Dana Foundation Blog

Virtual therapy yields real results

Therapists may one day conduct sessions with patients over the Internet to help them through bouts of insomnia. A new study finds that Web-based intervention using techniques established by the school of cognitive behavioral therapy (CBT) helped patients to effectively reduce sleep difficulties. CBT, which uses humanistic approaches to treat symptoms of a disorder directly, is the most common form of therapy for a range of anxieties and disorders.

Twenty-two patients received nine weeks of online therapy combining text, animations, quizzes and games based on the precepts of CBT—but no contact with human doctors. Another 22 control patients received no treatment. The insomniacs who had received the Internet-based treatment made significant improvements on the Insomnia Severity Index, a survey that measures the severity of the disorder, and maintained those gains after six months.

“An Internet intervention has the potential of meeting the large unmet treatment need of the population with insomnia by providing effective treatment through the Web,” the study authors said. “An effective and inexpensive Internet intervention would expand treatment options for large numbers of adults with insomnia, especially those whose geographical location prohibits access to relevant care, and could be a substantive first-line treatment choice.”

What the authors don’t elaborate on is other possible future uses of Web-based therapy. CBT is used to treat disorders from anorexia to depression and social anxiety disorder. Might people with these troubles find respite from therapy sessions available on their iPhones, while in line at the supermarket or multitasking at Starbucks?

Presumably not. I doubt therapists would recommend that people with debilitating or potentially life-threatening disorders look to online therapy for treatment any more than they’d recommend buying pharmaceuticals online from an offshore pharmacy. Drug prescriptions belong in doctors’ offices and, for most disorders, CBT still belongs in the therapist’s office, complete with soothing paint palette, pictures of sailboats and a reclining couch (although it’s my understanding that some modern psychologists consider this last feature now firmly in the territory of New Yorker cartoons).

On the other hand, more and more intuitively real-world activities are now available online. For instance, professors at MIT, Princeton and other big-name universities now offer online videos of their lectures, the great demand for which I can readily attest to as a former busy student. Therapists may similarly be hoping to appeal to the modern consumer’s finely tuned sense of convenience and seemingly boundless enthusiasm for novel uses of technology.

But I suspect most therapists would argue that Web therapy lacks the intimacy and openness of a half-hour on the couch (or what have you), especially when Web therapy involves little more than videos and quizzes, and that recovery inherently requires human—in-person—help.

One old computer therapy study comes to mind. In the 1960s, early artificial intelligence researchers wrote ELIZA, a computer program with very primitive language processing abilities. ELIZA could run a “script,” or set of instructions, that mimicked a stereotypical inquisitive psychologist. The result of engaging with even a simplistic AI therapist was eerily convincing, and many study participants refused to believe even during post-experiment debriefing that the “person” behind ELIZA’s dialogue was no more than a few hundred lines of code fed into a processor. People who spoke with ELIZA opened up to her about emotional problems and quickly grew to trust and defend her. Regarded as classics today, those early experiments reveal how quick we are to anthropomorphize computers and to become emotionally invested in technology, even when we’re told about the little man behind the curtain.

You can still play with (one version of) ELIZA today, on the Web. She won’t cure your insomnia, and she may be less convincing in today’s technological world of talking paper clips, but she’s still a pretty good good conversationalist.

–Ben Mauk

Attention networks and information overload

Paying attention to the visual world is a highly coordinated dance of neurons across several regions of the brain. Neurons in the brain’s decision-making centers must synchronize firing with those in the physically distant visual cortex, according to a new study in Science.

Scientists already knew that synchronized firing is one way information travels by neurons, but they hadn’t known how the visual system was alerted to pay attention to a significant stimulus such as a blinking e-mail alert or a flashy subway ad. As it turns out, prefrontal neurons increase signaling at the so-called gamma frequency, and this is coupled with dual signaling in the visual cortex.

You don’t have to browse far to see that the brain’s attention network has captured the attention (sorry) of the science media. As for me, I can’t start clicking on Web stories or I’ll start leaping from link to link in the productivity-killing manner described in the contentious Atlantic article “Is Google Making Us Stupid?” Well, is it? Has modern technology affected the brain’s ability to focus?

The New York Times urges caution in leaping to conclusions regarding modern information overload, in a question-and-answer session with attention researcher Robert Desimone.

“It’s not obvious that the attention load is higher today than it was in the past,” Desimone said. “Our ancestors had to attend to a lot of things that most of us can safely ignore. … My guess is that New Yorkers today learn to tune out stimuli that would have seemed inconceivably distracting to our ancestors.”

If you’re still reading this blog post, congratulations on your neurosurgeon-like concentration skills. But if you’re having trouble, I’ll also point out a recent article in Salon inquisitively titled “Why Can’t We Concentrate?” that helpfully mentions a few downloadable programs that will limit your Internet time or simplify your computer screen by weeding out distracters. As I read the article, a sidebar points out other recent Salon articles, a banner ad flashes at the top of the page, category tags invite me to browse similar articles in the archives and links within the text further tempt my info-hungry mouse.

Feeling a little unmoored, I search for a New Yorker story I remember reading—or, more likely, browsing—that looks at artificial brain enhancement at universities and in professional life, for the purpose of upping productivity by improving attention and focus.

But rather than Google for the nearest shady psychiatrist, I remember attending the recent “Learning and the Brain” conference in Washington, D.C., and writing that neuroscientist Michael Posner has suggested that arts training may help a child focus and perform better on cognitive tests. Perhaps that’ll help me, too—time for some new sheet music. Good thing Amazon is only a click away.

—Ben Mauk

Self comes to mind

Composers have drawn on science in the past (as in the recent John Adams opera “Doctor Atomic,” about Robert Oppenheimer and the atomic bomb), but this is the first I’ve heard of a collaboration between a composer and a neuroscientist. Bruce Adolphe worked with neuroscientist Antonio Damasio to present the multimedia composition “Self Comes to Mind,” which premiered May 3 at the American Museum of Natural History in New York. Damasio directs the Brain and Creativity Institute at the University of Southern California. He is also the author of Descartes’ Error and other books and is a member of the Dana Alliance for Brain Initiatives.

