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You've got 10 minutes with Einstein. What do you talk about? Black holes? Time travel?
Why not gambling? The Art of War? Contemporary parenting?
Each week, host Jason Gots surprises some of the world's brightest minds with ideas they're not at all prepared to discuss. Join us and special guests Neil Gaiman, Alan Alda, Salman Rushdie, Margaret Atwood, Richard Dawkins, Maria Popova, Mary-Louise Parker, Neil deGrasse Tyson and many more...
10 November, 2018
Conflict Photographer Lynsey Addario on Art, Love, and War
For two decades she's traveled the world, photographing humans in crisis. Pulitzer and MacArthur winning photojournalist Lynsey Addario on what it's all taught her.
Think Again Podcasts
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- a story of survival that leaves our host speechless
- and a story of casual cruelty that will leave you shaking your head in disbelief
Think about all the images you see in a day. The advertisements. The photos and videos as you search the web or scroll through social media, if you do that. Now think back a century and a half or so to when photography was new. Imagine the first time a British monarch saw a picture of an Inuit family, or vice versa. What did they make of each other? What did it remake in themselves?
My guest today, photographer Lynsey Addario, has spent over two decades traveling the world taking intimate and dramatic portraits, often of lives in crisis—the perpetrators and victims of tyranny, revolution, famine, and rape. Her work spans over 70 countries and has won her a MacArthur Fellowship and a Pulitzer Prize, but has never been gathered into a book until now. Of Love and War gives her most compelling photos the space they deserve, along with essays, interview excerpts, and letters she wrote home to process the things she was witnessing.
Lynsey's pictures offer people like myself, living out our lives in privileged circumstances, a window into the beauty, suffering, and everyday humanity of our contemporaries across the world. And like it or not, ready or not, when you stop scrolling long enough look into one of these images, it looks back into you.
Surprise conversation starter interview clips in this episode:
How tiny bioelectronic implants may someday replace pharmaceutical drugs
Scientists are using bioelectronic medicine to treat inflammatory diseases, an approach that capitalizes on the ancient "hardwiring" of the nervous system.
24 February, 2021
Credit: Adobe Stock / SetPoint Medical
Sponsored by Northwell Health
- Bioelectronic medicine is an emerging field that focuses on manipulating the nervous system to treat diseases.
- Clinical studies show that using electronic devices to stimulate the vagus nerve is effective at treating inflammatory diseases like rheumatoid arthritis.
- Although it's not yet approved by the US Food and Drug Administration, vagus nerve stimulation may also prove effective at treating other diseases like cancer, diabetes and depression.
<p>Could a tiny electronic device treat some diseases more safely and effectively than pharmaceutical medicines?</p><p>For Kelly Owens, the answer was clear. She spent more than a decade suffering from Crohn's disease, a chronic inflammatory bowel disease that left her with severe arthritis in her joints. The pain forced her to use a cane, sometimes a wheelchair. She tried more than 20 medications and racked up more than $1 million in medical bills, but her condition didn't improve.</p><p>A physician told Owens and her husband that they shouldn't have children, and that she'd have to take steroids for life.</p><p>Then Owens turned to bioelectronic medicine. She reached out to Dr. Kevin Tracey, a pioneer in the field and president and CEO of the Feinstein Institutes for Medical Research in New York. Soon after, Owens and her husband moved to Amsterdam to participate in a clinical trial involving a relatively new bioelectronic approach to treat inflammation.</p><p>Doctors implanted a small electronic device in her chest that stimulated her vagus nerve, the body's longest cranial nerve. After two weeks, Owens didn't need the cane or wheelchair. Soon she was jogging on a treadmill.</p><p>A growing body of research within bioelectronic medicine shows it's possible to treat diseases by manipulating the nervous system. The field is essentially a fusion of neuroscience, molecular biology and neurotechnology. Dr. Tracey and his colleagues think the field may someday replace or supplement many pharmaceutical drugs used to treat major diseases, including cancer and Alzheimer's.</p><p>But how? The answer centers on how the nervous system controls molecular processes in the body.</p>
<blockquote>...the most revolutionary aspect of bioelectronic medicine, according to Dr. Tracey, is that approaches like vagus nerve stimulation wouldn't come with harmful and potentially deadly side effects, as many pharmaceutical drugs currently do.</blockquote>
