given birth many times, they showed they were sort of behind the curve. They they showed less of these brain aging biomarkers than women who had not ever given birth.

Phil Stieg: I just want to be really clear so that those listening walk away with the right message. So what you are saying is; that having multiple children may be protective from a menopause standpoint and also from the onset of dementia standpoint?

Emily Jacobs: That is what this this one study has shown. Now, that shouldn’t be a reason why people should feel bad about not having children. But understand why that association was found is now the critical question. Does it have to do with the hormonal changes experienced in pregnancy or, you know, what is it about that link that’s causal?  And we don’t know yet?

Phil Stieg: What I do want the listeners to be able to walk away with is what are your recommendations from an endocrine health standpoint?

Emily Jacobs: Well, use your voice when you go into your primary care physician because you have severe cramps or because you want to go on birth control for reproductive reasons, ask what are the side effects of these medications? And read the literature, you know, read the popular press, educate yourself if your doctor won’t do it for you. For most women going on estrogen replacement therapy early in the menopausal transition. So in perimenopause, in early post menopause is is not going to have severe it’s it’s not the scary monster that we thought it was. There is now good evidence to suggest that for most women, this can be a really safe option. You certainly should have this conversation with your doctor about when to start it, about how long to stay on it. I think the official recommendation from what we call what’s called the North American Menopause Society is that using it for five years is is fine. And for many women, it can relieve symptoms of hot flashes, vaginal dryness, of brain fog.  And it shouldn’t be it should be a  tool that you consider using.

Phil Stieg: It seems to me that the other message would be that we need to transform this from a, you know, psychological problem.

Emily Jacobs: Absolutely.

Phil Stieg: And and people need to understand that this is not, you know, just something that happens willy-nilly.

Emily Jacobs: I mean, it’s it’s not. Yes, it is. It is biological. We can point to something physical in the brain, but for some women is changing. On the other hand, it is worth noting, as you’ve said, that some women go through menopause and are just fine and that’s great. But there are individual differences and variability. And so talk to your doctor about potential changes. If you are one of the women that is experiencing side effects, there are options for you.

Phil Stieg: Emily Jacobs, you are clearly passionate, clearly driven. And clearly focused on menopause and female health issues. God willing you’ll win a Nobel Prize.  But even if you don’t, I know you’re going to help many women understand their own biology. Thank you for being with us.

Emily Jacobs: Thank you so much.

S2 Episode 1: How Gabby Giffords Found Her Voice

Maegan Morrow, music therapist at TIRR Herman
Photo courtesy Maegan Morrow and TIRR Memorial Hermann Hospital

After the shocking 2011 attack that sent a would-be assassin’s bullet through her brain, former Rep. Gabrielle Giffords had to re-learn how to breathe, walk, and talk. In the Season 2 premiere episode of This Is Your Brain, Dr. Stieg talks with neurologic music therapist Maegan Morrow, whose innovative techniques helped Giffords regain her voice.  Plus: A bonus interview with Ms. Giffords herself

Phil Stieg: With me today is Maegan Morrow. She is a board-certified music therapist and a member of the American Music Therapy Association and currently works at TIRR Memorial Hermann Hospital. Maegan is well known for her work with Congresswoman Gabby Giffords. She has been featured in national and international media, including Dr. Sanjay Gupta’s medical interviews on CNN, Newsweek, USA Today, the Grammys.com and ABC Nightline with Bob Woodruff. In 2012, she and her team at TIRR Memorial Hermann were chosen as Diane Sawyer’s Persons of the Week.

Maegan, thank you so much for being with me today.

Maegan Morrow: Thank you for having me.

Phil Stieg: So we want to start focusing a little bit on Gabrielle Giffords. We should note that it was exactly 10 years ago this week she was the victim of a brutal assassination attempt…

911 Operator: 911, where is the emergency?
911 caller: Oh 911 – There is a shooting at Oracle where Gabrielle Giffords was. And I do believe that Gabby Giffords has been hit.
Local TV anchor: We have breaking news for you is coming out of Tucson, Arizona. Several people have been shot. Among those shooting victims is Congresswoman Gabrielle Giffords….
President Obama I know Gabby is as tough as they come. I am hopeful that she’s going to pull through.

Phil Stieg: Gabby’s condition was stabilized at the University Medical Center in Tucson, and about two weeks later she was transferred to TIRR Memorial Herman, your hospital in Houston, so that she could be near her husband, astronaut Mark Kelly. Maegan, I would really appreciate it if you could describe Gabby’s condition when she first came to your hospital.

Maegan Morrow: When Gabby first came to TIRR, she was unable to speak. She was unable to attend, and she was unable to move her right side. The left side of the brain controls the right side of the body. And after she had been shot, her right side was affected. So she was unable to speak and unable to walk and unable to move her right arm.

Phil Stieg: How do you communicate with the person that early on to try to get their attention? What trick did you use?

Maegan Morrow: (laugh) I like that. What trick? Well, before she even met me, one of her friends was a musician and he had come in to visit her. He borrowed my keyboard and he started playing musical theater tunes with her. So he was doing something that I usually do when I meet someone, which is just starting to prime the pathways in the brain by playing some familiar music, and I usually like to use something live so that I can control the tempo and the timbre and all that sort of thing.

Phil Stieg: And she responded to that music as you played it?

Maegan Morrow: She did. She was alert. She was attentive. She was moving her head. And that was similar to what happened when I met her in the next few days. So I knew that she was going to be working with some attention problems, communication problems. So I always start with something really simple or repetitive.  Like you said, the trick that I usually use is that I’ll bring in an instrument and I’ll accompany myself and sing something that’s very familiar.

Phil Stieg: This is amazing because just this week I was taking a tumor out of somebody’s brain that had located right in Broca’s area, the speech cortex. And the neuropsychologist during the procedure was having the patient sing Amazing Grace and the national anthem. And the patient preoperatively had a very hard time talking, but she sang the songs impeccably.

Maegan Morrow: Wow. They knew to do that. That’s what’s amazing to me.

Phil Stieg: So how did you go, I mean, you knew that this friend had played music. Is that how you started beginning to create connections with Gabby? Is that your first technique?

Maegan Morrow: Well, the family is a big part of the assessment process. When someone has aphasia where they can’t communicate what they want to say and they’re in such a state of mind where they can’t communicate, there’s there might not be attention there. I usually interview the family and I start to find out, OK, what is their musical background? What did they listen to on a daily basis? What did they grow up listening to?  So I was able to gather that information. And she actually you know, there are cues in the room. There was a boombox and some CDs. And one of her favorite bands was there, Calexico. They were an indie rock band from like L.A. or Arizona. And then there was, of course, U2. Bono was one of her favorite singers. So I knew what genre I could use with her. And also just Western music, what we use here in America.  I’m going to use things that she might have learned in school or, you know.  She was in band in high school, and I knew that she had played instruments before. So I’m kind of gathering from those that little pile of information. And then I would choose a song to sing with her to see if I would gain any attention from that or get any speak utterances.

Phil Stieg: So basically, you look for something familiar in any music genre that you’re going to be able to relate to with the patient   When was the first big “aha”?

Maegan Morrow: The first big “aha” was the very first time that I met her. I started singing some familiar songs by her bedside. I looked at her and I could see that she was attending to me and giving me that eye contact as I sang. And I knew that I could go a little step further and try to get her to sing. I gave her the directive to sing along to the most simple song, Happy Birthday to You. 

And when I sang Happy Birthday to — and I just left that phrase open for her to fill in, she was able to nod her head and give me a little thumbs up. So I saw in her gestures that she was trying to fill in the words to the song.  When it was her turn to sing, she would do a gesture for me. And when I saw that, I knew, OK, we’re onto something. We are going to get her speech back.

Phil Stieg: We’ll return to our conversation with Maegan Morrow after a break.

I’d like to introduce an occasional segment which is new to our podcast this season. We’re calling it – This Is Your Brain: The Guided Tour.

BREAK: This Is Your Brain: The Guided Tour: Ear worms

Phil Stieg: So let’s focus a little bit on what music therapy is and to start off with what’s actually going on in the brain that makes music such a powerful therapeutic tool.

Maegan Morrow: Music is really dispersed all over the brain in different areas. And I always go back to rhythm. We know that even if we’re just using rhythm in the environment, we can actually see changes in the brain. 

In the initial stages when I was working with Gabby and many of my patients, I will use instrument play to even get them to communicate through drumming or playing some type of non-threatening instrument that is easy for them as a non-musician. And some of those things can actually help with movement, attention, even speech. So if someone can’t communicate verbally or vocally, I can allow them to communicate on their instrument.

Phil Stieg: Do you think the speech gets better because, one, they’re forming new neuronal circuits or is there another component to it where their innate stem cells are activated and they form new neurons? 

Maegan Morrow: I think that, like within the technique of melodic intonation therapy, a lot of it is just the neuroplasticity of the brain. When when the brain receives the melody and the rhythm, it’s able to produce sound or singing vocalization. And at times like if you have a problem like aphasia or apraxia, they may be able to receive that information, but they can’t get it out. And so there’s an area in the brain that is a bundle of nerve fibers called the arcuate fasciculus that can connect the Wernicke’s area to the Broca’s area.

Phil Stieg: And so the listeners understand Wernicke’s uses the receptive area and Broca’s is the motor component of speech.

Maegan Morrow: Right. And so those two areas can be connected by building new pathways. And music is one of the best ways to build those pathways, because elements of music are all over the brain. And they used to say, you know, music is on the right side of the brain and language is on the left side. But now they’ve found that music is really dispersed throughout. But even within that melodic therapy technique that I use, I am retrieving lyrics from the right side and trying to build a pathway from right to left.   

Phil Stieg: So given the timeframe, you know, two weeks after injury, one has to assume that this is just new circuits, not new cells developing because that would take a lot longer for recovery and maybe that does play a role in later recovery.

Maegan Morrow: Yes! And that is that is still to be seen and researched. I mean, we’re talking to each other like we know what’s going on, but we know the tip of the iceberg right now. You know, just in the last 20 or 30 years, we have MRI so we can see where the blood flow is happening in the brain. But there’s so much more going on, obviously, and we’ll find that out over these years of doing research.

Phil Stieg: It never ceases to amaze me that there’s a another syndrome in the right parietal lobe, where if you talk to the patient—I’m sure you’re familiar with this—you talk to them and they won’t respond but if you put at telephone in their hand they’ll talk back to you.

Maegan Morrow: Yes, we do that trick all the time. That concept we use here, and I’ll bring in my microphone and I’ll do the same thing just to get them to initiate if I put the microphone in front of them.

Phil Stieg: What advice do you give to the family members? They’re sitting there looking at their loved one who can’t mumble a word and their face gets long. The patient can read that. So what do you tell them? How to behave around their loved one and at times like this?

Maegan Morrow: When patients are in a really low state of consciousness, we always try to explain to them that their auditory system is very powerful and they can still hear you. Whether we can tell if they understand us or not doesn’t mean that those regions aren’t working. So to still talk to them like they are your friend or your family, use their name, you know, treat them like as if they’re in the room.

Phil Stieg: Be normal—

Maegan Morrow: Yeah, normal, so to speak.  And further to give the family something to do using music, I always encourage them to have music by the bedside, you know, at good volumes that would be safe for them, for listening, not to overwhelm them with too much music that can be fatiguing, but it can definitely mask the environmental sounds of the hospital, which automatically create anxiety. Shut the doors, use music to mask that environmental sound and to bring that familiarity again, something that will comfort them and decrease anxiety in the hospital.

Phil Stieg: Is this common therapy that people are getting when they get transferred to a rehab hospital? Does every place have this or should the other people listening to this start asking for it when their loved ones have difficulty with speaking?

Maegan Morrow: Our program has music therapy as part of the standard of care.  And it is very normal here for me to see anyone and everyone in the hospital.  I think that just the more people see how it can be used with every diagnosis, it may, you know, alert them to give someone a chance.

Phil Stieg: Let me ask about different disorders, do we find that music therapy is beneficial in other neurologic disorders like anxiety, depression, loneliness, separation? I would think so. But is there a defined therapeutic intervention with music for those issues?

Maegan Morrow: Yes. This field started at the psycho-social domain. And so a lot of therapists are working in psychiatric hospitals and with mental illness. And using music is a very easy way to connect with somebody, even just having someone open up about their mental health, their depression or anxiety through listening to music and analyzing lyrics, maybe even writing your own lyrics and empowering people through writing music or even just participating in music activity.

Phil Stieg: In your notes, I was reading a little bit about your concentration on the topics of repetition and consistency. It made me think and I always like to disavow people thinking of the brain as a muscle, you know.

Maegan Morrow: Yeah.

Phil Stieg: I got to hit five thousand golf balls to hit one well, you know. But in that regard, I completely agree. I mean, the brain is trainable and repetition does help. Can you comment on that?

Maegan Morrow: Well, we’ve referred to the term neuroplasticity. It’s really just when there is, you know, an area that’s been damaged or an area that’s not there anymore in the brain, building a new roadway takes time. And that’s what neuroplasticity is, doing something over and over till you build that groove in the brain again so that there’s something new for the brain to communicate with

Phil Stieg: So I understand your uncle got you involved in your church band or a church band and that got you involved with music. And so what was the transition from loving music to all of a sudden wanting to be a neurologic music therapist?