The 30-minute work for cello and two percussionists is performed while a video of brain scans and recorded text by Damasio plays. A review in The New York Times, though mixed, nevertheless praised the musicianship of the performers and the audacity of the project’s “big questions” approach.

Serendipitously, Adolphe and Damasio’s meeting of art and neuroscience debuted during an exciting week for just such conjunctions. The Learning, Arts, and the Brain summit was held May 6 in Baltimore and the Learning and the Brain conference followed May 7-9 in Washington, D.C. Presenters at these conferences looked at how arts education might affect the learning brain and lead to increased cognitive abilities.

“Art must do something to the mind and brain. What is that? How would we be able to detect that?” asked Barry Gordon, a behavioral neurologist and cognitive neuroscientist at Johns Hopkins University, at a Learning and the Brain presentation May 8. Like Adolphe’s artistic explorations, many of the conference talks blended concepts in the arts with scientific musings. Gordon’s hypothesis was particularly optimistic: “Art, I submit to you without absolute proof, can improve the power of our minds. However, this improvement is hard to detect.”

— Ben Mauk

Subprime science

Last week, the Wall Street Journal reported that a prominent drug researcher allegedly falsified data in 21 pain studies spanning 12 years. The article is scant on details concerning the doctor’s possible motives, or what the faked data consisted of. One of the hoodwinked journal’s editors says, “These retractions clearly raise the possibility that we might be heading in wrong directions or toward blind ends in attempts to improve pain therapy.”

This news comes a few weeks after a Times of London report accused Andrew Wakefield and his colleagues of falsifying data on an infamous 1998 study in Lancet that sparked widespread concern about a possible link between autism and the measles, mumps and rubella (MMR) vaccine. Ten of the 12 authors had already retracted the paper, and the Lancet had previously admitted that the researchers had a “fatal conflict of interest.” Nevertheless, the hypothesized link persists among some parents and has contributed to a large bump in incidents of measles and rubella in young children during the past decade (but, unsurprisingly, not to any decline in rates of autism).

Fraud is the most common reason for the retraction of research papers in scientific journals, and if proved fraudulent the pain studies will certainly join Wakefield’s paper in the ranks of scientific malpractice. (Less commonly, papers may be retracted due to an accidental but major error.)

Science goes wrong not when an experiment fails—a natural part of the process—but when the long-term consequences of disseminating poor research are ignored in favor of the short-term gains of publication and renown. (A maxim in many a campus laboratory, “publish or perish,” doesn’t exactly promote responsible behavior.) If you’ve been following the news these past six months, the notion of myopic experts wreaking unintentional havoc on an unsuspecting lay community will not strike you as very strange.

However, I’m struck less by the audacity of incidents of subprime science than I am by their relative rarity. With a few notable exceptions (which naturally grab a disproportionate amount of the media’s, and therefore the public’s, attention), science works. We can believe the results we find in major journals, or at least accept them as honest attempts. No such claims of veracity can be made in the financial world, where many hypotheses and theories of the past several decades have been effectively disproved, and where incidents of deception have caused widespread mistrust. Why the difference?

If you answered “because of peer review,” you’d be wrong. An editorial in the British Journal of Medicine explains, “If authors write that they injected a particular drug or had 200 patients in their trial, then they are believed. Nobody asks to see the drug and analyze it or to see the records of the 200 patients. Peer review will sometimes pick up fraud, but it isn't designed to do so—and mostly doesn’t.” Furthermore, the editorial states that “peer review is held to be almost sacred within science, and yet accumulating evidence shows it to be highly subjective, something of a lottery, and prone to bias and abuse.”

So it’s not that peer review prevents fraud, and it’s not that scientists are simply more selfless, honest and trustworthy than financial experts, or anyone else. (At least, I doubt it.) If you ask me, the research system works because the field is by its nature full of skeptics. Research needs to be explained thoroughly and then replicated, and then replicated again and again if it is to truly lead to new technologies and treatments. Ideally, wrong ideas and erroneous results are weeded out in the process. It’s not fast or flashy, but that’s the point. If only I could buy stock in the scientific method!

—Ben Mauk

Darwin’s Odyssey

Two days after Christmas, and a little more than a month before his 23^rd birthday, young Charles Darwin boarded the H.M.S. Beagle for its second voyage.

The first had resulted in a rough hydrological survey of several islands off the coast of South America, and for the second Captain Robert FitzRoy, hoping to waste no opportunity to gather information about the unstudied lands, proposed that “some well-educated and scientific person should be sought for who would willingly share such accommodations as I had to offer, in order to profit by the opportunity of visiting distant countries yet little known.”

Thus Darwin—a beetle collector, amateur geologist and recent college graduate—joined the crew. Delayed twice due to unfriendly weather, the ship launched from England’s Plymouth Sound not in October as scheduled but on December 27, 1831.

Today, 200 years after his birth, Darwin’s renown as a chronicler of the origins and odysseys of life on this planet overshadows the impressive odysseys of his own life. Merely 22, and studying to lead a modest parson’s life, Darwin left England on a planned two-year survey that turned into a five-year absence from home, much of which he spent exploring tropical islands and documenting the undocumented world. His journal from the trip, published shortly after his return, brought him fame and recognition as a geologist, theorist and writer, but while we remember well the theories of evolution borne of those early observations, we tend to ignore Darwin’s contributions to the field of travel writing.

Consider the passage Darwin wrote following the Beagle’s first landfall, several weeks after leaving port, on the island of St. Jago in Cape Verde:

The scene, as beheld through the hazy atmosphere of this climate, is one of great interest; if, indeed, a person, fresh from sea, and who has just walked, for the first time, in a grove of cocoa-nut trees, can be a judge of anything but his own happiness. The island would generally be considered as very uninteresting, but to any one accustomed only to an English landscape, the novel aspect of an utterly sterile land possesses a grandeur which more vegetation might spoil.