The nervous system’s ancient reflexes
<p>You accidentally place your hand on a hot stove. Almost instantaneously, your hand withdraws.</p><p>What triggered your hand to move? The answer is <em>not</em> that you consciously decided the stove was hot and you should move your hand. Rather, it was a reflex: Skin receptors on your hand sent nerve impulses to the spinal cord, which ultimately sent back motor neurons that caused your hand to move away. This all occurred before your "conscious brain" realized what happened.</p><p>Similarly, the nervous system has reflexes that protect individual cells in the body.</p><p>"The nervous system evolved because we need to respond to stimuli in the environment," said Dr. Tracey. "Neural signals don't come from the brain down first. Instead, when something happens in the environment, our peripheral nervous system senses it and sends a signal to the central nervous system, which comprises the brain and spinal cord. And then the nervous system responds to correct the problem."</p><p>So, what if scientists could "hack" into the nervous system, manipulating the electrical activity in the nervous system to control molecular processes and produce desirable outcomes? That's the chief goal of bioelectronic medicine.</p><p>"There are billions of neurons in the body that interact with almost every cell in the body, and at each of those nerve endings, molecular signals control molecular mechanisms that can be defined and mapped, and potentially put under control," Dr. Tracey said in a <a href="https://www.youtube.com/watch?v=AJH9KsMKi5M" target="_blank">TED Talk</a>.</p><p>"Many of these mechanisms are also involved in important diseases, like cancer, Alzheimer's, diabetes, hypertension and shock. It's very plausible that finding neural signals to control those mechanisms will hold promises for devices replacing some of today's medication for those diseases."</p><p>How can scientists hack the nervous system? For years, researchers in the field of bioelectronic medicine have zeroed in on the longest cranial nerve in the body: the vagus nerve.</p><blockquote>What's more, clinical trials show that vagus nerve stimulation not only "shuts off" inflammation, but also triggers the production of cells that promote healing.</blockquote>
The vagus nerve
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTYyOTM5OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NTIwNzk0NX0.UCy-3UNpomb3DQZMhyOw_SQG4ThwACXW_rMnc9mLAe8/img.jpg?width=1245&coordinates=0%2C0%2C0%2C0&height=700" id="09add" class="rm-shortcode" data-rm-shortcode-id="f38dbfbbfe470ad85a3b023dd5083557" data-rm-shortcode-name="rebelmouse-image" data-width="1245" data-height="700" />Electrical signals, seen here in a synapse, travel along the vagus nerve to trigger an inflammatory response.
Credit: Adobe Stock via solvod
<p>The vagus nerve ("vagus" meaning "wandering" in Latin) comprises two nerve branches that stretch from the brainstem down to the chest and abdomen, where nerve fibers connect to organs. Electrical signals constantly travel up and down the vagus nerve, facilitating communication between the brain and other parts of the body.</p><p>One aspect of this back-and-forth communication is inflammation. When the immune system detects injury or attack, it automatically triggers an inflammatory response, which helps heal injuries and fend off invaders. But when not deployed properly, inflammation can become excessive, exacerbating the original problem and potentially contributing to diseases.</p><p>In 2002, Dr. Tracey and his colleagues discovered that the nervous system plays a key role in monitoring and modifying inflammation. This occurs through a process called the <a href="https://www.nature.com/articles/nature01321" target="_blank" rel="noopener noreferrer">inflammatory reflex</a>. In simple terms, it works like this: When the nervous system detects inflammatory stimuli, it reflexively (and subconsciously) deploys electrical signals through the vagus nerve that trigger anti-inflammatory molecular processes.</p><p>In rodent experiments, Dr. Tracey and his colleagues observed that electrical signals traveling through the vagus nerve control TNF, a protein that, in excess, causes inflammation. These electrical signals travel through the vagus nerve to the spleen. There, electrical signals are converted to chemical signals, triggering a molecular process that ultimately makes TNF, which exacerbates conditions like rheumatoid arthritis.</p><p>The incredible chain reaction of the inflammatory reflex was observed by Dr. Tracey and his colleagues in greater detail through rodent experiments. When inflammatory stimuli are detected, the nervous system sends electrical signals that travel through the vagus nerve to the spleen. There, the electrical signals are converted to chemical signals, which trigger the spleen to create a white blood cell called a T cell, which then creates a neurotransmitter called acetylcholine. The acetylcholine interacts with macrophages, which are a specific type of white blood cell that creates TNF, a protein that, in excess, causes inflammation. At that point, the acetylcholine triggers the macrophages to stop overproducing TNF – or inflammation.