We’re Starting to Read the Blueprints on Mental Health

Blueprint Mental Health.jpg

Companies like “23andMe” have allowed us to have a little fun with personalized genomics. Spit in a cup and let our knowledge of genetic diseases and traits predict that which you may or may not know about yourself, they propose. A genetics professor in college once told my class that the ability to read out our personal genetic code is as useful as one of us trying to build and fly a Boeing 747 from blueprints; that is, blueprints aren’t everything.

Similarly, simple maps of our brains might be of no more value to us than a personality test or a pretty desktop background. But new technology is advancing the ways in which we can study, predict, and potentially therapeutically intervene in mental illness.

A recent study in Neuron used brain scans of nearly 50 prison inmates to explain how disturbances in certain brain circuits may translate into criminal behavior. Josh Buckholtz, senior author of the study and Associate Professor at Harvard, used mobile MRI scanners on the brains of inmates participating in a verbal delayed gratification test. The test asked whether the participant preferred to take less money now or more money later, if given the choice. Those who scored high for psychopathy showed greater activity in the ventral striatum, an area of the brain associated with evaluating subjective rewards. Buckholtz says,

So the more psychopathic a person is, the greater the magnitude of that response. That suggests the way they are calculating the value rewards is dysregulated, they may over-represent the value of an immediate reward [taking less money now rather than taking more money later].

As they mapped the connections between the ventral striatum to other regions known to be involved in decision-making, they found a possible explanation:

We found that connections between the striatum and the ventral medial prefrontal cortex were much weaker in people with psychopathy.

This portion of the prefrontal cortex is thought to provide one with the ability to envision future consequences for actions. We rely on the prefrontal cortex to evaluate our decision-making process and predict what may happen to us in when we act out a particular decision. Think of it as a computer program that maps out every possible move in a chess game, and every result associated with those moves. As you might imagine, a deficiency in this relay, resulting in a preference for immediate reward, could prompt one to make a bad decision (i.e. participate in criminal behavior).

Finally, this weakened striatum-to-cortex regulation was so pronounced that the group was able to accurately predict frequent convictions of crimes in the inmates studied.

An old way of thinking has left us with an incomplete understanding of how to approach mental health. The media does a poor job explaining mental health as a source of violent crime, and our justice system has not learned how to punish criminals who have obvious mental illnesses. So it is easy to see why we get trapped into blaming the wrong mechanisms.

However, a new wave of neuroscience research is challenging the long-standing idea that emotion drives behavior. Buckholtz’s study suggests that we turn instead to the choices that criminals make as a result of an imbalance in risk and reward, perpetuated by dysregulated brain circuitry. Once we identify deviations in neuronal signaling, we can start to predict behavior and attribute emotion:

If we can put this back into the domain of rigorous scientific analysis, we can see that psychopaths aren’t inhuman, they’re exactly what you would expect from humans who have this particular kind of brain wiring dysfunction.

These new technologies are not redrawing old blueprints. They are telling us that the blueprint has been there all along—we were just busy building the wrong plane.

Image: NewsOK

Episode 6: The (Lack of) “Better Care” Act and Threatening Cuts to Research Funding

Senate GOP just dropped the highly anticipated “Better Care Reconciliation Act” (read our latest Health on the Hill post about it here). Keifer and Ti break it down [1:19] before talking with Martha Streng, PhD candidate in neuroscience at the University of Minnesota [27:46]. She discusses the threats of significant cuts to research funding under a Trump Administration and what effects it could have on the already shaky climate in academia, and sheds light on the dawn of a new era in neuroscience tech research.

Trump’s new budget proposal includes steep cuts to basic science research, and does not show any understanding of the relationship between basic and translational sciences. Martha argues that these cuts would be detrimental not only to advancing research on the treatment of disorders like schizophrenia, but to our comprehension of even the normal brain.