While travel writing lacks the scientific ideals of objectivity and peer review, as well as the rigor of scientific method (the modern understanding of which was rapidly developing during the years Darwin lived and worked), the passage above nevertheless conveys truth about the excited young writer and, more generally, about the human mind, touched by wanderlust. Reading his entries, one finds nearly as much of interest in the observations of an Englishman abroad as in the critical thinking of a budding scientist.

Good travel writing shares with good science the need for a keen eye to explore hidden details of a world—a penchant for insight into the literal or metaphorical geography under observation. It may be no coincidence, then, that one of the modern world’s most cherished scientists wrote so revealingly of his travels that we can observe the churning of thoughts, emotions and beliefs—the very workings of Darwin’s brain—even as he documents the build of an unremarkable island.

—Ben Mauk

Words and numbers

Daniel Tammet has taught himself French, Finnish, German, Spanish, Lithuanian, Romanian, Welsh, Estonian, Icelandic and Esperanto. He also remembers and manipulates numbers with incredible skill. In 2004 he set a record for memorizing the first 22,514 digits of pi in five hours.

If all that weren’t enough, Tammet also speaks eloquently and revealingly about the way his mind works, an ability not shared by many savants (or people with modest memory skills, either). That Tammet also has Asperger’s syndrome and synesthesia makes any interview with him an absorbing read.

“You wouldn't use a word like ‘giraffe’ without understanding what the words ‘neck’ or ‘tall’ or ‘animal’ mean,” he says. “Words only make sense when they are in this web of interconnected meaning, and I have the same thing with numbers. Numbers belong to a web. When somebody gives me a number, I immediately visualize it and how it relates to other numbers.”

Read the rest of the recent New Scientist interview plugging Tammet’s forthcoming book. And check out an article on savants and a book review about Asperger’s syndrome from our Cerebrum archives.

(For extra credit: Grab a stopwatch and see how many digits of pi you can memorize in five minutes. I managed to memorize and recite correctly the first 31 while sitting at my desk. Presumably, Tammet was memorizing at a rate of about 375 digits every five minutes!)

—Ben Mauk

Dancing on the radio

After I wrote about the Mark Morris Dance Group’s Parkinson’s project during the Society for Neuroscience meeting last month, a co-worker pointed me to this radio piece, from the December 13 All Things Considered on National Public Radio, titled “Parkinson’s Patients Find Grace in Dance.” It’s another good story about the success that the program has enabled in patients afflicted with the neurodegenerative disease, and it speaks convincingly, if not very scientifically, of the healing power of the arts.

The radio piece even contains a few speculative words from Eve Marder, former president of the Society for Neuroscience: “The Parkinson’s patient [in the class] may find themselves moving much more fluidly and much better than they would if they were alone in a room and just saying, ‘Now I want to do those same movements.’”

I found dance instructor David Leventhal to be well-spoken and thoughtful regarding his students, but reticent to compare the classes to any sort of treatment for the disease itself. Rather, he linked the Parkinson’s classes to his thinking about learning to dance in general:

“I always thought [dance] was just about getting your body to do the right thing,” he said. But teaching Parkinson’s patients has taught him that “really, it’s about learning how to learn. ... The beginning of the process is 99 percent mental, 1 percent physical.”

—Ben Mauk

Great minds in neuroscience history

As the story goes, Archimedes discovered how to measure the volume of an irregular object while taking a bath. (He simultaneously coined the phrase “Eureka!”) In several probably apocryphal accounts, Isaac Newton linked gravity to the planets while he sat under (or, depending on your version, was bonked by fruit falling from) an apple tree. The structure of benzene—a groundbreaking discovery in 19^th-century chemistry—came to August Kekulé in a dream.

Important daydreams pepper the history of physics and chemistry. This is less often the case in neuroscience, whose history, focused more on physical lab work than on armchair theory, is burnished with at least as many damaged minds as great ones.

Any freshman in biology will know of Phineas Gage, the 19th-century railroad worker whose unfortunate accident—an iron rod blasted straight through his brain’s frontal lobe, leaving him alive and mostly functional but with a radically different personality—taught scientists much about the role the frontal cortex plays in social functions.

One 20th-century counterpart to Gage is H.M., a widely studied memory-impaired patient whose unusual condition has helped to establish what we know about the brain and different types of memory.

Brenda Milner of McGill University spoke about her personal experiences with H.M. over several years on Nov. 18 at the 2008 Society for Neuroscience meeting in Washington, D.C.

In the 1950s (and even today), patients with intractable epilepsy would sometimes undergo surgery in which parts of the brain—often parts of the hippocampus, a seahorse-shaped structure in the temporal lobe—would be removed.

After just such a surgery, in which H.M. lost about two-thirds of his hippocampus along with other areas, he appeared to have no ability to form new long-term memories. “[He was] unable to build his life up from then on,” Milner said.

She found that H.M. could remember a string of numbers or a name as long as he could repeat it to himself without interruption. However, as soon as she distracted him, “the whole complex train of thought he had kept going in a very obedient way was gone,” she said.

H.M. allowed for many new theories of memory and learning, but Milner played a part in an especially significant breakthrough.

“I'd like to give myself a little credit for choosing a motor task,” she said. It had been posited that motor skills might belong to a different brain process than verbal recall. In the “mirror drawing task,” H.M. had to trace a star shape while looking at his drawing hand in a mirror.

Unlike his performance with other tasks, H.M. showed regular improvement over subsequent trials in a day. More incredible, he also showed improvement over subsequent days, despite not remembering having performed the task before. And his skill level seemed to pick up right where it had been on the previous day. Milner realized that his “implicit memory” of the star-drawing procedure must involve different neural mechanisms than the damaged circuits responsible for the “explicit memories” of facts and events. Thanks in part to the unusual brain and participatory willingness of H.M. (and in no small part to Milner as well), we now have definitions for “explicit” and “implicit” memories, each of which has known correlates in the brain.