</p><p>Experiments showed that when a specific part of the body is inflamed, specific fibers within the vagus nerve start firing. Dr. Tracey and his colleagues were able to map these relationships. More importantly, they were able to stimulate specific parts of the vagus nerve to "shut off" inflammation.</p><p>What's more, clinical trials show that vagus nerve stimulation not only "shuts off" inflammation, but also triggers the production of cells that promote healing.</p><p>"In animal experiments, we understand how this works," Dr. Tracey said. "And now we have clinical trials showing that the human response is what's predicted by the lab experiments. Many scientific thresholds have been crossed in the clinic and the lab. We're literally at the point of regulatory steps and stages, and then marketing and distribution before this idea takes off."<br></p>The future of bioelectronic medicine
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTYxMDYxMy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjQwOTExNH0.uBY1TnEs_kv9Dal7zmA_i9L7T0wnIuf9gGtdRXcNNxo/img.jpg?width=980" id="8b5b2" class="rm-shortcode" data-rm-shortcode-id="c005e615e5f23c2817483862354d2cc4" data-rm-shortcode-name="rebelmouse-image" data-width="2000" data-height="1125" />Vagus nerve stimulation can already treat Crohn's disease and other inflammatory diseases. In the future, it may also be used to treat cancer, diabetes, and depression.
Credit: Adobe Stock via Maridav
<p>Vagus nerve stimulation is currently awaiting approval by the US Food and Drug Administration, but so far, it's proven safe and effective in clinical trials on humans. Dr. Tracey said vagus nerve stimulation could become a common treatment for a wide range of diseases, including cancer, Alzheimer's, diabetes, hypertension, shock, depression and diabetes.</p><p>"To the extent that inflammation is the problem in the disease, then stopping inflammation or suppressing the inflammation with vagus nerve stimulation or bioelectronic approaches will be beneficial and therapeutic," he said.</p><p>Receiving vagus nerve stimulation would require having an electronic device, about the size of lima bean, surgically implanted in your neck during a 30-minute procedure. A couple of weeks later, you'd visit, say, your rheumatologist, who would activate the device and determine the right dosage. The stimulation would take a few minutes each day, and it'd likely be unnoticeable.</p><p>But the most revolutionary aspect of bioelectronic medicine, according to Dr. Tracey, is that approaches like vagus nerve stimulation wouldn't come with harmful and potentially deadly side effects, as many pharmaceutical drugs currently do.</p><p>"A device on a nerve is not going to have systemic side effects on the body like taking a steroid does," Dr. Tracey said. "It's a powerful concept that, frankly, scientists are quite accepting of—it's actually quite amazing. But the idea of adopting this into practice is going to take another 10 or 20 years, because it's hard for physicians, who've spent their lives writing prescriptions for pills or injections, that a computer chip can replace the drug."</p><p>But patients could also play a role in advancing bioelectronic medicine.</p><p>"There's a huge demand in this patient cohort for something better than they're taking now," Dr. Tracey said. "Patients don't want to take a drug with a black-box warning, costs $100,000 a year and works half the time."</p><p>Michael Dowling, president and CEO of Northwell Health, elaborated:</p><p>"Why would patients pursue a drug regimen when they could opt for a few electronic pulses? Is it possible that treatments like this, pulses through electronic devices, could replace some drugs in the coming years as preferred treatments? Tracey believes it is, and that is perhaps why the pharmaceutical industry closely follows his work."</p><p>Over the long term, bioelectronic approaches are unlikely to completely replace pharmaceutical drugs, but they could replace many, or at least be used as supplemental treatments.</p><p>Dr. Tracey is optimistic about the future of the field.</p><p>"It's going to spawn a huge new industry that will rival the pharmaceutical industry in the next 50 years," he said. "This is no longer just a startup industry. [...] It's going to be very interesting to see the explosive growth that's going to occur."</p>
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Sharon Salzberg - On Balance
In this episode master teacher Sharon Salzberg considers whether it's ok to teach mindfulness to the armed forces, how practitioners of meditation and mindfulness should balance openness with discipline, and so much more.