Maegan Morrow: So my family, they’re all musical. And, you know, everything in our household was playing music, practicing, singing together. I grew up also in a very charismatic Christian environment, so I saw music doing some very interesting things to people in those crowds at church. And I knew that it wasn’t just spiritual.  And so I wanted to just first and foremost study music like, What is it? What why is this so amazing to us? Why does it work? My my mother was also in drug rehab and received music therapy and art therapy. And so I saw it work firsthand in my family.

And so I was just getting these glimpses of it. And when I started to study I realized, you know what? I want to help people and music is what I know, and someone told me that music therapy existed and it just totally clicked with me.

Phil Stieg: …the light bulb went off.  

Maegan Morrow: Yeah, exactly.

Phil Stieg: So what are your thoughts about all of the anxiety going on now with Covid and music therapy? As I was listening to, I was going I think everybody just needs listening to music on a regular basis and tapping their foot and taking a few deep breaths.

Maegan Morrow: Yeah, well, I mean, that is a big part of healing for me. I just, I’ll make a playlist or I might use music that’s matching my mood at the time. Like if I am very anxious, I’ll start there and just try to calm myself down over that time.

Phil Stieg: What I find amazing is I don’t like music in the operating room. I find that it distracts me. I mean, I like the music more than what I’m doing and it distracts me.

Maegan Morrow: Are you a musician at all? Have you trained?

Phil Stieg: I played the piano when I was growing up…

Maegan Morrow: Yeah, you probably ear-trained trained yourself so much that music could be more like a language to you. So I’m the same way. If I’m working on something like that, tedious, I’m going to be, my brain is going to be going back and forth trying to listen to the melody lines and then—

Phil Stieg: It distracts me, so I just don’t do it.

Maegan Morrow: Yeah, that’s smart.

Phil Stieg: So how is Gabby doing today? Have you seen her recently?

Maegan Morrow: I have seen her recently on TV the night of the DNC.

 (Crossfade to excerpt from Gifford’s DNC Speech)

Maegan Morrow: I heard that she’s playing music again. She’s learning Spanish again. she was such a determined person. She, she had a lot going on.

Phil Stieg: Maegan Morrow, a famous neurologic music therapist who worked miracles with Gabby Giffords and is down at TIRR Memorial Hermann Hospital in Houston, Texas. Thank you so much for being with us today. I think this has been fascinating and hopefully everybody’s going to hum a tune after listening to you.

Maegan Morrow :Thank you so much again. I had fun.

Phil Stieg: In the decade since her rehab treatment in Houston, Gabrielle Giffords has continued to make remarkable progress in her recovery and has continued to make music a central part of that process. In 2013, she and her husband, Mark Kelly, founded Giffords, an organization that has led a national effort in promoting gun safety and opposing gun violence.

Gabby Giffords: Stopping gun violence takes courage, the courage to do what’s right, the courage of new ideas.  I’ve seen great courage when my life is on the line. Now is the time to come together, be responsible. Democrat, Republican, Independent. We must never stop fighting. Fight, fight, fight!

Phil Stieg: She continues to be active in politics, having supported her husband’s successful campaign to become the next U.S. Senator from Arizona. Recently, she shared her thoughts on a recording made exclusively for our podcast.

Gabby Giffords: Long time ago, shot in my head, blind in one eye. Difficult words, aphasia. I don’t like it at all.

Interviewer: So can you tell me a little bit about what it was like working with Maegan and what your relationship was like with her?

Gabby Giffords: Maegan, really funny, really funny. Lovely, lovely, lovely, wonderful music therapy, really good stuff. Really good stuff. The body, the brain, a lot of homework.  (sings)  This little light of mine. I’m gonna let it shine. Let it shine. Let it shine. Let it shine.

I’m getting better, I’m slowly, I’m getting better… I’m getting better…

S1 Episode 56: Genetics, Metabolism, and Alzheimer’s Disease

One in three cases of Alzheimer’s disease may be preventable, but some cases are quite predictable. Dr. Richard Isaacson, Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine, explains how scientists look at genetics, lifestyle, and medical history to evaluate an individual’s risk of developing the disease.

Dr. Phil Stieg: This is Dr. Phil Stieg. Thanks for making this show one of Apple’s top 25 life sciences podcasts. It is an achievement we are very proud of. I also want to thank my guests, the many fascinating medical experts and neuroscientists who joined me each episode to share their insights and scientific discoveries, the patients who share their inspiring stories, our executive producer, Licia Hahn, our musical producer, Karen Driscoll, and the production team at The Podcast Authority for producing the show. Stay tuned for more episodes of This Is Your Brain in 2021. Happy New Year and wishing you all good brain health.

Dr. Stieg: Happy to have Dr. Richard Isaacson back with me today. He is a director of Weill Cornell’s Alzheimer’s prevention clinic and memory disorders program. And one of the leading authorities on Alzheimer’s disease. Richard, welcome. What are some of the common misconceptions about Alzheimer’s disease?

Dr. Richard Isaacson: The major misconception about Alzheimer’s disease is that there is nothing you can do that. There is nothing a person can do to to protect their brains and reduce risk. And I hear this all the time. My mom did everything right, and still got Alzheimer’s. And I get that. One of the three cases of Alzheimer’s may be preventable. The other two out of three cases, unfortunately are not, and maybe we can delay it by a year, two years or five years.

Dr. Stieg: What age do you suggest people start thinking about this?

Dr. Isaacson: That’s a good question. I’m not sure we know the answer to this yet. And I would say my answer has changed. I mean, we started the Alzheimer’s prevention clinic at Weill Cornell Medicine in New York Presbyterian back in 2013. And I can tell you that this field has exploded and I have learned so much, I’m learning so much every day in about more than half of the things I recommend to patients today, I didn’t even know about in 2013 and that wasn’t that long ago. So I think if I would’ve had to answer to this question a long time ago, I would have said probably 40 is a good baseline.

I don’t agree with that anymore. We see patients age 25 and above, and you know, I’ve seen people in their late twenties that have some degree of something and I can’t exactly put my finger on it, but something’s going on. I think for the vast majority of people, thirties and forties is reasonable. I think if you ask most Alzheimer’s experts out there, they’ll probably say fifties or sixties, I think some will say 65. And that’s just a round number that I don’t agree with in any way, shape or form, because again, this disease starts decades before symptoms. I think it depends on family history.

I think it depends on risk, but twenties, thirties, or forties is probably a decent time

Dr. Stieg: Given the healthcare financing climate. Do you think that the insurance companies are going to say, we’re not going to pay for all of this neuropsychological stuff? If you’re that worried about having Alzheimer’s go get the definitive tests, number one. Number two, is there the definitive test.

Dr. Isaacson: Great question. And unfortunately, our medical system is really good at paying a lot of money when people get sick. But unfortunately our medical system is not so good at investing money in preventative healthcare and reimbursing for preventative healthcare. So, you know, simply put, some third-party payers in the government just won’t pay for preventative care to get that cognitive baseline. So it’s unfortunate, but I hope the climate will change. You know, we’re now really studying the cost effectiveness of our care in putting in grants so that we can specifically research this.

What I would say is we don’t have a perfect, definitive Alzheimer’s test that someone can take right now, especially on the broad scale that’s cost-effective, easy to obtain, that can definitively say, do, does this person have Alzheimer’s or not? That being said, there were really fancy tests out there. There are PET scans, amyloid PET scans. Amyloid is the bad protein. It’s a protein that gets gunked up in the brains of people with Alzheimer’s. And they’re now the union, since the 2012 on the FDA has approved tracers or brain scan studies where they inject something that labels or binds to this amyloid, and you can see the pictures light up.

And that means that if a person has amyloid in their brain and they have symptoms similar to Alzheimer’s, then it is Alzheimer’s disease.

Dr. Stieg: Specifically that if we see amyloid, which is the breakdown of proteins in the brain on one of these PET scans, that one, you have Alzheimer’s or two you’re at high risk for developing Alzheimer’s.

Dr. Isaacson: So if the person is symptomatic and the symptoms are consistent with Alzheimer’s-like symptoms like we discussed, then it’s pretty definitive than the person has Alzheimer’s. If a random person in the community gets a brain scan and they have amyloid, and it’s just a random scan, it is absolutely not definitive that that person will develop Alzheimer’s disease.

Dr. Stieg: So have they done the study that looks at a random population of patients and compare it to, to patients with Alzheimer’s and shown that there’s an equal proportion of patients positive with this PET scan, as there are patients that have all of these

Dr. Isaacson: So different studies show different things, but the take home message here is at about a third of people with amyloid in their brain that have no symptoms will not develop Alzheimer’s dementia. And this is tricky and this is one of the confusing aspects of the field. And, and that’s why I’m a clinician. I see patients, I talk to patients and I manage the patients sitting in front of me. And I try not to get too caught up with some of the fancy brain imaging in the fancy tests. And I try to just treat the patient as best I can.

Dr. Stieg: But again, for the person that’s worried about this, you know, there’s this, a lot of have heard about APOE4 gene. And whether you have one of those genes or two of those genes and how that is predictive for developing, and can patients go get that? Would you order it if somebody asks you to let them do it?

Dr. Isaacson: So APOE E is a gene and you get to a three or four from mom or dad. So you’ll either be a three-three or two, three or four, four, or whatever it is getting. One copy of the four gene does increase your risk. Somewhat. If you have two copies, it increases it more. If you get a two from mom or dad, that’s actually protective. And a three basically means you’re at neutral risk. So With the advance of commercial-based testing. Anyone can really spit in the little tube, send it away. And six weeks later understand what their APOE gene is.

Here’s the tricky thing about this. People can have the APOE4 gene and never get Alzheimer’s. People can also not have the gene and absolutely get Alzheimer’s. The APOE4 gene in my opinion, is not used and shouldn’t be used to be a diagnostic test. What I use the test for and where I think the field is going is precision medicine. And what that means is different people with different genes need different therapies. People with the APOE4 gene may need therapies, A, B, and C. People without the APOE4 gene may need therapies, X, Y, and Z.

And we’ve, we’ve published several studies now and several reports that really detail this. So from a personalization of therapy perspective, I do think the APOE4 gene is helpful. And I do test it on my patients. From a diagnostic perspective, we don’t use it for that.

Dr. Stieg: You have the worried 30 or 40 year old patient. They say, gosh, I want to do everything I can to prevent this. I’d like a PET scan. I’d like to get the, the APOE4 test and they’re positive for both. Would you recommend that? So that then they could start to try to do the things that you are preaching about preventing the disease progression, right?

Dr. Isaacson: Right. So we tend to not order amyloid PET scans, especially in people in their thirties and forties. Now we do have research protocols that look at people between the ages of 40 to 65, where we do get amyloid PET scans on everybody. We also get MRIs and other studies, we also get the gene tests, but someone in their thirties or twenties or thirties, I would tend not to order a PET scan because the likelihood of it being positive is pretty low. That being said, there are people out there that will do this. They will beg and want and plead and, and force a doctor out there to have to order the scans and have the genes.

But, but again, the problem is these tests are not entirely definitive. If someone has amyloid, or if someone has the gene, it doesn’t mean that they’re going to get the disease. So regardless, we use the best information possible. And we look at their risk factors. We look at their exercise levels. We look—

Dr. Stieg: What are the risk factors?

Dr. Isaacson: There’s so many risk factors for Alzheimer’s and we’ll talk about some of the highest yield ones. But I think it’s really important for people to know that one out of every three cases of Alzheimer’s disease may be preventable if that person does everything right. And the modifiable risk factors are these everything right choices that people need to do. So, first of all, we look at blood and we look at cholesterol levels. We look at nutrition markers. We look at inflammatory markers. When we look at metabolism like, like blood sugar, we look at what a person’s body fat is, where the body fat is.

As the belly size gets larger. The memory center in the brain gets smaller. And what most people don’t realize is that people think of Alzheimer’s as a brain disease. I think of Alzheimer’s disease as a medical disease and a medical condition that later affects the brain. So as the belly size gets larger, the person’s metabolism gets slower. The person’s blood sugar goes up, the person is more at risk for pre-diabetes and diabetes. People with diabetes have twice the risk of Alzheimer’s. People with metabolic problems and high blood sugars have memory problems, Metabolism and memory are connected.

And most people, again, just don’t realize this. But the notion that you can do nothing is false. There are so many things, of course—

Dr. Stieg: No. And I looked at the list of things that you say one can do. And again, it fits into the perspective of heart health, brain health. You know, make sure you don’t get diabetes, get regular exercise, lower cholesterol, you know, all those things that, that, that we preach in the American Heart and the American Stroke Association. But there is a suggestion that regular discussions and social interactions and intimate relationships are beneficial for prolonging cognitive function.

Dr. Isaacson: Oh, definitely staying engaged, having a sense of purpose, learning a new language, a new skill, a new hobby, learning how to play a musical instrument—

Dr. Stieg: How does learning a new language help? What is what’s going on there?