— Ben Mauk

Dancing with Parkinson's

Professional dancers and people with advanced Parkinson's disease would seem to move on opposite ends of the spectrum of agility and fluidity. But they share the same challenges in their daily lives and can teach each other a great deal about the frustrations and rewards of the body in motion.

Such was the opinion of David Leventhal, a dancer with the Mark Morris Dance Group who for the past six years has taught “Dance for Parkinson's Disease” classes in Brooklyn, N.Y. I interviewed Leventhal after watching a dance workshop in which he and a co-instructor led a group of Parkinson's patients and a few willing neuroscientists. The workshop took place Saturday afternoon at the 2008 annual meeting of the Society for Neuroscience in Washington, D.C.

Beyond the satisfaction of watching his students bravely work to overcome their symptoms—which can include tremors, clumsiness, stiffness and fatigue—Leventhal finds that the experience informs his own artistic thought.

“What I've realized is that professional dancers and people with Parkinson's have the same challenge ... to take unfamiliar movement—awkward, difficult movements—and to make it graceful. To bring logic to movement that is difficult.”

That the daily struggles of a neurological affliction might parallel the physical challenges of an art form never crossed my mind, but it made me see Parkinson's—and, by extension, other brain-based afflictions—in a whole new light. Might the attempts of an autistic child to enlarge his social understanding and empathy skills similarly reflect those of an actor or writer trying to access an unfamiliar character? Is there any link between a person with schizophrenia making sense of a fragmented world and a painter making aesthetic sense of (and translating to canvas) the visual world? And could these links be explored through the occasionally frightening and often beautiful examples of “outsider art”?

To pose a rough generalization: perhaps an artist makes a living by navigating around the same sort of mental roadblocks that many of us struggle with in our daily lives, in the form of neurological disabilities, emotional stress and cognitive frustrations. I admit that as a hypothesis, it sounds a bit clumsy. But if I learned anything on day one of SfN, it's that science and art share a commonality: whether crafting theories, learning to dance or coping with disease, clumsiness can aim at something graceful.

—Ben Mauk

Materialists take Manhattan

Two weeks ago I emigrated from Washington, D.C., to New York City, a move that might seem slight to international émigrés but that has thoroughly shaken up my routines and surroundings. My office, housemates, hobbies and, most jarringly, my physical environment have all changed.

For the most part I am enthused to have exchanged my squat city of domes for this vertical landscape of glass and steel, but at times I wonder what factor tipped the balance Manhattan-ward. Ostensibly, I moved for a number of reasons related to personal relationships, artistic interests, and perhaps a touch of wanderlust. But I can’t think of any single moment when these murmurs grew to a demanding roar. Like a rising tide or the movements of stars, I noticed the creeping change only after it had occurred.

Even if I could pin down the moment of conscious decision, could my memory be trusted to recall it accurately? Might the confluence of forces that pushed me north of the Mason-Dixon line have acted first on my subconscious, gradually shaping my neural circuitry in such a way as to eventually produce a “remembered” decision as an after-effect?

Quite possibly, say many neuroscientists. An op-ed in today’s New York Times called “Your Brain’s Secret Ballot” takes this election’s as-yet undecided voters as exemplars of the decision-making process. Authors Sam Wang and Joshua Gold discuss how indirect questions can predict a decision even among those who declare themselves unsure. And although the authors caution that we cannot yet use brain imaging to reveal the inclinations “lurking somewhere in the brains of undecided voters” (for more on that, see our recent Cerebrum article), an April 2008 study showed that, by looking at fMRI scans, scientists can accurately predict a subject’s decision as to which hand he will use to press a button up to seven seconds before the “conscious” decision is made.

These and other, similar results sit uncomfortably with our folk notions of free will. My great-grandparents also immigrated to New York City, by way of Ellis Island, so that they might live where they could choose their own destinies. As a nation founded on liberty and independence, we’re fine with determinism in the physical sciences, but leave our pursuit of happiness alone!

Several lay-friendly philosophers and scientists, such as Daniel Dennett, Douglas Hofstadter and Michael Gazzaniga, have attempted to salvage a notion of free will commensurate with the bleak but scientifically sound determinism that has come to dominate our understanding of the mind. Theirs are noble efforts, but not particularly mollifying ones as I peer down at the bustling bodies below my high-rise Midtown office. In our chaotic, seemingly single-minded quests for hot dogs, for respite from the morning rainstorm, for some spare change or for an open taxi, I see too much of the psychologist’s rodent scrambling for food or reeling from an electric shock, too much of the powerful but predictable electrical circuits in front of you right now. Not to question my brain’s motives, but my ground-floor office in D.C. offered a less unsettling view.

—Ben Mauk

Spotless mind, spotty science?

Aalok Mehta's shrewd but impassioned exposé on the neuro-ignorance of Fox's new thriller Fringe led me to examine my own critical eye for science on the screen. When it comes to demanding realism from fictional brains, have I been—forgive me—turning the other cortex?

I grew up watching Mulder and Scully solve The X-Files, and I feel the same sort of ingrained loyalty for these childhood friends as I do for superheroes, astronauts and the 1995 Baltimore Orioles. So my tolerance for telepathy and brain-controlling viruses (not to mention infield errors and pop flies to second base) might be higher than yours. In general, I don't mind the “fi” elements of sci-fi shows such as The X-Files and Star Trek.

Nor do I mind the Freud-inspired fantasies of Memento, Fight Club or Eternal Sunshine of the Spotless Mind, in which tight plotting and smart writing use but do not abuse a few science-stretching elements. These films explore the mysteries of brain function—memory, qualia, emotion, personality—without insulting their audience or exploiting their subject matter. But I balk at the lazy tactic of using brain disorders as a catch-all explanation for odd personalities and villainous behavior.