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<p>Since 1974, <a href="https://www.sharonsalzberg.com/" target="_blank">Sharon Salzberg</a> has been sharing ancient meditation and mindfulness practices in a voice the contemporary West can understand. Her warm, funny, down-to-earth books, dharma talks, and guided meditations have helped struggling meditators worldwide establish a strong practice and reduce the suffering in their lives. In this episode Sharon sits down with Jason to consider whether it's ok to teach mindfulness to the armed forces, how western practitioners should deal with the almost militant tone of some eastern teachers when it comes to discipline and "right effort", and so much more. Sharon's latest book is <a href="https://www.sharonsalzberg.com/real-happiness-book/" target="_blank">Real Happiness: a 28 day program for realizing the power of meditation</a>, now thoroughly updated and revised for its 10th anniversary.</p>
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<p>Thelma and Louise, Ponch and John, Pancho and Lefty, Quixote and Sancho Panza, Marx and Engels, Marx and Chast…history and literature are full of magical buddy stories. Every now and then, for reasons no one can explain, Two people come together and produce something greater, or at least very different, from the sum of their parts.</p><p>I'm here today with one such team: the writer-cartoonist duo of <a href="https://www.newyorker.com/contributors/patricia-marx" target="_blank">Patricia Marx</a> and <a href="https://www.newyorker.com/contributors/roz-chast" target="_blank">Roz Chast</a>. They're both longtime contributors to the New Yorker and fearsome humorists in their own rights. But together they form a third fearsome thing, a thing which has created books such as Why Don't You Write My Eulogy Now So I Can Correct it: A Mother's Suggestions, And their latest: <a href="https://celadonbooks.com/books/you-can-only-yell-at-me-for-one-thing-at-a-time/" target="_blank">You Can Only Yell At Me For One Thing At A Time: Rules for Couples</a>. They're also the enigmatic figures behind yet a fourth thing, the legendary ukulele band Ukelear Meltdown.</p><p>– <a href="http://jasongots.com/" target="_blank">Jason Gots</a></p>
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mindfulness and meditation teacher Joseph Goldstein – doubt comes masquerading as wisdom
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<p>Freedom. Everyone wants it, but knowing where to look for it is another matter. And to make matters worse, the world is full of things that feel like freedom but might just get us more tangled up in everything we're trying to escape. How much freedom can money buy? How much money? How free are you on a tropical vacation? Would uploading your consciousness into the cloud and downloading it into a robot avatar on Alpha Centauri make you more free? How about falling in love again? How about three margaritas with friends? Or six? How about falling in love again? A better government? Less government? No government at all? </p><p>I'm here today with <a href="https://www.dharma.org/teacher/joseph-goldstein/" target="_blank">Joseph Goldstein</a>, a beloved teacher of Buddhist ideas and practice in the West and a personal inspiration to me, to talk about freedom of the mind and spirit—and the kinds of effort and insight that can lead there. Joseph is the co-founder of <a href="https://www.dharma.org/" target="_blank">Insight Meditation Society</a> in Barre, Massachusetts and the author, most recently, of <a href="https://www.soundstrue.com/store/mindfulness-3372.html" target="_blank">Mindfulness: a Practical Guide to Awakening</a>.</p>
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