Dr. Isaacson: So the, the, the most general way to describe it as it creates a cognitive backup system, and it really creates, you know, extra pathways that can be relied upon later when the usual pathways start to burn out. So learning something new, keeping the brain engaged is just a great way to build something called cognitive reserve or this cognitive backup system.

Dr. Stieg: What you tell us is, is really hopeful. Where are we in terms of the status of a cure for Alzheimer’s disease?

Dr. Isaacson: So, unfortunately when someone already has dementia due to Alzheimer’s, they’ve had Alzheimer’s disease in their brain for decades and curing Alzheimer’s when someone already is symptomatic is fraught with challenges. However, prevention, in my opinion is a cure. If you can prevent the disease from happening, or if you can prevent a person with the disease from developing dementia, then in, in a sense that’s a cure in itself.

Dr. Stieg: So give me five easy steps to prevention.

Dr. Friedman: So number one, get educated, get informed. Listen to this. What’s your appetite, go online. Read about, Prevention read about how a person can protect the risk over time, get educated, get informed. Number two, exercise. There is no one single thing a person can do today that is more powerful for brain health than exercise. And I don’t just mean taking your 5,000 or 10,000 steps. I mean, doing something real and getting your heart rate up, going, doing weight training, doing cardiovascular training every every few days. At least 150 to 180 minutes a week at a minimum, in my opinion, based on the evidence is the best thing a person can do to fight Alzheimer’s disease and protect the brain.

Number three, know your numbers, know your cholesterol, your blood sugar, your blood pressure to people don’t even realize. But in 2019, there was a study that showed that just aggressive or comprehensive control of blood pressure—just blood pressure alone. Under the supervision of a physician can reduce the likelihood of someone developing pre dementia by 19%. That’s just blood pressure control from the 140s over 80s to 120s over 70s, just blood pressure control. Know your numbers, know your vascular risk factors. Super important.

The fourth thing is nutrition. You are what you eat when it comes to brain health, eating a Mediterranean style diet, eating less carbs, less is more when it comes to the bad carbs. Good carbs, great green leafy vegetables, no problem. Berries, no problem. It’s the processed foods and processed carbs that aren’t good for the brain or the body, and also fish. Fatty fish, lake trout, mackerel, herring, albacore, tuna, wild, wild salmon sardines, super high in omega-3 fatty acids. And the final thing is: take a deep breath.

Stress is a great way to fast-forward brain aging. Take a deep breath, mind your sleep. Take care of yourself.

Dr. Stieg: Richard, thanks so much for being with me today and giving us insight on the steps we can all take to help prevent Alzheimer’s disease. We all look forward to having you back to discuss the results of your groundbreaking clinical.

S1 Episode 55: The Gut-Brain Connection

Episode 55: The Gut-Brain Connection

Microbes in your intestine are talking to cells in your brain all the time – and what they say can affect everything from inflammatory diseases to psychiatric disorders. Microbiologist David Artis, PhD, and psychiatrist Conor Liston, MD, PhD, explain the connection between your microbiota and your mind – and how to influence their conversation.

Dr. Phil Stieg: I’m really excited to have two scientific pioneers with us today. Their newly published research is significantly advancing our understanding of the powerful connection between our gut and brain health on the cellular level. Their research has major implications for the development of treatments for autoimmune diseases like multiple sclerosis and irritable bowel syndrome, as well as psychiatric disorders like anxiety and depression. Dr. David Artis is the Michael Kors professor of immunology, director of the Jill Roberts Institute for Research in Inflammatory Bowel Disease and director of the Friedman Center for Nutrition and Inflammation at Weill Cornell Medicine. Dr. Conor Liston is an associate professor of neuroscience in the Feil Family Brain and Mind Research Institute and associate professor of psychiatry at Weill Cornell Medicine. David, Connor, thank you so much for being with us. It’s a great pleasure to be here. So you’re the two stars that are highlighting the connection between the gut and the brain. I realized that these are animal studies and someday we’ll do it in humans, but what have you found in a nutshell?

Dr. David Artis: The project really began with our knowledge that the gut and the brain speak to each other. And we know that in everyday language—what is your gut instinct, what is your gut telling you? But we’ve never understood the molecular mechanisms and the cellular mechanisms that underlie that communication. Very recently Conor and I identified the relationship between the microbiota that colonized the intestine and how they influence brain development and function. The microbiota is made up of viruses, bacteria, fungi, and parasites. We acquire those very early in life and they are our partners in life on changing constantly every day from our first breath to our last. We know now that the microbiota can influence many different diseases, inflammatory diseases like arthritis, fungi bowel disease, multiple sclerosis, metabolic diseases like obesity and diabetes. We understand more recently the impact of the microbiota on cancer. And also, as we’ll talk about today, on the impact on your psychiatric associated diseases.

Dr. Conor Liston: Understanding how the microbes in our guts interact with the brain has been quite challenging. And it’s a question that I wouldn’t have dreamed really of pursuing, except that I have this amazing immunologist collaborator here at Cornell who really made this kind of work possible. I think it’s, it’s the kind of work that you need expertise in both neuroscience and immunology and microbiology to pursue.

Dr. Stieg: The gut-brain connection has been known for centuries. Going back to Hippocrates. What took so long? Why are we finally asking these questions now? We’ve had some technology to do this in the years past. What happened?

Dr. Liston: I think one of the big challenges to tackling that question is that it really requires a different kinds of expertise, the kinds of expertise that you get as an immunologist and a microbiologist focused on understanding the immune system and, and the microbes that populate our guts, but also neuroscientific expertise. And, uh, without those two kinds of expertise that don’t usually exist just in one lab, it’s quite challenging to, to pursue these questions and make progress on it.

Dr. Stieg: So it’s a stroke of luck that the two of you have found each other? Or I’m presuming this is happening throughout the United States. There’s other centers like this?

Dr. Artis: Biomedical research and medicine traditionally has been somewhat siloed. You’re either a neuroscientist or you’re an immunologist, or you’re a microbiologist or a physiologist or, or whatever it is. Where we are seeing the new technologies bring us is that these silos are breaking down. Conor and I are extremely fortunate. We happen to have met each other somewhat by chance, a number of years ago, and developed this interest in broad technologies from diverse fields that would normally not speak to each other to ask questions that have never been properly addressed before.

Dr. Stieg: One of the important things that that I’m hearing is that it’s the technological advancements in terms of our understanding of the molecular profile. It’s not just identifying which bug you’ve got in your gut, but it’s what molecular profile of that bug. And those are extremely variable from patient to patient or from animal to animal?

Dr. Artis: They can be quite different between any given individual human or animal. So you and I, Phil share certain aspects of our microbiotas, but when we go deeper and deeper in the sequencing, we will find individual differences. You and I have more similarities to each other’s family members than you would have to mine. You have more similarities to your dog than you would to my dog. And so certainly we’re just beginning to understand how dynamic and diverse these communities are.

Dr. Stieg: The two of you have made a significant discovery about the gut-brain connection. Can you characterize that for us?

Dr. Artis: One of the remarkable series of findings that we made involved, the collaboration between psychiatry, neuroscience, microbiology, immunology and chemistry, to begin to understand how the molecular mechanisms operate between the gut and the brain. First, if you deliberately manipulate the microbiota, you can change the behavior of mice, their ability to learn, and to experience fear. And we can talk a little bit more about that. We went on to show that there was a dramatic effect on subsets of neurons and other cells that are resident in the brain. So signals derived from the gut were directly impacting cells in the brain. We also went on to identify with our chemistry colleagues in Cornell-Ithaca, a subset of what molecules that we call metabolites are made in the gut and make their way through the, through the blood, into the brain and can influence specific cell types in the brain itself to recondition them and influence their ability to form memories and undergo learning.

Dr. Liston: And one of the things that really stood out to me as really interesting from this series of studies was that there was this narrow developmental window early in life. So a specific time early in life, when these signals from the gut microbiota were required for regulating the kind of normal developments of the brain. And if those signals were absent, the brain did not develop normally. And those effects could actually be permanent throughout the life of the organism. And I think that was, was quite surprising to both of us when we first saw that, that you could intervene very early in life and, uh, and rescue these problems with learning. But intervening later, say at the age of five or six in a person or in young adulthood was not sufficient to reverse these deficits. So it really emphasizes this, this role for signals, uh, from the gut in regulating brain development early in life,

Dr. Stieg: We suggested earlier, however, that there is a relationship between your microbiota and some psychiatric disorders like depression, are we forming links now? So if we look at the microbiota and we look at the, uh, the clinically at the patient, can we draw any conclusions about relationships?

Dr. Liston: I think we’re moving in that direction. So one of the big challenges with any kind of research like this, where you have an association between one thing and a disease on the other hand is testing. Whether those two things are actually causally linked with one another. And I think the research that is coming out of David’s lab and my lab does suggest that these signals are important for a very basic function that is relevant in many psychiatric conditions. This kind of learning that helps you to update information in your brain about how stimuli in the environment are related to threats. This seems to be very sensitive to these signals.

Dr. Stieg: Well I know you’re interested in the inflammatory cells of the central nervous system called the microglia, and you have some data about that that I read in your paper. Can you tell us what’s going on there?

Dr. Artis: One of the pathways that we identified links, the microbiota that are resident in the intestine with cells that are resident in the brain in particular, there is one cell type, as you’ve said, called the microglia. There are many others as well, the astrocytes and others that we know were impacted by microbiota derived molecule. So certainly there will be an immunologic component to this too. And a good example is multiple sclerosis where we know that’s an inflammatory disease of the central nervous system, but we know the meninges or another compartment of the brain is highly populated by immune cells. And we’re just beginning to understand the relationship between the microbiota and the meninges. We are really at the beginning of a new era of where neuroscience, microbiota science and immunology are coming together. And there are new technologies whether through imaging or sequencing or the ability to genetically manipulate the microorganisms themselves. We were able to do things that were simply not possible a decade ago. And I feel like we’re in a great place right now to make groundbreaking discoveries.

Dr. Stieg: Your study has great import in terms of its application to diseases in the psychiatric realm, such as autism, post-traumatic stress disorder and depression. Can you describe what you’ve found and how you think it relates?

Dr. Liston: We were interested in a specific kind of learning here, which we call fear conditioning and extinction learning. It’s a big term, but the basic idea is simple. You can think of a soldier at war. The meaning of like a loud, crashing sound outside is different at war than it is back here in New York City, where a loud crashing sound is less likely to be a bomb and more likely to be a car backfiring or someone dropping some construction materials outside. We need to be able to unlearn all the associations and learn new meanings when we, when we change our environments. And what we found in this study was that mice that had been treated with large doses of different kinds of antibiotics that eliminated most of the microbes from their guts that these mice had this particular deficit in that kind of learning. They were unable to learn new meanings for, for stimuli in their environments. And we saw a similar effect in what we call germ-free mice, mice that were born in sterile conditions and don’t have any microbes in their body.

Dr. Stieg: I don’t want anybody to be confused here that we’re thinking antibiotics are bad if you’re taking antibiotics. Do you think there is a relationship between antibiotics and excessive antibiotic use and, say, post-traumatic stress disorder?

Dr. Liston: I don’t think the science is there yet for that. I absolutely agree. Antibiotics have done tremendous good for people. And I want to emphasize that neither one of us is encouraging people to not take antibiotics when they’re sick, but there’s a bigger problem of a lot of people taking antibiotics when they don’t really need them. And if you don’t, you might just want to exercise a little more caution in whether you take these because they have, they have lots of effects that, that, that we might not be thinking about.

Dr. Stieg: And to be clear, the work that you’ve done is on animals. Is there any data in humans about, or is it anecdotal—about changing the gut microbiota and an impact on their psychiatric disorder?

Dr. Artis: There are certainly associations in the scientific literature, particularly in children with autism in subsets of patients with schizophrenia, older patients, where the composition of the microbiota has been altered. There are yet to be large-scale clinical trials to deliberately manipulate the microbiota and test the effects of that on psychiatric symptoms. But I think it’s certainly an area that will require future study. When we think about changes in the microbiota, there are certain aspects of lifestyle that can have perhaps the most profound effect on the composition of a healthy microbiota. The first as a healthy diet and a balanced diet, the second is exercise and general wellbeing, and it’s everything your grandmother told you: it’s eat well and look after yourself. And I think that would be a message I would send to everybody.

Dr. Stieg: It’s not really then, you are what you eat—which is important, but it’s also what your gut does with what you eat. And it creates these molecules, as you said that, and I’m presuming that they get reabsorbed through the gut, they get into the blood and they go to the various organs where they’re utilized appropriately. That leads to the question, are we going to start regulating everybody’s gut microbiome once we understand what’s good for you?

Dr. Artis: One could envision a scenario in the not too distant future where a routine visit to your physician might not just involve blood work and other regular readouts, but a microbial or microbiota profiling that may become part of our standard of care. And I hope that that will, in the near future, will become part of our analysis of patient wellbeing. Should we be considering manipulation of the microbiota, and how would one go about doing that? We have much more work to do before there will be a therapeutic phase of that.

Dr. Stieg: What tips can you give me to leading a gut healthy diet that will also translate into being a brain-healthy diet? Because that’s what I’m most interested in.