Hand-waving away an evildoer's motives with breathy mutterings about “paranoid schizophrenia” is a favorite move in action blockbusters, even though violence in patients with schizophrenia is rare—rarer than among alcoholics. Criminal offenders? The two latest Batman fight-o-ramas The Dark Knight and Batman Begins, both of which portray schizophrenic patients as agents of mayhem.

Then you have films such as Forrest Gump, in which a cloyingly sentimental portrait ignores the realities of illness and instead triumphs its protagonist as a wise sage. This cheapens the struggles faced daily by patients and their families, life-affirming aphorisms notwithstanding.

For a sympathetic and unsentimental depiction of the mentally ill, look to Miloş Forman's masterpiece, One Flew Over the Cuckoo's Nest. The characters are humans: not saints, not villains, not placeholders for their disorders. They are troubled, yes, but, to quote Jack Nicholson's R.P. McMurphy, “no crazier than the average asshole out walkin' around on the streets and that's it.”

At a recent post-screening discussion at the AFI Silver Theatre, Forman shed some light on his methods. He forbade his actors from reading up on the mentally ill; rather, he had them spend several weeks interacting with patients at a mental hospital. Some of these patients appear in the movie.

One Flew Over the Cuckoo's Nest's cultural legacy may be defined by the scenes in which Nicholson undergoes electroconvulsive (shock) therapy and, eventually, a lobotomy. The harrowing result helped to define in the 1970s popular conscience what treatment in “the system” involved. It is an oversimplification of therapy that doctors are fighting still. Nevertheless, I think this film succeeds where many others fail in depicting with real humanity the mysteries, both dark and whimsical, of the human mind. No brain-warping viruses necessary.

—Ben Mauk

Shakespeare’s word use embiggens the brain

Shakespeare’s word use embiggens the brain

A famous philosopher once said “verbing weirds language.” While I admit that Calvin doesn’t exactly have the ivory tower cred of, say, his namesake, in this case not even Wittgenstein could have said it better.

Of course, Calvin (the tiger-towing tyke, not the theologian) couldn’t have known that, years after he coined his linguistic maxim, I would Google the phrase in order to find a JPEG (jay-peg) of the strip, to which I could hyperlink while blogging. In fact, the previous sentence would have seemed like so much gibberish to Calvin, who philosophized from the funny pages between 1985 and 1995, before Internet-speak invaded our vernacular. Language weirds quickly these days.

But then, writers have always weirded words, for practicality or contrived effect. The recent Literary Review article “The Shakespeared Brain” looks at how the Bard reinvented nouns as verbs and verbs as adjectives in his offerings of “the great creative example of what the human mind can do”:

I told my brain scientists that one small but powerful example of this quick Elizabethan shorthand is what is now called functional shift or word-class conversion … . For example: an adjective is made a verb when in The Winter's Tale heavy thoughts are said to 'thick my blood.' A pronoun is made into a noun when Olivia in Twelfth Night is called 'the cruellest she alive.'

In an experiment detailed in the article, functional shift is found to have a distinct and unique effect on the brain, one that this author argues makes us “more alive, at a level of neural excitement never fully exorcised by later conceptualization.”

As with music, we’re a long way from explaining the mysterious pleasures of the spoken word. Our brains revel in both, “those sounds and sweet airs, that give delight and hurt not.”

However, these studies at least suggest hopeful beginnings, as does The Bard on the Brain from Dana Press, which explores Shakespeare’s dramatization of the human mind and brain, including the magic of language, through brain imaging.

—Ben Mauk

Marathon Mind

Monday's Washington Post outpaces the typical Olympic news coverage with a curious story on the neuroscience of running.

The surprising study in “The Sprinter's Brain” suggests that all sprinters take off faster when they position their right-foot on the starter's block. The advantage holds for novice runners and Olympians alike, regardless of their handedness or preferred foot. Researchers chalk up the unexpected results to the asymmetric structure of our brains.

We know that the right hemisphere—which largely controls the left side of the body—plays a central role in reaction time. But because the left hemisphere dominates in overall movement control—especially in moving the right side of the body—the right-foot-back position has, on average, an 80-millisecond advantage. If you've been following the summer games, you know that such slivers of time cleave runners with gold feet from those with lead.

While reading this article and checking my e-mail Monday morning, I leaned awkwardly at my desk, holding an ice pack to my throbbing knee with one hand and typing with the other. After an hour of working diagonally, my work ethic was palling, and I began to wonder whether my decision two months ago to begin training for the Baltimore Marathon signaled some sort of brain disorder.

A quick scan through the Dana Guide to Brain Health failed to confirm this suspicion, but it did console my joints with the fact that regular exercise is linked to enhanced levels of a growth factor in the brain that sustains many types of neurons. News about the beneficial effects of exercise on brain health makes headlines regularly—our August issue of Brain in the News will feature a story focusing on Alzheimer's disease.

Less common are those stories on the neurology of sport. How would the brain scans of these Olympians contrast with mine?

I suppose I can test the movement, balance and coordination of my own motor cortex this October, when the marathon takes place. For now, the neurons are willing, but the knees are weak.

—Ben Mauk

My neurovacation

Do other people take vacations to relax their brains? My recent 10-day trip through Turkey was a neuron-jangling ride of unfamiliar places and puzzles. Cross-continental travel jerked my brain out of its workaday habits and taxed it with wholly new sights and sounds.

Sound stressful? Perhaps my pale Polish skin has deprived me of the beach-bumming holidays enjoyed by my easily bronzed friends, who happily while away days with poolside naps, daiquiris and Dean Koontz novels. But I console myself that while they’re lounging toward melanoma, I’m engaged in a more rewarding, if less relaxing, “neurovacation.”

For more than a week, I massaged my cerebellum by navigating through the byzantine (and Byzantine) neighborhoods of Istanbul. Street map in tow, my traveling companion and I sampled the fish sandwiches cooked in carts along the Bosphorus River and survived a temporary 1 a.m. blackout in the bustling hotspot of Beyoğlu. (Ordering a foreign drink in near-total darkness made me feel like the subject of an experiment in human behavior!)

Our lobes boggled to behold the incredible vistas of Cappadocia and the ruins of ancient Ephesus, and in the small town of Selçuk we learned to play backgammon from a bartender who, for lack of a shared tongue, taught us with excited hand motions and frequent head-slaps. (This too had the feel of a study in social psychology.)

I prodded my Broca’s and Wernicke’s areas by learning merhaba for “hello,” lütfen for “please” and a dozen other foreign phrases. Most frequently, though, I pummeled my prefrontal cortex with problems of cultural differences. (Which hand do I eat with? How do I haggle a low price for souvenirs? How do I use this toilet?)

Aside from confusing my hypothalamus with all the time-zone hopping (thus inviting some serious jet lag), I feel the break from routine gave my mind a recharge. Dana Press has published books that suggest the brain thrives in novel situations. I plan to cite these findings to my tanned peers, who will no doubt be horrified to learn that I passed by all those Mediterranean beaches.

—Ben Mauk

Immunocalifragilisticexpialidocious

The day after he accepted the AAI-Dana Foundation Award in Human Immunology Research, I sat down with the affable Jim Allison so that he could explain to me what his research was about and what it means for cancer patients and their loved ones.

The subsequent article, published on this Web site (and to be included in July’s print edition of Immunology in the News), examines a small sliver of the current research scene that goes by the name “immunotherapy.”

I knew the term and was familiar with the basic underlying science, but I had heard “immunotherapy” used only rarely, and never before I became an editor here (where immunology, along with brain science and arts education, is part of our daily three-course meal).

I wondered if the word wasn’t a fairly recent portmanteau, perhaps introduced to describe succinctly to a lay audience what is in fact a complex domain of modern medicine (or maybe to jazz up dull med school lectures). I asked him how long the term had been around.

Allison, with the patience of a man who doubtlessly has long-suffered such public ignorance, responded: “Oh, 80 or 100 years.”

Red-faced, I later slinked back to my books for an ultimately fruitless investigation into the word’s etymology. In the process, however, I learned about the William B. Coley, a popular candidate for the title “Father of Cancer Immunotherapy.”

Coley worked at the New York Cancer Hospital (now part of the Memorial Sloan-Kettering Cancer Center, where Allison is a researcher), where as a young surgeon in 1890 he treated a childhood friend of John D. Rockefeller Jr. in a tragic case that meant a great deal for the future of cancer research.

I found the story in the first chapter of “A Commotion in the Blood,” available for free here. It is impossible not to be moved by the tale of a young, adventurous woman, killed in her prime by an excruciating disease for which 19^th century doctors had virtually no treatment.

That her death so devastated and inspired both one of our country’s great philanthropists and one of its pioneering cancer researchers makes this a medical drama that bests any “House, M.D.” or “Gray’s Anatomy” I’ve seen.

Coley devoted his life to studying biological vaccines for cancer, and his medical lineage can today be traced ahead to researchers such as Allison.

“Immunotherapy” may sound inscrutable, but behind the medical jargon is a history of loves lost and saved, doctors’ mad passions, medical miracles, deaths, and violent battles fought by microscope.

In truth, the reason one hears the term only rarely in public discussions of medicine is that, as Allison asserted in his lecture, the field has long been “thought of by too many as some sort of alternative medicine.”

Hopefully Allison and his fellow warriors change all that.

—Ben Mauk

Miracle Drug Cures Scientific Ignorance!

I check my e-mail and download music but have no idea how the Internet works. I pay taxes and obey laws with only a cursory understanding of the legislative process. I eat hot dogs but couldn’t tell you how they’re made.

In the same naïve fashion, many people digest science results in the news with no understanding of how a hypothesis becomes a pill. Health and science writers can only explain so much in their allotted 700-word spaces, and most of us don’t dig any deeper than that.

But just as that frank wasn’t birthed in the supermarket freezer, no drug or treatment emerges fully-formed from the local pharmacy or Times science section—not before a multi-stage process of research, review and approval occurs, and that can take many years.

For example, consider a press event I attended at the April 2008 Experimental Biology/American Association of Immunologists convention in San Diego. Its title, “Caffeine Prevents Multiple Sclerosis–Like Disease in Mice,” suggests promising research.

So, coffee prevents MS, right? That’s good news for my four-cup habit, and, moreover, for the many thousands of people who will develop the debilitating movement disorder in the coming years. Start percolating, people, and we can eradicate this scourge today!

On second thought, that might be a bit premature.

It’s easy to buy into results by masking a study’s failures and limitations. This is doubly so when those results are writ large in headlines, which are made to be easy to digest, not to convey every particular of a story. Writers must be careful to add caveats in the form of conditionals and scare quotes: “Coffee May Help Ward off Dementia, Study Suggests.” “Study Shows Brain Power Can Be Bolstered—Maybe.” “Mobile Phones ‘More Dangerous than Smoking.’ ”

There are various limitations that dog even the finest research. Studies with provocative or “sexy” results are often based on animal models of the disease, which don’t always correlate meaningfully to the human form. And if humans are studied, it might be in a small sample or depend upon tactics such as self-reporting, which can skew data. A study could also fail to be double- or even single-blind.

News stories rarely front these facts, which are difficult to explain to a lay audience, and one must be fluent in research-ese to decipher them in the original academic paper. (I, for one, am not.)

Luckily, the scientists involved in the MS study were wary of possible misunderstanding by us eager reporters. “These are very preliminary studies,” cautioned Margarent Bynoe, a researcher at Cornell University.

What their study found was that mice given caffeine (the equivalent of a human drinking six to eight cups of coffee per day) were protected against a mouse-model version of multiple sclerosis.