Dr. Artis: Eating a healthy diet, a balanced diet composed of lots of fruits and vegetables, and maybe reducing the amount of red meat that you’re consuming. Maybe high fiber exercise has a major impact on the composition of the microbiota. Lower levels of stress, have an impact on the composition of the microbiota, all of the things that your grandmother told you many years ago.

Dr. Stieg: As a psychiatrist, do you see this healthy diet cutting down on inflammatory agents as a direct effect on the gut, thereby transferred to better brain health? Or is there also a direct effect on the brain?

Dr. Liston: There’s, there’s definitely a direct effect on the brain as well. Exercise is a great example of a really simple intervention that people can take for themselves and improve their brain health and their quality of life and their stress levels. For example, we know that exercise can change the rate at which new neurons are being generated in the brain’s new nerve cells. And those effects seem to be important in conferring. Some of the mental health benefits of exercise, and it’s really simple intervention as well.

Dr. Stieg: One of the fears that I have is the commercialization of this whole concept. What can you say to us about where we are? I feel, in talking with you that we’re really early and we shouldn’t see any commercialization.

Dr. Liston: We are really early. And I agree with you. I think we need to exercise a lot of caution or jumping into intervene on the microbes in our gut and try to manipulate them before we know how to do it properly. I think there are some exceptions where the science has advanced further. For example, the treatments of particular kinds of infections in the guts. Cluster and endothelilal colitis. That might be one example where the science has progressed further, but in many other cases, I think that the public interest in the opportunity to change our microbes in our gut in order to improve our health has perhaps grown a little faster than, than the data has.

Dr. Stieg: David and Conor. Thank you for being with me. I think for me, the carry home message is how young this field is. And I think that you have responsibly reported where you are. We’re still at the animal level. There is great excitement, I think, and I believe about what you’re going to be able to do in the next couple of years and how we’re going to be able to treat psychiatric diseases by modifying the gut microbiome. Thank you so much for taking the time to elucidate and clarify a lot of the information for us.

Dr. Artis: It was a great pleasure. Thank you Phil.

Dr. Liston: Thanks for having us.


S1 Episode 54: Focus on ADHD

Diagnosing and treating attention deficit disorder can be tricky – not every hyperactive kid has ADHD, and some very calm children are extremely inattentive. Pediatric clinical neuropsychologist David Salsberg, PhD, explains what part of the brain is “asleep” in those with true ADHD, and how to identify kids who need intervention. Plus… when is medication really necessary?

Dr. Phil Stieg: Hi, this is Dr. Phil Stieg. And with me today is Dr. David Salsberg. David is a neuropsychologist and adjunct assistant professor in the Department of Neurological Surgery at Weill Cornell medicine. You may be surprised to know that up to 10% of people in the United States have a learning disability and estimated 6.4 million American children between the ages of four and 17 have been diagnosed with ADHD. We have Dr. Salsberg here today to discuss this in more detail with us. David, welcome. So let’s start off with the ultimate question. What is ADHD? And is there a spectrum of ADHD?

Dr. David Salsberg: So there’s absolutely a spectrum. So ADHD, attention deficit hyperactivity disorder, is the name of the diagnosis, and it really should be a deficit in attention that it is very hard for you to pay attention, very hard for you to think before acting and control impulses, and not be distracted. Those are some hallmarks. Sometimes it’s with the hyperactivity, sometimes it’s not. And there’s three different classifications ADHD with hyperactivity predominant, or predominantly inattentive, or combined. So that’s the core deficit. That’s the neurological underpinnings, is that the part of your brain in charge of how you shine a flashlight and where you shine a flashlight in terms of attention is not operating the way it should be.

Dr. Stieg: We all remember the kid in the corner of the room during kindergarten because he just, he or she just couldn’t sit still. Is this something that you pick up on very early or are there later onset disorders of ADHD or ADD—both?

Dr. Salsberg: And this is part of the problem is that it often is more picked up in the child. Who’s running around the class and externalizing their difficulties, as opposed to someone who might be more passive, who might just be in their head or, or not necessarily show it behaviorally or externally, they might have just as horrible control of their attention and need as much services as the child who’s much more squeaky.

Dr. Stieg: What I’m hearing from you is that the inattentive form of ADHD is probably a little bit more difficult for you to treat than the hyperactive form.

Dr. Salsberg: I think it’s more difficult to identify and know that it needs treatment. The treatments will not necessarily be different it’s just those kids might fall through the cracks for a longer period of time and then develop other difficulties.

Dr. Stieg: First of all, what are the signs I, as a parent, or as a coworker, what would I see in somebody?

Dr. Salsberg: Sometimes you again, see it as they’re just not looking at you or focusing. So I could be twirling around in my chair right now, but if I was actually still speaking into the microphone and continuing my paragraph or understanding your questions, that’s not so much the attention deficit, that’s more behavioral and physical movements without as much of the attention difficulties. So you might see that tuning out, uh, needing to repeat things over and over again, needing to break instructions down to one or two steps as opposed to three steps. So those kinds of things are things that you see in childhood, as well as in adulthood.

Dr. Stieg: There’s some suggestion that this is more common in boys than it is in girls. Is that real or is it just not picked up as well in girls?

Dr. Salsberg: Probably a little bit of both. It probably is a little bit real, but certainly it is underdiagnosed in girls. It’s underdiagnosed in children who just manifest behaviors differently. We’ve seen children with severe ADHD that have not been identified because they’re really sweet and they’re smart enough to get by. They’re not causing problems, and the squeakier wheel next to them is. And that is more the manifestation without sounding biased, girls are not as annoying as boys, typically.

Dr. Stieg: I know some incredibly successful people that have the worst cases of ADHD, but because they can multitask and just flip from one thing to the next they’re incredibly successful.

Dr. Salsberg: Someone who is able to really focus on their areas of passion, and a child who has ADHD might focus for hours on something—chess or Harry Potter or something that that is their passion. And the parents are always saying, well, I don’t understand, “He or she focuses for five hours. How could they possibly have it?” But if you take the skillset that forms pathology and concern in childhood, passionate about something and can pay attention to that ad nauseum and get doesn’t get stuck in the minutiae or the little steps along the way, just wants to focus on the big picture and move on. Those are qualities that are really hard to deal with in elementary school and throughout school, but are what we applaud in many areas of successful adults.

Dr. Stieg: Every time I see a hyperactive person in the workforce, somebody says, “Oh, they’ve got ADHD.” What are the mythologies around this disorder?

Dr. Salsberg: There’s certainly a lot of talk about diet and sugar and gluten and all of these different things that are thought to be either causes or interventions that are proven. Again, there isn’t a lot of research to say that any of these things cause that. I would say that a child with deficits in attention is a little bit more sensitive to some of these difficulties. If all I ate was white bread and processed pasta all day, every single day, I will be more cranky, a little bit more tired, and not as attentive. If I already have a deficit in attention, yes, that might manifest even greater in me, but it doesn’t mean it’s the cause.

Dr. Stieg: Are the brains in a person with ADHD, any different when we image them?

Dr. Salsberg: So yes, there’s definitely differences in imaging and differences. Sometimes in the EEG, the electrical activity that we see in even a very hyperactive child, the part of their brain in charge of attention actually might look like they’re sleeping. They have these, increased, what are called theta waves. The predominant waves, when you’re sleeping, seem to be the predominant wave in that area of a brain. And that should not be, that’s an inattentive brain. And we want to see more of the active brain electrical activity. So we’d sometimes actually can confirm that with different imaging or EEG tests.

Dr. Stieg: Let’s focus on two things, a diagnosis and what you do about it. So I’m a parent. I’m worried that my child has ADHD. What do I do?

Dr. Salsberg: So well, first and foremost, get an evaluation.

Dr. Stieg: By?

Dr. Salsberg: By a psychologist, neuropsychologist, educational psychologist. Sometimes that’s available through school. Sometimes you have to go outside to get more information. And psychiatrists, neurologists pediatricians also give the diagnosis. The diagnostic criteria for ADHD is pretty simple. Some people literally just diagnose it with a checklist from a parent and a checklist from a teacher—poof, you have the diagnosis. Of evaluations such as what we do and other professionals are, there’s a lot more due diligence involved. So yes, there’s the deficits in attention by observation, but let’s look at all the different strengths and weaknesses. Let’s see, make sure there aren’t other learning disabilities or other emotional things that are happening. You can be inattentive for a lot of different reasons. You can be a very anxious person who does isn’t paying attention. So the diagnostic clarification is crucial and understanding and necessary in my opinion, in terms of treatment. And then we get to treatment recommendations and intervention recommendations.

Dr. Stieg: I’m not a big proponent of going to drugs as the first form of therapy. What do you, as an expert in this area suggest as the hierarchy, where do you start and where do you?

Dr. Salsberg: So I chose my profession as a neuropsychologist, as opposed to a neuropsychiatrist because I also don’t believe in medicine. When I identify ADHD, I sort of go through three steps with parents before I even talk about medicine. First, do I feel that this ADHD is not within their control, that this is clearly biological or neurological as if we were diagnosing God-forbid, diabetes or something that was clearly not within their control. We could say, you’re going to go to the 50 yard line and the Super Bowl if you could pay attention for the next hour and the kid can’t do it. That’s first. Second is that attention because we know your brain will get better and mature over time. Is it affecting their education, their learning, because we can’t wait and see for their child to get more mature. And then, then be behind educationally. The crucial thing that tips my scales for telling parents, we have to explore and talk about medicine is self-esteem.

Dr. Stieg: So you start with what types of therapy? And then when do you get into medication?

Dr. Salsberg: First and foremost, understanding. Having a child and the adults around them understand this is not in their control. No one gets mad at a child for not controlling their blood sugar, if they have diabetes. So first that level of debriefing and understanding then accommodations in the class—where they sit, how they sit. Maybe they do need to get up some schools and see that even some work sites have have standing desks for a reason. It helps them pay attention. Maybe every 10 minutes, we remind them to get a drink of water. If they’re not attending, tap them on the shoulder while you walk by, instead of calling their name across the room, there’s nothing good will come from that. Behavioral interventions, therapist, psychologist at the school, outside of the school to help set up checklists and behavioral structure.

Dr. Stieg: When do you say it’s time for medications?

Dr. Salsberg: When it’s impacting them educationally, and certainly if it was looking like it’s starting to impact them socially and emotionally, that that time is crucial, but also speaks to why you need to do it early. And you need to understand the whole child, because if the child is, let’s say already suffering self-esteem and anxiety, and here we are introducing a medicine, which typically is a stimulant, which makes you more focused. Doesn’t tell your brain what to focus on. You might now be more focused on, “Oh my God, I’m in trouble all the time,” or, “Oh my God, I’m two grades behind.” Whereas before you weren’t ruminating on that, because you were inattentive and moving on to something else. So it really requires a lot. It’s not an easy fix.

Dr. Stieg: And finally, what’s your success rate? I’m sure there’s a spectrum of success, but define that.

Dr. Salsberg: When we attack it in a multifaceted way with interventions in school, out of school and understanding and awareness, the success rate is very strong and it is often with medicine. Parents often say, well, what are the long-term effects of medicine? And my answer to them typically is, well, I could tell you what the long-term effects of feeling terribly about yourself as a student are. And those are not pretty. So let’s, before we think about long-term effects of medicine, let’s talk about doing it and seeing how a child does. These medicines can be done for shorter periods of time, but at least then you’re learning what you need to so you’re not behind educationally. We’re hopefully making you feel better and more empowered as a student and derailing any of the negative consequences.

Dr. Stieg: David, thank you for enlightening us on attention deficit disorder and attention deficit hyperactive disorder. I don’t think any of us has not had experience with knowing somebody that has this issue. And it’s extremely nice to know that there is hope for these people. Thanks so much for being with me.

Dr. Salsberg: Thank you.

S1 Episode 53: Conscious and Trapped Inside

From drug cocktails to deep brain stimulation, there is new hope for brain-injured patients with “locked-in syndrome” in minimally conscious states. Dr. Nicholas Schiff, Professor of Neuroscience at the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, tells the dramatic stories of patient reawakenings from comas lasting many years.

Dr. Phil Stieg: Today, I have the pleasure of being with Dr. Nicholas Schiff. Dr. Schiff is Professor of Neurology and Neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medical College. In this segment, we’re going to be talking about the newest diagnostic techniques used to assess altered mental states, and then talk about hope, what we’re doing to treat patients that have these altered states. So let’s take a specific example of one of your intriguing cases, Maggie Worthen. Tell us about that.

Dr. Nicholas Schiff: So, so Maggie Worthen is a public figure, there’s a very nice and beautiful book written by my colleague, Joe Fins called Rights Come to Mind that tells her story. There’s also a Scientific American article that describes her history, but Maggie came to us after having been thought to be in a vegetative state for two years after a stroke, her mother brought her into the research studies we were doing at Cornell. And when we do our studies, we bring people in for several days and examine them and do different tests. And the first day that we brought Maggie in, we couldn’t identify any evidence of awareness—that was true for the full day. And then the next day, when she was more alert, we discovered for the first time that she had one movement that showed unambiguously, that she was aware. We asked her to look down and with one eye, she was able to look down from that point on, we then were able to do a whole series of tests with her.

Dr. Schiff: And we brought her back to do what’s called functional magnetic resonance imaging magnetic resonance imaging is MRI. Everybody who’s been in a hospital or watches TV probably knows what an MRI is. It’s a machine that can take pictures inside body tissue. When you use it in the brain, there are a lot of different things you can do. Functional MRI means that you use the MRI machine to study oxygen in the brain. And when oxygen changes its level, it’s associated with the activity of nerve cells doing work. So many investigators before us had discovered that if you imagine doing a task like playing a sport in your head, if you or I were to do this, there’s a very reliable signal that comes up in a particular location in the brain. Colleagues of ours in England demonstrated for the first time in early 2006, that you could use this technique to look at patients who appeared to be vegetative or minimally conscious to see if they had higher level consciousness that you couldn’t see.

Dr. Schiff: We did this test for Maggie, except that we had her specifically swim because she was a swimmer. The results were totally unambiguous. She did the task. She had very, very clear results, just like a healthy control. And the thing that remember about this, I think most people don’t appreciate it as it’s an awfully hard thing to do. If you take a stopwatch and time yourself for 30 seconds. Imagine yourself swimming. Imagine yourself swimming for 30 seconds and then say, stop. You have to do it seven more times and complete each of those accurately to meet the threshold, to generate the little colored picture that you see in the newspaper. That is why this is a very convincing test. If you pass it. Not passing, it doesn’t necessarily mean you’re not conscious because that’s a very high bar.

Dr. Stieg: I’d like to move on to the concept of hope and what you are now doing now that you are able to determine that people are in a minimally conscious state or a locked in state and how you can help change their lives. And one thing is this concept of deep brain stimulation or DBS. What is it? And where are you going with it?

Dr. Schiff: Okay, I’m going to take that question as a whole start with at the outset, because I think this is the whole point that we can develop therapies and we can actually turn the hope of understanding into something practical to do. And I think there are sort of two major issues. One is we have to identify people who are hiding the level of high-level consciousness at the bedside, find ways of identifying them and giving them a chance to try to communicate. That’s one line of work. The other line of work is that we have a lot of patients who can talk, who can interact to some degree, but can’t do it reliably. And we can work to try to restore their function. The organizing approach that that I’ve taken has been around a concept of a particular role of a circuit called the meso circuit and the deep brain stimulation work has really been centered on this idea.

Dr. Schiff: Deep brain stimulation is a technique in which essentially you put electrodes just like cardiac pacemakers inside of small structures in the brain. This has been in use since the 1960s, but really came into sort of a Renaissance in the late 1990s with the advent of deep brain stimulation for Parkinson’s disease. The work we began over 20 years ago and demonstrated the first proof of concept in 2007 for was to put deep brain stimulating electrodes in the central thalamus, a particular region of the brain in the minimally conscious state. We found in 2007, that we were able to restore consciousness in the form of spoken language, consistent interaction and recovery of organized goal-directed movements in a patient who had remained in the minimally conscious state for six years. Prior to that surgery, that demonstration proof has led to the full, sort of, development of thinking about the circuit, the network, and how deep brain stimulation, along with medications, might eventually be developed into a systematic therapy.

Dr. Schiff: One of the breaks on that, and one of the challenges has been, that this is a problem that exceeds small individual investigations. We need infrastructure to access patients like this and commitments to doing it. And honestly not a lot of people have gotten behind this problem. It’s a serious problem. And the general approach has implications beyond minimally conscious state across all structural brain injuries, going to the problem of people trapped in their heads. That problem gives me the most worry. I have a picture of five of the 15 people we just randomly found like this in our own studies on my wall. And I put it up on the wall to remind me every day that we haven’t really helped them. We found out that they’re there. We know that they’re trapped in their head and we’ve tried things. And even for Maggie Worthen who got one way communication with a very nicely designed closed circuit camera that allowed her to capture this one downward eye movement to do yes, no questions, And she got better and better at it.

Dr. Schiff: And when she did that, we found, and we published a paper two years ago that her brain was rewiring. That was showing large-scale plasticity associated just with being able to recommunicate again with the outside world, but she never established a two way communication. We have examples of some patients who stayed in this cognitive motor association state, where they have this high level cognition, but they can’t respond who then, on their own, after years, recover gestural communication or speech. And they look the same as all these other patients that we have who haven’t yet emerged. The, the question I ask myself every day is, “What’s it better to believe? Is it better to believe that the people who got out and started talking and show that they were high-level conscious and could be tested on normal intelligence tests are different than the 10 or 15 other people who look the same on the fMRI studies and the EEG studies that we have, or is it better to believe that those other people are trapped in a brain that doesn’t have motor control, but need a way out.

Dr. Schiff: And I think that even if the answer is, it turns out that only the people who have emerged and could show us that they’re there, were the ones who could, it should be a burden on us to try to see if we can get the other people out and fail.

Dr. Stieg: Just a brief question about this deep brain stimulation—is it durable?

Dr. Schiff: Kind of like a, it’s like gilding the lily, right? You know, yes. It’s durable. I’m speaking to the chairman of neurosurgery. Deep brain stimulators are placed in many, many patients around the world for many conditions and have performed extremely well, just like cardiac pacemakers.

Dr. Stieg: There are different kinds of electrodes we can put in a patient’s brain. Thinking about the person with Lou Gehrig’s disease or the quadriplegic, the person who can’t move any extremities. There are now ways to bypass that kind of activity, at least communicate through computers.

Dr. Schiff: So in fact, with colleagues, uh, we’re exploring the, the potential for developing the use of these brain computer interfaces in this population of patients who are severely brain injured. And I think that is going to be a very important line of work. And that’s one of the main directions toward new therapeutics that we’re trying to take.

Dr. Schiff: Don Herbert, who was a firefighter in upstate New York, who ran into a burning building and was on the top floor when the building collapsed. And he had a traumatic brain injury, but he also lost oxygen. He had started the process of recovery. He was in coma, vegetative state, minimally conscious state. He was starting to be moved, you know, and walked and ambulated. And then he regressed and went back into what was probably a very low level, minimally conscious state. And his family went, took him to doctors and they said, well, you know, there’s nothing to do. You can see this guy just looks like he can’t do anything. And for 10 years, he stayed that way until an enterprising new physician in a rehab center or a convalescent center where he was at decided to put them on a cocktail of three medications, something called L-DOPA, which is a medication used for Parkinson’s disease. And two drugs used for ADHD, one called Celexa and one called Strattera. And in about four weeks, the family got a call that Don Herbert was awake!

Dr. Schiff: I remember getting the call. The thing that was so remarkable was that when he woke up and this is 10 years, he was fully present. He was blind, and everybody who came to see him that day, he recognized them by voice. But he now, he was able to recognize all of them, but he was shocked and dismayed that he had been away for 10 years. And he talked about it and he agonized about it that like, that’s the most dramatic example I’ve ever seen in my career or something like this. That’s your Rip van Winkle. People ask you all the time. Is it like Rip van Winkle? That one is Rip van Winkle. And, you know, we got to avoid all of this. We got to do better for Terry Wallaces and we gotta do better for Don Herberts. And that’s basically what the game has been for me since I got into this one.

Dr. Stieg: Hopefully we can.

Dr. Schiff: I think we can. I know we can. We’ve actually shown we can, this is proof. The proof of concepts out there, the generalized ability and getting people behind it is not, that’s more than just the interest investigators.

Dr. Stieg: So let me ask you a future question. You’re still young. Where do you want to be in ten years?

Dr. Schiff: 10 years. I want to see systematic clinical studies of deep brain stimulation for people with structural brain injury. And I want to see screening of all patients at risk for being trapped in their heads and a graduated program of trying to see who we can help get out. I’m starting on it now with my colleagues and hopefully you and others here. And that’s where I want us to go. 10 years from now. I’m sure we can do that.

Dr. Stieg: Have you thought about the cost of that?

Dr. Schiff: It would save so much money. I’d love to get a healthcare economist to come in right now and figure that out.

Dr. Stieg: So the rehab and—

Dr. Schiff: Well, let me give you an example. We didn’t have the forethought to figure this one out, but our first patient, the patient that we published in 2007, who had the minimally conscious state after traumatic brain injury was beat up, assaulted, stayed in a nursing home for six years. We brought him into the trial and he was stimulated, was able to start to move, you know, do things with his arm to work, like, pick up a cup or, you know, show you all a functional movement. He could speak. He could talk before that. He couldn’t do any of that. Well in those six years, he also learned that the other thing that we found out in that trial that we learned was that after six years of being fed by a tube in his stomach, one of the therapists working with him notice that he wasn’t pooling the secretions in the back of his throat and was swallowing every morning.

Dr. Schiff: So she thought, well, maybe we should start to feed him. Within five months he was chewing and swallowing three meals a day within 15 minutes. Now, here are the hidden costs for traumatic brain injury. For six years, he had bedsores and aspiration pneumonias and medical problems he couldn’t make anybody aware of, almost regularly on clockwork every few months from when he got the deep brain stimulators for the next six years that he lived. And this is in Dr. Fins’ book. He didn’t have another aspiration pneumonia during that initial time. And he moved. So he didn’t get bed sores. And when he was in pain, he could tell us, “This hurts.” Okay. You tell me that that’s not going to save money. And it turns out every now and then I get approached by somebody from the reinsurance companies, right? You know, the reinsurance companies are, they’re the people who pay the big societal costs that underwrite all of the major, major economic problems. And I learned from them that about 12% of the re-insurance budget is long-term care for people who basically had brain injury. So I don’t think this is a problem of adding money. I think this is, this is recouping costs and adding benefits by reconnecting people with their families. I am certain, this is going to save money. So I’m happy to answer that question.

Dr. Stieg: And I’m happy I asked it!

Dr. Schiff: If somebody’s listening and they’ve got a family member that’s in one of these states, is there a website or somewhere where they can go? You said, one of the comments you made earlier was you got to educate yourself. If you’re the family member, where are they go to educate themselves.

Dr. Schiff: So, so I think this is, I mean, if there were a resource for families and patients, this is, this is another issue for this whole area of medicine. Everybody’s vulnerable to this. Therefore nobody is, and you understand this from neurosurgery and traumatic brain injury: most problems of this scale have advocacy and groups and families. And everybody’s devastated when this happens and nobody thinks it’s going to happen to them. So there’s no prospective organization. It’s not like I had a family member who had this. And so I’m involved in this for the future of my grandchildren. It could affect everybody. It effects nobody. So there’s very little out there, but I think that’s going to change over time. I wish I could tell the people who are listening to this. Okay. Here’s where you go. And they’ll, they’ll solve all this for you.

Dr. Schiff: Unfortunately, I think what ends up happening is that you go and you try to find people who you can talk to who are knowledgeable about this. It’s not hard to find people who’ve had the same experience, but not everybody can go to the web and access it and read, you know, read it and get information. So I think what I found has been most effective for most caregivers and most families is that there’s usually one doctor in their sphere of physicians who really cares and is smart. And they may not be a neurologist and they may be a foot doc. They might be whatever they are, but they’re the person who is willing to talk to them think, and then think of a friend or a colleague who they can put them in touch with you work through your social network and you try to educate yourself. And if it’s past your ability to do it, you go and you get, you get sort of a buddy and that buddy could be a nurse or somebody in your social sphere who is a little bit more tuned in the medical system. And you try and take notes and you write it down and you, and you document and you learn. And for, I mean, we should be doing a lot better than that. And believe me, I understand that, but at least I’m telling you what I’ve learned.

Dr. Stieg: Well, I’m hopeful that somebody listening to this might take up the mantle and say that we want to put together a website. Just listening to you describe the panoply of different altered states is complex and for the lay person to understand this is hard. Dr. Nicholas Schiff, thank you so much for spending time with me. It’s been fascinating talking with you.

Dr. Schiff: Been great to be here. Thanks Phil, appreciate it.

S1 Episode 52: Dread Making Decisions?

What happens in our brains when we’re confronted with decisions? And why do some people dread making decisions more than others? Dr. Gregory Berns, neuroscientist and Professor of Neuroeconomics at Emory University, explains that there are different brain systems involved in the decisions we make. When faced with choices, we want to pursue pleasure and happiness as much as we want to avoid pain and negative outcomes. Decision making is also about projecting ourselves into the future and how much uncertainty we can handle.

Dr. Phil Stieg: Have you ever had trouble making decisions? That’s probably a rhetorical question we all have. In fact, making decisions often makes us dread making the wrong choices. Our expert guest today will explain what’s going on in our brains, why we feel this way and how we can become better decision makers. I’m happy to welcome back. Dr. Greg Berns, Distinguished Professor of Neuroeconomics and Director of the Center for Neuropolicy and Neuroscience at Emory University. He’s the author of several popular books, including Iconoclast and the New York Times Bestseller, How Dogs Love Us” Greg, welcome back.

Dr. Greg Berns: Thanks Phil. Great to be here.

Dr. Stieg: Neuroeconomics, neuropolicy, and neuroscience. I mean, these are individual, but really diverse topics. How do you tie them together professionally?