The researchers plan to collaborate with physicians who are studying MS in human patients, “and propose our findings to them, to find out at what stage it might be possible to establish a clinical trial.”

The early trials might be as simple as an epidemiological study, in which the researchers would “look at people who drink coffee, [and] look at the status of their MS.” This would be a typical step for such research, after which might come more animal tests, lab work, case studies, and then eventually, if all goes well, human trials.

All researchers think their findings deserve good media coverage, and it isn’t rare to hear results hyperbolized. Kudos to these scientists for their forthrightness, and to reporters for not sensationalizing this easy-to-misread study. But the next time you hear about that miracle food or cure-all drug, consider the long and sober scientific process that often gets lost in the telling.

—Ben Mauk

Of science, cinema and scaremongering

Last Sunday’s Outlook section in the Washington Post featured an epic half-page image of the glowing “2001: A Space Odyssey” star child, above which all-caps letters proclaimed: “The Science Century.”

All writers want to communicate some shared understanding of a topic with their readers, and a familiar allusion or archetype often does the trick nicely.

But science writers—those dedicated souls who bear the cross of making sober science seem engaging and, yes, sexy—justifiably look to movies and literature more than the average journalist. Most of us readers have neither the academic background nor the sustained interest to follow the research involved in a scientific study, except by way of vastly simplified scenarios and analogies. We, the people, demand “Star Trek.”

This time, though, the Post may have gone a bit overboard. In nearly all of the section’s half-dozen science articles, sweeping headlines and generalizations predicted futures either glowingly optimistic or catastrophically dystopian. Peppered references to Philip K. Dick, Michael Crichton, “Star Trek” and “Gattaca” were no accident.

Though I’m certainly guilty of using the device, movie-dropping starts to induce involuntary eye-rolling once you’ve read your hundredth article on the new “Blade Runner” brain-scanning breakthrough.

Worse than merely cliché, however, was Nita Farahany’s article, which in the print version touted the bombastic title: “What Are They Thinking?: The Government Is Trying to Wrap Its Mind Around Yours.”

Farahany’s piece overflows with doom-and-gloom speculation while failing to include even a single quote from, you know, an actual scientist. Her simplification of current research ignores the mile-wide gulf between current brain scanning technology and Orwellian mind-reading practices.

Let’s not dismiss her valid concerns for our civil liberties. We at Dana take an active interest in these neuroethical worries. And I’ve no doubt that Farahany, an assistant professor of law and philosophy at Vanderbilt University, is familiar with both the original research and its coverage in the media. But her Chicken Little-ing belittles the actual issues, and her second-paragraph cinematic reference doesn’t help:

“Though [pre-emptive crime prevention based on brain activity] may sound a lot like the plot of the 2002 movie “Minority Report,”…I’m not talking about science fiction here; it turns out we’re not so far away from that world. But does it sound like a very safe place, or a very scary one?”

Indeed, it was scary when Tom Cruise faced unjust persecution in that hypothetical land of techno-totalitarianism, and barely dodged those Hollywood effects. But what’s scarier—and nearer to reality—is when our trepidation toward new technology trumps our dedication to informed journalism.

Don’t think that I mean to criticize every use of sci-fi as prefabricated argument in the ethical wrangling of modern-day science. Such cultural shortcuts can come in handy and, as I said, I’m guilty of it myself. However, I hope that my recent post on artificial cognitive enhancements came off as more tongue-in-cheek than feet-on-soapbox, and that by referencing “The Time Machine” and “Gattaca” I managed to recall the ethical questions raised by those far-off fantasies without sounding like a Luddite.

—Ben Mauk

A pox on cancer

For many, the beginnings of an education in immunology do not occur until parenthood, when a number of previously unconsidered hard truths of disease come to light. Among them: The only thing that might be less fun than having chicken pox is having a child who has chicken pox.

The usually permanent immunity that follows from infection will be little comfort to the sunken-eyed parent, cradling a shrieking, polka-dotted infant at 3 a.m. But the stresses of chicken pox pale in comparison with those of mumps, measles and rubella, infections that commonly come with health-endangering complications, and that in unvaccinated populations prove wildly infectious and even deadly.

Thankfully, widespread use of the MMR vaccine among one-year-olds in the developed world has largely eliminated these illnesses from family life. There's a chicken pox vaccine, too. (Again, small comfort for dad and daughter on vaccination day.)

But recent research may have found an upside to the otherwise unfortunate cases of poxes, measles and mumps. These infections, when incurred early on, teach the immune system to recognize and attack tumors later in life.

Of course, it would be unwise to forego vaccination in favor of racking up potential cancer defenses. But one consequence of this discovery will be clinical trials of cancer vaccines that take advantage of the same immune-memory mechanisms observed to result from infection.

I arrived too late at the American Association of Immunologists annual meeting, this year part of the triennial Experimental Biology conference, to hear in person the AAI Presidential Lecture “Immunologic weapons acquired early in life win battles with cancer late in life,” delivered April 5 by AAI President Olivera Finn. But I wish I could have attended, because the material released in conjunction with the presentation contains thought-provoking notions about the important role foreign invaders play in our growing bodies.

Finn, who is chair of the Department of Immunology at the University of Pittsburgh School of Medicine, lectured that these infections create an immune memory not only for the foreign molecules known as antigens that invade the body but also for “self antigens” that are abnormally expressed on the body's infected tissues. When these same antigens are produced on tumor cells later in life, the immune system has the experience to respond appropriately.

In fact, Finn's laboratory linked the inflammation caused by non-malignant events such as measles and mumps to significantly decreased risk for cancer. Future cancer vaccines could use the “self” antigens produced by the body's infectious tissues to provide protection similar to that acquired from the more dangerous germs and viruses themselves, Finn argued.