Dr. Berns: Sometimes I don’t do so very well doing that. And I kind of compartmentalize my professional spheres of life. When students ask me kind of to explain my career, the common thread through all of it is using neuroscience and technology to understand how the brain works and with people, how we make decisions. And so that’s what really ties kind of the neuroscience, the economics and the policy altogether.

Dr. Stieg: Since we’re talking today about decision making, do you approach that from the perspective of neuroeconomics, neuropolicy, neuroscience, or again, do you combine them into the decision process?

Dr. Berns: It’s really a combination of all of it. And so my training is really more of a biomedical scientist as a neuroscientist and a physician. My first stance comes at it from looking at the brain. So I always want to know for a given circumstance, whether it’s a decision making problem or simply how one reacts to things that are kind of passively falling into your lap. I first want to know what is the brain doing? How is the brain reacting to new types of information? And then is there something in the brain that we can learn that then may either predict how someone makes a decision or how maybe we can even intervene and help them make better decisions? Now, the economics in particular came in, I would say later in my career, because I’m not classically trained as an economist. What happened was, this is probably back in kind of the early 2000’s, a group of neuroscientists, like myself, who were primarily interested in reward and decision making got together with a group of economists who were mostly experimental economists, meaning that they studied how people make decisions, kind of from the outside, just looking at the person and began talking to each other, to see if in fact we were actually studying the same problem. And it turned out that we were, and we had very different approaches to it, one with the brain and one studying kind of mathematical models. And then neuroeconomics was born out of that, which attempts to combine both of them. So that’s kind of how I view myself now,.

Dr. Stieg: What got you interested in decision making?

Dr. Berns: It was an evolution. And so my interests have kind of originated in how the reward system works. And so, through most of my career, I’ve been trying to understand what drives the human reward system. And, you know, we can get into how you define that, but it’s basically talking a lot about the dopamine system. So the neurotransmitter dopamine, under what circumstances that’s released, how does it affect other synopsis? And then ultimately, how is that related to the choices that we make? And so my interest in that system eventually led me to economists because most of the mathematical models that economists use are fundamentally about decision making. And what economists do that I think is quite different than what psychologists do, is that economists tend to look at what people do, not what people say. So there’s kind of an expression, you know, you can either walk the walk or talk the talk but to an economist the only thing that matters is what you actually do. So it’s the walk. It’s not what you say, it’s what you do versus a psychologist who might ask you, Oh, how do you feel about this? Or what do you think about that? That doesn’t matter so much as opposed to the actual choices that you make. When neuro economics started, this was all kind of a rather novel idea because what economists brought to the table was this idea that there’s—think of it as a meter inside your head and economists call it utility. That’s just a word for essentially, what’s an imaginary concept that says no matter what you do for a moment to moment, you’re always trying to maximize the utility that you expect to get out of that world, whatever you do, you feel like that’s in your best interest at that moment. We can make that assumption and then say, Hmm, well, if that’s true, then maybe your reward system is constantly trying to predict how much utility you’re going to get out of the world, whether it’s a purchase that you make, or whether it’s an interaction with another person, your reward system is constantly monitoring that.

Dr. Stieg: When I’m working with my residents or my children, and we’re in the process of making decisions, I ask them to make lists of pros and cons and then sort of kick it around. But then there’s also the aspect of time and timing that play a role in our decision making. Can you distinguish those factors for us?

Dr. Berns: Time, time is a bitch, really, because I just said that decision making is about the future. You have to project yourself into the future. And of course, there’s great uncertainty about the future. We don’t have crystal balls and the further into the future, you have to project yourself, the greater, the uncertainty. Now economists kind of have brought a very neat way of dealing with the future into their equations. And the idea is that essentially the further into the future, you go, the less valuable anything is. If I make a decision and the outcome is going to be immediate, that’s a very powerful reinforcer, if you will, that will give me a very strong reward system response because I know the outcome is going to happen right now. If I make a decision and I’m not going to get the results of that, say, for a year, well, that’s not going to carry nearly as much weight as something with an immediate payoff. And, the standard way economists deal with that is what we call exponential discounting, which means that a day from now is the same as a day a year from now. A day is a day as a day, or a minute is a minute is a minute. But what’s interesting about that is that humans actually don’t treat time that way. In fact, no animal treats time that way. We all suffer for what’s something, the different names for it, but we all suffer from myopia, meaning that we’re kind of near sighted when it comes to time. Anything that’s going to happen in kind of the immediate future, something that’s imminent, carries an outsize weight to us. And, and we can’t help it. It’s the fundamental reason why that chocolate cake is so appealing, even when you know that you shouldn’t take it. It’s, it’s the reason why New Year’s resolutions always fall by the wayside by February.

Dr. Stieg: When we think about decision processes, as you said, it’s future-oriented and is that orientation then based on pleasure, money, pain, or power? And if that’s the basis upon which we make decisions, so be it. But then I ask where does integrity and compassion and the moral things in life play in our decision process?

Dr. Berns: Oh, that’s a great question. The economists would say, yes, all of these decisions are, are ultimately based on what they call utility, which kind of simplistically is the amount of pleasure you expect to get out of that decision or conversely, the amount of harm and pain you hope to avoid. Those are typically treated on the same scale as opposites. Although I think it’s an interesting conversation to have, whether in fact pain and pleasure are actually opposites of one another. They may be independent, but the question you raise about things that don’t fit in those categories, I think is very interesting. And it’s something that I’ve studied a fair bit of and is quite unique to humans. And that is this idea that abstract ideas, philosophies, politics, religions, just things that we hold in our mind acquire value in and of themselves. And I think that’s absolutely true, but because of their nature, you can’t really put a monetary value on them. You can’t put kind of a materialistic value on it. And, uh, some of the studies that we’ve done with, with MRI have suggested that in fact, those types of decisions are governed by different systems in the brain altogether.

Dr. Stieg: But do you think it’s possible that the concept of integrity or compassion is intriguing to me and it’s a value of mine. And so I would then turn that around and say, if I make the decision the right way, it provides me pleasure because I’ve done it in my mind, the correct way. It’s not either or, but it’s a circle.

Dr. Berns: It is. And, and there’s, I, there is no doubt that, that the systems are linked and, and kind of one of the ways to tell the difference in terms of how you’re making a decision. And this is, this is an old philosophical debate. Is your decision based on expected outcomes? Is something gonna be good or bad? Is it going to go this way or that way? Or is it completely independent of that? So one way to tell whether a system is value-based or what philosophers call deontological is if it’s completely independent of the outcomes, it’s just something that, you know internally is right. It’s what the right thing to do is.

Dr. Stieg: Are there certain generic qualities of what a good decision is?

Dr. Berns: That is a tricky question because of course.

Dr. Stieg: Didn’t want to make it easy for ya…. *laughs*

Dr. Berns: I know, well, my first thought, or my question to the question is that I’m good for whom? Good for the individual or good for someone else? And then if it’s good for someone else that kind of reflects back on you and you get kind of an internal benefit from it. So I think one has to be more precise in saying good for whom?, But that actually brings up an important point and kind of the situation that we find ourselves in presently with COVID right? This whole crazy issue of wearing masks. Is it good for me or is it good for you? Well, when you get down to it, it’s good for everyone, right? Why wouldn’t you do it? I mean, that’s been, it protects you, but mostly it protects other people. Uh, and that’s what we call a public good.

Dr. Stieg: So when we’re making a decision, the psychological factors that are going on are what? And are there other associated biological factors? You know, your heart rate goes up, your respiration goes up, you start to perspire and are those linked ?

Dr. Berns: Well, there’re of course they’re going to be many processes involved. There are a kind, a simple way that I like to think about it is, you can divide it into cognitive processes and emotional processes. And that’s just a very simplistic way of dividing this up. So anytime you’re faced with a decision, you can kind of think of it kind of dispassionately and pros and cons, as you mentioned, that’s kind of an effective strategy, I think it was Benjamin Franklin who liked to use that strategy. And that’s one way to separate out the emotions from it. You just kind of write down, okay, well, these are the good points. These are the bad points and you try to weigh them. Then of course, there’s the emotional responses, which are frankly more difficult to control and you might properly call these gut feelings, whatever those are. And I think these are very different systems and it kind of comes back to the interconnectedness of the brain. And you might have one system, the cognitive system, maybe prefrontal only based telling you to do one thing. And then your gut is telling you to do another thing. And it’s not clear to me where the actual decision maker is. There’s not the kind of the modern view of the brain. There’s not like a little, a little person inside your head that’s pulling the levers, it doesn’t work like that. We frankly don’t know.

Dr. Stieg:  You’re an expert on the concept of dread and that state of mind in terms of making decisions. Can you explain what you mean by dread and how it plays a role in our decision making processes?

Dr. Berns: Many years ago, when we were in the midst of studying the reward systems, my colleagues and I, we, we recognized that reward is only one half of the equation, really. Yes, we pursue pleasure. We want, you know, we want to be happy, but we also want to avoid pain and unhappiness. And that is, we think a rather different system in the brain. And so we wanted to study what role that had and the choices that we make. Now, there’s a logistical and ethical, difficultly to hear when we, when we want to study this, because I think we can all acknowledge that pain is a big part of life. You can’t avoid it, although we try to. Nobody likes it, but it is a fact of life. But how can you study that in the laboratory? You can’t, you can’t bring people in and, and subject them to suffering. And so we were kind of faced with this conundrum. We knew the pain was important, but we didn’t really know how it affected decision-making because you can’t ethically do stuff like that to people. We actually devised a paradigm where we inflicted a, let’s say, minor amounts of pain to people, and they did this willingly. So I want, I want to be clear about this, that when people signed up for these experiments, we were, and what we did is we, we put little electrodes on the top of their feet and, you know, we gave them a little electric shocks. To be completely ethical about it, we first titrated the amount of voltage that the person found uncomfortable. We gave them control of that and said, you know, okay, this is the maximum amount of shock we’ll give you. And we won’t give you any more than that. And people were fine with that. As long as they knew what they were in for. And what we did was we asked people to make decisions. And these were these brought in the element of time. And the interesting choices were, would you prefer a large voltage shock now, or would you prefer a less voltage shock, say in a minute? But you’ll have to sit there and wait for it for a minute.

Dr. Stieg: And the answer was?

Dr. Berns: Nobody likes to wait for painful things. And that is, that is what we call dread. That state that you’re in, you know, like where you’re waiting for the shot, or, you know, you’re waiting for the dentist to come in where nothing has happened to you yet, but you’re imagining it. And so nobody likes that. Now what’s interesting about it is that people vary a fair bit and how much they don’t like it. So some people we called “extreme dreaders.” And these were folks who hated waiting so much that they absolutely said, “Yes, I’ll take the bigger shock now I can’t stand to wait for a smaller shock. I know, it’s less painful, but I don’t want to wait for it. So just give me the big one now.: And then there were kind of more mild people who said like, “Yeah, I don’t really like to wait, but no, I’m not going to take a bigger shock just to get it over with.” And what’s interesting is we looked at what was happening in their brains between these two types of people. And pain, unlike reward, is represented in a much more diffuse way. Pain is a very complicated phenomenon, as you know. It’s in part it’s due to what we called nociception, which is the physical transduction of, of a painful stimulus into a nerve impulse, you know, in, in your finger, your hand, your foot. And then that has to get translated into something in the brain and all sorts of things get mixed in with that. And the one that’s probably the most important for this circumstance is attention. If you’re about to get a shot and you’re focused on your arm, and you’re just kind of looking at it, waiting for that needle to go in, yeah, that’s going to hurt a lot more than if you’re distracted. And so what we saw in these folks’ brains was that there was activity ramping up in their cortex in areas associated with the foot and other sensory areas in advance of the actual shock. It’s like people were simulating what was going to happen even before it happened. And in some cases that simulation was greater than the shock itself.

Dr. Stieg: How do you differentiate or do you not the concept of dread versus anxiety? You know, I mean, I’m just sitting there where, “Oh God, how bad is it going to be with, how long is it going to be?” The component of anxiety I presume plays some role in dread or others, do you equate them?

Dr. Berns: For sure. They’re, they’re definitely related. And I think kind of in this specific context, they probably are the same thing. Although I would, I would use anxiety kind of in a more free floating way. You know, usually we talk about anxiety as, as a diffuse emotion. Whereas in this case it was quite targeted, you know, where, okay, I’m anxious or I’m dreading that shock.

Dr. Stieg: So let’s take a Navy SEAL, you know, they’re put in ice cold water, they’re suffocated. I mean, all of these extreme things that they go through and they learn how to deal with that. I’m presuming that they are by nature, mild dreaders. That’s one question. And the second question is, can I be, if I’m an extreme dreader, can I be trained to be a mild dreader.

Dr. Berns: That’s a great question. We haven’t done those studies, but I would think that you can train people. I believe in the ability to learn. So I don’t see why you couldn’t. For dread and specifically the dread or anxiety of pain, the technique is, is pretty simple. It’s distraction. What we observed in that study, it was the more attention you focus on that body part, that’s gonna get jabbed or shocked or whatever, then yeah, the more you’re going to dread it, the more it’s going to hurt. Techniques like distraction are highly effective.