We've long known roughly how immune defense cells recognize viruses and other foreign invaders. The news here is that the immune system can learn to recognize its own abnormal antigens, located on tumors within the body, and that this learning takes place during the immune system's early schooling.

Immunotherapy techniques based on these findings will soon enter a new phase of clinical trials. The seven trials that have been conducted, Finn reported, showed no adverse effects, and in 20 percent of cases the patients suffering from advanced cancers showed a stabilizing immune response.

So perk up, sleep-deprived parents! Your long-living children will thank you.

—Ben Mauk

The treatment doctors forgot

“You're not ever going to cure cancer unless you engage the immune system,” said Jim Allison, a scientist at the Howard Hughes Medical Institute/Memorial Sloan-Kettering Cancer Center, April 6 during his AAI-Dana Foundation Award in Human Immunology Research lecture.

I'll be writing more extensively on Allison and his (fascinating) work on cancer therapies later, but one general point of his so surprised me that I think it merits mention here.

Immunotherapy as a cancer treatment is not a new idea, but, Allison claims, it is a much maligned one. He began his lecture by saying, “What I'm going to try to do at the end of the talk is to make a case for moving immunologists into the mainstream. ... [Immunotherapy] is thought of by too many as some sort of alternative medicine.”

Immunology as alternative medicine? Looking around the Experimental Biology/American Association of Immunologists conference at the hundreds of posters, presentations and lectures by experienced scientists, Nobel and Lasker award winners among them, it is hard to believe that the “mainstream” would lump those therapies that target the immune system in order to enhance or suppress its activities with less conventional treatments such as acupuncture and herbal-based remedies.

And yet, doctors and clinicians have been slow to take to the new advances coming out of immunology research, in part because past failures have made doctors and the public skeptical of more successful recent studies. “Something new comes out and we hype it,” he said to me, “and [when] it doesn't work, people [say], ‘Eh.’ ”

It is inherently difficult to get the immune system to do what you want, Allison said in the lecture, because “there are a lot of intrinsic and extrinsic regulatory circuits to make sure the immune system doesn't go awry.” These fail-safe mechanisms in the body had in the past prevented successful manipulation by researchers of T cells and other immune defenses.

Allison's research during the past 25 years has led to treatments that target one of those fail-safe mechanisms that regulate the production of immune defenses. Recent trials of these treatments show great promise in comparison with the disappointing results of some past immunotherapies.

The payoff is that while traditional cancer treatments either involve a painful tradeoff of health concerns (as with chemotherapy) or are limited by their inability to adapt to tumor cell mutations (as with vaccines), the immune system can be harnessed to fight tumors with limited serious side effects and with the flexibility to create “neoantigens” that target virtually any tumor cell mutation, Allison said.

While en route to San Diego I met a man at the Denver airport whose daughter long suffered from headaches until she brought a decidedly alternative treatment to her doctor's attention, a treatment that seemed to successfully rid her of the affliction. Although our opinions on the strength of evidence for the medicinal benefits of Alaskan wild blueberries differed, one thing he said did come back to me during Allison's lecture:

“The onus is on the patient, now, to bring new treatments to the attention of the doctor.”

A bit of an overstatement, perhaps, but it wouldn't be outrageous to say that, when it comes to bringing immunologists into the mainstream, the onus is on all of us: patient, doctor, scientist.

--Ben Mauk

Educating the educators (with immunology lab time)

This week I report from the Experimental Biology 2008 convention in San Diego, where, from April 5-9, 13,000 members of several organizations, including the American Association of Immunologists, converge to discuss the year's advancements and next year's challenges. It's all a little overwhelming, but I hope to check in with as many findings and tidbits as possible.

A Sunday morning workshop at the EB/AAI convention brought together middle and high school science teachers, immunology-focused researchers and outreach activists to discuss one of AAI's more successful programs in bringing immunology to the classroom.

Many of those present had recently participated in the John H. Wallace High School Teachers Program, in which science teachers work with “mentor” scientists at immunology laboratories. Over the course of four to six weeks the teachers participate in research and devise lab exercises to take back to the classroom.

The program hopes to engage teachers who may not have had much experience in a research lab setting, thus giving them, as program director Brain A. Cobb quoted one satisfied educator, “street cred with ... students for having worked in the lab.”

As someone who remembers far too many 80-minute PowerPoint slide shows in high school science classes, I appreciate any program with the overarching goal of, as Cobb said, “enhancing science education [in] the middle and high school classroom,” as well as assisting “in narrowing the performance gap between majority and minority students.”

Since 1985, 145 teachers have participated in the program, including 75 teachers from 22 states since 1996. (AAI began sponsoring the program in 1993.)

After a summer internship investigating the role of cytokine levels in the autoimmune disease lupus at the University of Rochester, teacher Laurie Asermily returned to her school, the rural Mynderse Academy in Seneca Falls, N.Y., with fresh ideas.

“Kids see crime shows, and [with that background] are much more interested in investigating what's wrong than looking at [an immune system] where everything is working,” she said. The experiment she designed for her students dealt with looking at images of B cells, studying cytokine levels and “diagnosing” a patient as having either lupus or a healthy immune system.

“Autoimmune diseases affect mostly females,” Asermily said, “and my students were very interested in that. They've started to form their own hypothoses.” The children prepared posters and gave presentations on autoimmune diseases, including one student who spoke at length about his own juvenile diabetes.

Participating teachers worked with a curriculum expert to devise both the lab project and the activities surrounding it. For instance, Asermily demonstrated a computer-based, autoimmune-themed Jeopardy game. “Don't try to make one of these from scratch,” she said.

A major task of the Dana Foundation is educating the general public about immunology-related health guidelines and advancements in research. We strive to accomplish this through our free periodical Immunology in the News and our free Dana Sourcebook of Immunology, a textbook for secondary and post-secondary students and teachers. Hopefully, teachers are taking advantage of these resources in planning activities that get kids engaged. It helps, of course, to have an engaged, lab-experienced teacher.

—Ben Mauk