Dr. Stieg: And when you talked about, you know, the big shock quickly, or the lesser shock and in a period of time, can individuals be categorized on the basis of time versus whether they’re a mild or extreme dreader?

Dr. Berns: Yeah. Great question. Yes. You can. If you give people enough choices and kind of different tradeoffs of voltage and time, yes. You can calculate what we call the discount rate. And it’s, it’s exactly the same as if it was for rewards, except now it’s for, for painful outcomes. So you can classify people as steep discounters or gradual discounters, or as we did, it was based on their brain activity and how much they ramped up their sensory systems in anticipation of it. It turns out that they were correlated over the times that we looked at.

Dr. Stieg: I know there’s people sitting out there saying, “Oh my God, I’m a, I’m an extreme dreader.” Or somebody thinks I’m a mild dreader. Is there any help that you can give people to guide them in their decision making to make it easier? Are there exercises or steps that they can take?

Dr. Berns: Yeah. I mean, I’m probably in the extreme dreader category.

Dr. Stieg: *laughs* You don’t sound like it.

Dr. Berns: I’m neurotic enough to call myself that. You know, I kind of lump people. You’re either dreading the future or you’re regretting the past. So pick your poison. No, but seriously, the extreme dreaders, I think have to kind of fall back on things like distraction because it becomes a self-perpetuating cycle. The more you dread the future of what might happen, the more you focus on it. And then that just amplifies the process. And the only things that, that really help with that is to distract yourself and do something else to take your mind off of that. You know, these are basic things, you know, exercise helps a lot, hobbies, especially things that if you can use your hands and you get kind of just absorbed in… these all help.

Dr. Stieg: Greg Berns, it’s been fascinating. You’ve been helpful to me, both personally, and also I think in how I can deal with patients in battling through the process of making difficult decisions. Thank you so much for being with us.

Dr. Berns: Thank you. It’s really been my pleasure.

S1 Episode 51: Do Our Dogs Really Love Us?

​Dogs and the humans who cherish them have a unique bond unlike any other. We wonder all too often, do our dogs love us as much as we love them? What are they really thinking? Are we projecting our own feelings onto t​hese treasured family members in trying to understand them? Emory University neuroscientist Dr. Gregory Berns, has made some extraordinary findings. After spending years using MRI imaging technology to study the human brain, he then used this same approach to study dogs’ brains. It turns out that our furry friends are much smarter than we thought! 

Dr. Philip Stieg: Do dogs really love us, or just care about food toys and shelter? How do we know what a dog is feeling? What do they understand about us and how can we better communicate with them? To answer these and many other questions about humankind’s best friend is my guest neuroscientist, Dr. Greg Berns. Dr. Berns is distinguished professor of neuro-economics and director of the center for neuro policy and neuroscience at Emory University, He is also the author of several popular books, including the New York times bestseller. “How Dogs Love Us: A Neuroscientist and His Dog Decode The Canine Brain.” Greg, thanks so much for being with me.

Dr. Greg Berns: Oh my pleasure.

Dr. Stieg: So I’ve watched enough Lassie movies to really wonder are dogs smarter than humans? Can we clarify, you know, how big is the dog brain in comparison to a human brain?

Dr. Berns: So the dog’s brain is actually not very big and across most of the breeds it’s, doesn’t vary much from being about the size of a lemon. Even if you, if your dog has a huge head like those big Labs out there, or a St. Bernard I’m afraid, most of that head is either air or muscle. Or as we say in the biz, they’re either air heads or meat huts.

Dr. Stieg: I like that. So just like their human counterparts, but does a dog brain have the same regions as a human brain, the frontal lobe, the temporal lobes, et cetera?

Dr. Berns: Most mammalian brains of course have the same basic structures because we’re all evolved from the same common ancestors way back. Yes, there’s a frontal lobe. There’s occipital lobe- all the major lobes are there. In fact, you can go down to even smaller structures, find again, all the same structures are there. You can look at the brainstem, all the nuclei are there, which, you know, as, as a neurosurgeon, that shouldn’t surprise you because brains are brains, really

Dr. Stieg: One question I had is about the common ancestry that you just mentioned in regard to dogs versus humans. How long ago did this actually happen? And did dogs evolve from wolves?

Dr. Berns: That’s the million dollar question in terms of common ancestors. The last common ancestor that we have with dogs themselves is actually about 80 or 90 million years ago. That is incredibly long ago. So the carnivores as they’re called split off from what would later become primates a very long time ago. In evolutionary time, we’re not that close to dogs. Now, what’s interesting though, is that sometime, I’d say maybe between 15,000 and 30,000 years ago, blink of an eye in evolution time, is when dogs appeared. And the million dollar question is exactly when did that happen? We can say unambiguously that there were dogs in the first human settlements. So settlements around, uh, the Middle East, the Fertile Crescent. You can date fossils that are clearly dogs to about 11 or 12,000 years ago. Before that it gets a little fuzzier because people weren’t living in communities, people were nomadic and they moved around. And the question is, were dogs, dogs then? Or were they wolves or were they something else? And the short answer is we don’t really know yet because the fossil record only differentiates changes in bone structure. So we don’t know, for example, if say a Wolf brain turned into what we now know as a dog brain, because the brains are gone. There aren’t any fossilized brains that have been recovered. And so now folks are turning to genetics to try to figure this out. And it’s all over the map. Somewhere between 15 and 30,000 years ago is when dogs became dogs.

Dr. Stieg: So when they were found in excavations from the Middle East, I’m presuming at that point, dogs had already been socialized within the human environment.

Dr. Berns: That seems to be the case, whatever their ancestor was, you know, and kind of my view, I, you know, I envisioned nomadic humans traveling around the world and kind of these small bands of Wolf dogs, whatever they were were kind of hangers ons, if you will, maybe living off the garbage that people discarded. But eventually, you know, getting socialized enough so that they would approach the humans and, uh, eventually become friendly with them. And then once humans stopped moving around and started living in cities, then those creatures, those dog-wolf, creatures, whatever you want to call them, started breeding with each other and became more and more socialized and very comfortable living around humans. And then, then it really took off. I would say,

Dr. Stieg: I have to ask this question. I mean, given your background in neuroeconomics and neuro policy, why dogs? What interested you in the first place about dogs and how does that relate to your background?

Dr. Berns: I think I’ve always been a dog person. I grew up with dogs. I’ve had dogs in my house for really my entire adult life. My background before I got into dogs was in neuroeconomics, which simply means that I use brain imaging tools to understand human decision making. And it was, uh, back around 2011 that had the idea, well, if we’re using these tools to study human decision making, why can’t we do that with dogs? Why not just train dogs to go into a scanner the same way that people do and see how their brains work. And that was, that was the beginning of it. And at first, it was just kind of one of these side projects, just to crazy idea. It literally started with one of my own dogs, you know, looking at her Cali, you know, I just wonder, it’s like, wouldn’t be cool if I could train her to go on the scanner and see what she’s thinking. And then it just took off from there.

Dr. Stieg: We’ve all heard the expression herding cats. And I also, I also think about that quite often when I’m trying to manage my department, is that why you didn’t pick cats? It would be hard to get them into an MRI scanner and try to train them to do that?

Dr. Berns: No offense to the cat people out there. Um, it just seems highly unlikely that you could convince a cat to do this and the way, and to be clear, kind of what we started doing was was without anesthesia, without sedation, without any restraints. And so the whole idea was to treat the dog the same way as a human volunteer or perhaps a child volunteer where they have to do it voluntarily. They have to be taught how to do it and, and want to do it actually. And so it’s just hard to imagine getting a cat to do that.

Dr. Stieg: Also, the important thing I would think don’t cats see things differently than a dog. I think can’t see things in vertical and horizontal lines, and it’s my understanding that dogs actually see forms and faces. So it would be from my perspective, I think probably easier to really assess a dog’s response to some visual stimulus in a functional MRI. Is that true?

Dr. Berns: Well, dogs also have rather different visual systems than we humans do. Um, so I would say that they’re both different in their own particular ways. So dogs are dichromats so they, they only see in two colors, primarily blue and yellow. They also actually don’t have a fovea, which is an interesting tidbit. What that means is unlike humans and other primates who have a fovea central area of higher resolution in their visual field dogs actually have what’s called a visual streak. So it’s like you take the fovea and you kind of stretch it out into a horizontal line across the retina. We think that’s because they evolve from predators. And so they’re very good at scanning things along the horizon. But I think probably, behavioral reasons aside, cats brains are actually quite small. The dogs are small, lemon size, but the cat’s brain is more like a walnut. So that makes, that makes the job even harder should we even get a cat into the scanner, which I don’t foresee.

Dr. Stieg:  Do you think the dog’s vision has anything to do with their social ability or is it other components of the brain?

Dr. Berns: I think it’s part of it kind of, we think of dogs as, as having smell as their primary sense, although they are also very visual creatures, so they, they process body language amongst each other. And there’s good evidence that they’re also attuned to our body language as well, as well as even facial expressions. That’s something common, I would say in most predators especially predators that have a history of hunting in packs, where they have to communicate with each other to bring down prey, they use a variety of signals, which could be smell. It could be visual and it could be auditory as well. We also know that dogs have tremendous hearing to frequencies as well beyond our hearing range. So I think it’s all of these things. And in many ways they may be more kind of well-rounded in their use of their senses than even we are, because smell is not something that we use as much, perhaps as dogs, maybe the dogs kind of parsed it out more evenly amongst the census, but we’re trying to figure all this out, right.

Dr. Stieg: Sociability in a dog is actually so much genetic, correct? As it is in humans, or, you know, I think of my dog, my son’s dog, my gosh, he has to put his paw on me every time you see, as me puts his head on my lap. He just needs physical contact all the time. In fact, the most needy dog I’ve ever seen, which I like, but you know, it’s very different than other dogs that we’ve had.

Dr. Berns: When we’re talking about behavior. It’s always a combination of genetics and environmental experience or upbringing. What we know about dogs is they have really wide social imprinting window, which means that when a puppy is born, there’s typically a window and in dogs, I think it goes up to about 16 weeks. So almost four months where they’re very plastic and they will just kind of glom on to whoever or whatever is around during that period and get very comfortable with them. So dogs can socialize to humans, but if you have a dog on a farm, they will socialize to the livestock just as easily. Now, it’s interesting when you compare that to say wolves. Wolves who are, for all intents and purposes still the same species as dogs, actually have a really short a sociability window, only about 10 days or so. And so after those 10 days, it’s like, if they did not see a human or bond to human, then in that period, then forget it. But you can socialize them. I don’t know if you want to live with them, but you can get them comfortable around humans. There’s something really interesting about dogs and what happened in their social process. And I think that goes back to the evolution. We actually know a little bit about what genes might be involved in that. So we’re making progress on that front earlier.

Dr. Stieg: You alluded to a dog’s sense of smell. It’s another thing that I marvel at when I take my dog out for a walkout, how he can just stay on there for God knows how long not moving and sniffing the spot. Are there particular scents? You know, the owner, a dog biscuit, another dog, a female dog, what is it that attracts a dog’s sense of smell?

Dr. Berns: The short answer is, I don’t think we know. I don’t think that we have good insight into what a dog’s world looks like at the, at that level. There’s an ongoing debate in the detection dog community. So these are people who train dogs on, on a variety of detection tasks, which could be bomb sniffers. It could be medical detection, you name it, it could be agricultural dogs. And the debate is when a dog encounters kind of a mixture of stuff, a potpourri of scents out there in the world. Are they like getting every single scent and kind of tagging it? It’s like, Oh, okay. That’s Rose, that’s lavender. That’s roadkill from three days ago. Um, we just don’t know. Is smell, like our sense of vision to them. It’s perplexing to us. Uh, because olfaction is, is one of the most difficult scents to study, frankly.

Dr. Stieg: Well, that alludes a little bit to memory too. Like you said, roadkill from three days ago, that would imply that they remember from three days ago,. Does a dog have that capacity?

Dr. Berns: They certainly have memory. This goes back to what we said at the beginning that they have all the same basic parts of the brain that we do. So they have a hippocampus and in fact, their hippocampus is actually quite large for their sized brains. So they’re doing something with memory, probably spatial memory. And to me it makes sense that they do have that capacity. When you look at other animals that cache food, they hide it and they store it. Even a squirrel, a squirrel will store nuts. Are they just doing that on kind of autopilot? Or are they actually thinking, I need these acorns to get me through winter? I mean, I’m anthropomorphizing, but the point is that they probably do have some rudimentary abilities in terms of longterm memory like that.

Dr. Stieg: You know I always wonder whether it’s memory or whether it’s just programmed behavior? Again, my dog, there’s a ball by the swimming pool. He’s gotta be in the pool, fetching it. And he just won’t stop. I can throw it a hundred times, 200 times. He just keeps going. I’m presuming that it’s just inbred behavior patterns.

Dr. Berns: I don’t know. I mean, some of that, some of that is behavioral patterns, but I’m also convinced that that dog probably all animals have some form of what we call episodic memory, that they have the capacity to store memories of things that have happened to them, if you will. Which is different than memory for facts, which they probably don’t have because they can’t store things that way.

Dr. Stieg: I presume every dog owner looks into their dog’s eyes and says, they’re thinking they love me. And they start thinking about their emotions. I think it’s particularly creative the way you tried to analyze dog emotions by feeding a model dog. And then in the functional MRI, looking at what happened their brain. Can you explain it to us?

Dr. Berns: That experiment was ostensibly about jealousy and there’s a huge debate amongst animal researchers in general and dog researchers, and in particular about the extent to which animals experience emotions like we do. Some people researchers believe that you actually need language to have an emotion that the two are so yoked together that you can’t experience something like jealousy or love, for example, because you don’t have the words for it. Then, then the feeling is meaningless. Personally. I don’t agree with that sentiment. I actually agree with kind of the other school, which says that these emotions, uh, that we have probably evolved from some common basic function because they serve a basic function in terms of living with each other, in terms of social emotions. Actually, this is what Charles Darwin thought. He thought that emotions and man came from something in, in animals. And actually he, he looked to dogs as, as an example. In that experiment though, we were focused on jealousy. And so what we did, we had a dog in the scanner and we, they were facing their owner. And then behind the owner, we had a very realistic statue of a dog. And from time to time, the owner would turn around and instead of feeding their dog in the scanner, they would turn around and feed this very, a realistic looking dog. And so our goal was to look at the brain activity to determine what was happening. So yeah, the dog was disappointed. They weren’t getting the treat. And as a control for that, we also had a bucket. And so sometimes the owner would turn around and put food in a bucket. And so we compared that—we compare it putting food in a bucket, it’s a feeding this other fake dog. And what we found was activity in a particular area called the amygdala, which is associated typically with emotional arousal in humans, as well as other things was particularly active when we fed the fake dog. And it was even more so in dogs who had a history of aggression. Putting two and two together, you kind of can start to draw this picture, that dogs with a, I called it a twitchy amygdala tended to respond to these social signals in an amplified way. And in their case, they tend to, you know, become aggressive.

Dr. Stieg: Do you think dogs have a range of emotions? Like fear, love, anger, anxiety, affection. Uh, I’m sure I’d like to know that. Cause I, you know, when I look at my dog, I’m hoping that he loves me as much as I love him.

Dr. Berns: Oh sure w you know, why wouldn’t they? Very few things I think are kind of all or nothing phenomena in the brain. Especially when it comes to emotion. I think the crux of the question though, is like, how nuanced do we get into the dog’s brain if we’re talking love, for example. Cause this seems to be what most of us want to know is does my dog love me? The problem is, we have one word to describe, you know, dozens, if not hundreds of shades of love, right? So you have romantic love. You have parental love, you have platonic love, all sorts of types. And so the question then is which of those types or shades of love does a dog experience? I don’t think we’re going to be able to answer that easily because honestly I don’t see a way to get at say romantic love in a dog. I’m not sure that that exists, not in the way that we think of that.

Dr. Stieg: it’s hard to design, I would presume, a test that you could assess that. So that that’s probably the limiting thing, correct?

Dr. Berns: Yeah. I mean, when you get into the weeds of, of dogs, reproductive behavior, frankly, it’s not very romantic, but you contrast that though with wolves and coyotes and other animals, coyotes and wolves, for example, mate, for life, which is very interesting.

Dr. Stieg: We had a Yale neuroscientist on, Dr. Marvin Chun, and we were talking about human functional MRI imaging and brain function and where that’s going, is the applying the use of artificial intelligence for further information. Do you think that you’ll be doing that with dogs as well?

Dr. Berns: It’s already happening. We’re doing it . Kind of my dream has always been kind of the Dr. Dolittle version of this, which is to build a brain decoder. So yes, you need AI, you need machine learning and you’re right. That’s how all brain imaging is going in human research. And so, yeah, we’re going to do the same thing with dogs.

Dr. Stieg:  I understand that you’ve been very involved with the training and selecting of, of service dogs. Are there particular breeds that are very effective for them or those across all breeds? Is there a gender difference? Can you expand on that a little bit?

Dr. Berns: So it obviously depends on what you need a dog to do. In the service dog industry, where a dog is trained to assist someone who is disabled in some way. So someone in a wheelchair, for example, you see a lot of retrievers, a lot of golden retrievers and actually more Lab, Labrador retrievers. And I think in large part, that’s due to their just their general easygoing friendly temperament. What’s interesting to me is you go back 40 years, 30, 40 years ago, if you were talking about service dogs, you would most certainly be seeing German shepherds. And so those, those were always the dogs you saw that were for blind people and they’re frankly not used that much anymore, just because the retrievers have seemed to have a better, more friendly temperament. We have been involved with studies. We actually posed the question, “Could we use brain imaging in these dogs to, to predict whether a dog would actually be a good service dog, even before you embark on the training,” which is, is quite costly and time consuming. We actually adapted some of our tasks and teamed up with canine companions for independence to test this hypothesis. And it turned out that you can, you can actually recover some important signals from the dog’s brain in particular, again, coming back to their amygdala. So a dog, with a reactive amygdala, we found tends not to be a good service dog, and this is not surprising. It’s like the emotional person. It’s like, that’s an emotional reactive dog. And we can see it in their brain before it even manifests as an overt behavior. And so that seemed to carry some predictive value.

Dr. Stieg: So the better service dog is a dog that’s mellow, more even-tempered.

Dr. Berns: Exactly, exactly. That’s exactly what you want. Now you might want a more reactive dog in different types of jobs, for example, or in other types of jobs, you might need an independent thinker as they say. So, so a dog who can problem solve without being trained on every specific, little detail.

Dr. Stieg: I was shocked to see that you actually have, I guess you call them service dogs for people that are experiencing post-traumatic stress disorder and, you know, turning on the lights in the room when it’s dark, that I find very impressive. So there are a whole set of various emotional, psychological problems in humans that you can train a dog to help them get through that, that difficult time.

Dr. Berns: Indeed. There’s a huge demand for it. There are many, many more people who would like to have dogs that can help with these problems then than dogs out there. And unfortunately it’s, the training process tends to be quite expensive. So if you can find someone to train them, it can cost anywhere from probably 10 to 30,000.

Dr. Stieg: Yeah. We’re talking about different breeds being effective for these service dogs—are dogs, individuals like us like human beings?

Dr. Berns: Absolutely. You know, I’ve, I’ve now probably looked at probably about 300 scans of dogs, functional MRI scans. And I can tell you that they are as variable across each other as any of the human ones that I’ve seen. My take is yeah, they are as individual all as we are.

Dr. Stieg: Where do you see your work going in the future? I’m sure that everybody listening now is going to be fascinated by the things you’ve written. Where are you going to take us?

Dr. Berns: Well, in terms of the dogs, I think I’m really focused on, on decoding. So this is the AI approach and machine learning approach to, to build some form of brain decoder, to understand, you know, based on images we can record from their brain. Can we get some sense for what the thinking, whether it’s in terms of images that they might be thinking of, do they think visually, do they imagine things visually as we often do, They certainly don’t have an interior monologue. I doubt. I can’t imagine what that would sound like, but they might have kind of a Smell o’ vision version of it. That’s what I want to do.

Dr. Stieg: I read a little bit about Chaser who was able to identify a thousand toys, which to me implies that there must be either it was a program dog, or they must have a memory. Tell me about that.

Dr. Berns: Chaser was the dog of John Pilli, who lived in South Carolina and he passed away last year as did Chaser actually. So Pilli, uh, had this Border Collie who he noticed from as a puppy, just, you know, like many border collies just needed a job to do. They’re there they’re very unhappy without jobs to do. He was a psychology professor and he just started teaching her the names of toys and, and found that she was very adept at apparently learning the names of toys. So she could go retrieve, I couldn’t, I can’t possibly give all the names, but he would just give weird names to things and she would go get them. And he claims that he trained her on over a thousand objects in there as kind of ample YouTube video of her doing this. She’ll go into another room to get toy out of a stack. So there’s no kind of inadvertent queuing. And what’s weird to me about this is, I don’t think I could do that kind of task because it’s like, okay, think of a thousand names for just random objects in the world with kind of no way, no kind of common sense classification scheme. Could you remember a thousand arbitrary names? It’s like, I don’t think so. We actually don’t know what she was doing or how she was doing it. I had wanted to scan her before she died, but I never got the chance to.

Dr. Stieg: I’ve a hard enough time remembering names from day to day. So..

Dr. Berns: Exactly.

Dr. Stieg: That’s why I was really astounded by the story. I was also taken by the fact that dogs will actually listen more intently to gibberish than a human will. A human will naturally block it out and kind of go on with what they’re doing. Whereas a dog will look at you and I actually tested it on my dog this weekend. And when I was speaking nonsensically he would just sit there and look at me and actually act like he was paying attention to me. What’s going on there?

Dr. Berns: Yeah. So we did a study a few years ago where we try to understand how dogs process human language and the way we set this experiment up. As we kind of built it off of a standard human experiment in, in human studies of, of language. Oftentimes you’ll have someone go in a scanner and if you’re in, if you want to know what parts of the brain are involved in language processing, you’ll play various kind of standard words to them, the person in the scanner, and then as a control, you give gibberish words or what’s called pseudo language. Obviously it’s not that interesting to see what lights up, uh, when you hear a word versus just some arbitrary sound. So you need stuff that sounds like language, these words and pseudo words. We did this with the dogs, but first we had to do an experiment or actually train the dogs on what the words meant. So we use the Chaser protocol where we taught the dogs, the names of new objects and new toys, and we only had two. And then we had the owner speak those words to the dog in the scanner. And compared that to what happens when they just spoke gibberish words, like kind of think like Jabberwocky words and kind of what we found was interesting because it’s opposite what we find in humans. So in humans, when, when we hear words then the language, parts of our cortex tend to become very active, more on the left than the right, um, a lot of activity in the temporal lobe and the angular gyrus and parietal lobe. And in dogs, we found the opposite pattern where the gibberish words were causing much more activity. And my conclusion from that was that dogs are processing human language in ways that are different than we do. And that I guess is not terribly surprising because they don’t speak. So they don’t have language production like we do. I mean, they communicate, they bark and they, they whine and they groan and, and howl, but that’s very different than language. So they don’t speak words. So they don’t have the neural real estate to make language. And so whatever they’re using to process our speech is different. And it seems to be based very much on, okay, I’ve heard this word before in particular context, or I have not heard this word before or this set of sounds, and I need to figure out what that means. Very different than humans.

Dr. Stieg: Greg, can you tell me, can you teach an old dog new tricks?

Dr. Berns: Yeah, I think you can. I mean, I guess it depends on how old the dog is just like humans, but we’ve had volunteers in this project that have run the age range from puppies. really. The service dog study was in what I’d call adolescents. So they were, you know, 15, 16 months old, but we’ve also had people volunteer their dogs who are, shall we politely say middle-aged meaning double digits, early double digits? So that would be 10 for a dog. And they, they seem to learn the task just fine. In fact, just this last week we certified two new MRI dogs and one of them was eight and he was spectacular.

Dr. Stieg: Everybody that goes out to buy a dog now is going on Google and trying to find what is the smartest dog? Is that true? Are those ranking lists of dog intelligence relevant? And do you ascribe to them?

Dr. Berns: I don’t give much credence to those rankings. One thing I learned from the service dog study that we did, we studied 50 dogs and these were all primarily Golden Retriever, Labrador Retriever crosses. For all intents and purposes they were all the same breed. And yet they were as different from each other, as other breeds were from other breeds and, and their MRI data showed the same thing. So there was, again, this huge individual variability. One thing to take away from kind of these breed lists is those are just someone’s opinion and rankings based on typically arbitrary criteria, which are rarely validated. And then you’re going to have huge variation even within that breed. I would not go off of that. And plus ask yourself if you really want a really smart dog, because if you have a really smart dog, then you might have a wolf on your hands.

Dr. Stieg: I don’t want any dog smarter than me. But so what advice do you give to a person buying a dog? You know, the one scenario is you’re going and you’re picking a dog out of the litter, or, you know, you want to save a dog and you go to the compound and you find a dog. Are there characteristics, you think that make an exceptional dog as a pet?

Dr. Berns: It’s really tough. I mean, uh, it’s personal, you know, and I have, I have many dogs in my house right now, but only one is my favorite. And that’s Cali. What’s interesting to me about her was she came from the Humane Society. So she was a rescue dog. We adopted her, she was about nine months old. So she wasn’t a puppy, but she wasn’t full-grown either. And I didn’t think I was going to like her initially, because she was kind of a standoffish dog, she’s a terrier and kind of has a terrier mentality. But what I found in the course of doing the project itself, so she was the dog I trained and it was in the training and the bonding that happened through that, that certainly I changed, but I think she changed as well. And so it’s partly the dog, but it’s also the human. And so it’s like any relationship you have to build it. And the more you put into it, the stronger it’s going to be.

Dr. Stieg: Dr. Greg Berns, author of “How Dogs Love Us: A Neuroscientist and His Dog Decode The Canine Brain.” Thank you so much. It helps me understand and makes me want to believe that I love my dog and my dog loves me. Thanks so much for being with me.

Dr. Berns: My pleasure.