We Need to Take Supplements (Seriously)


We’ve all seen the commercials. “Prevagen, a dietary supplement shown to improve memory, contains a unique ingredient originally discovered in jellyfish.*” What we often miss is the clarifying asterisk, that “these statements have not been evaluated by the Food and Drug Administration (FDA)” and that “this product is not intended to diagnose, treat, cure or prevent any disease.” The truth is that the supplement industry is built on the premise that you can equate supplements wit FDA-approved drugs which have been subjected to the rigors of research, development and clinical testing (or at least that you won’t be able to distinguish between the two).

Like Prevagen, only some of these false claims are charged as fraudulent—and often years after many hopeful Americans have been conned into buying the product. An article in The Atlantic this week discusses the booming dietary-supplement industry and its unencumbered sprint to free-market success at the cost of both credible science and our wallets. Dr. James Hamblin explains the case that many supplemental companies make when selling their product:

A metabolite that no one could ever get from food, and in which nearly 100% of people are deficient, represents a big market. And while consumers are waiting for clinical trials to play out, people don’t need to wait to buy [it].

What’s scary is that supplements are treated more like foods than like drugs by the FDA. They can go straight to market without requiring evidence of efficacy. When provoked, the men in suits pushing supplements will admit that their product is not a drug, but will often continue to make the argument that it is better than food. Again, Dr. Hamblin:

I reacted by asking him about broccoli and salads, and why those aren’t medical foods. They make people with diabetes and heart disease less sick, when used regularly. Conversely, chronic abuse of Pop-Tarts and Pepsi contributes to lethal disease. Eating mostly whole plants will protect most hearts more effectively than the most widely prescribed cardio-protective pharmaceuticals, statins, and yet food is not medication.

So a product that is treated like food—while claiming to be better than food—lacks credibility to be a drug. What can be done?

The future of the dietary-supplement industry might lie in the hands of Dr. Scott Gottlieb, President Trump’s pick to lead the FDA. Gottlieb has received criticism for taking millions of dollars from nearly 20 biopharma and health firms while vowing to fight the opioid crisis. He stands for a libertarian, regulation-free approach and even accused the FDA of evading the law.

But how can a free-market approach to supplements succeed when consumers in the marketplace are unable to tell when a product is actually helpful? As a future physician, I am terrified by the idea that a low-budget commercial for a product with no clinical evidence for efficacy can bear the same weight as my own medical advice developed over years of grueling education.

I’d like to believe that the answer is adequate patient education and more deliberate communication. I learned a lot about the power of “fake news” recently; but unfortunately, convincing those around me that the facts still matter may be one of the toughest tasks in my own career down the road.

Image: Harvard Health

Advancement in the Time of Zika


This week, Katie Falkenberg, a photographer for the LA Times, was named a Pulitzer finalist for Motherhood in the Time of Zika. Not only is her work stunning, but it captures the very honest, everyday tragedy of an incurable and unpreventable disease.

Zika infection is usually harmless in healthy adults and children. The risk of fetal developmental disorders like microcephaly strikes fear in pregnant women and devastates those affected, as described in Falkenberg’s Times profile:

As many as a third of mothers are unmarried in [Brazil], where the rate is highest in impoverished rural villages and crowded slums. Even mothers who have a partner have found themselves suddenly abandoned as their relationships crumble under the emotional strain, economic burden and social stigma that come with raising a child who may require almost constant attention. Many [of these babies] develop severe cognitive and physical disabilities that require expensive therapy and monitoring by specialists.

Meanwhile, Washington endured an embarrassing fight over a spending bill to provide relief in both domestic and international efforts to handle Zika. The Obama White House requested emergency funding when the World Health Organization declared the outbreak a Public Health Emergency of International Concern. Over the next 6 months, these funds were held hostage in a bill that also addressed things like defunding Planned Parenthood and allowing Confederate flags to be flown at cemeteries. That is, the Zika outbreak fell victim to the reality of 21st century U.S. politics: sometimes even tragedy and epidemic are insufficient pressure for political action.

Now, nearly half a year after the $1.1 billion bill was finally signed into law, the first live-attenuated vaccine candidate was found to show complete protection from Zika infection. Pei-Yong Shi, author of a study published in Nature:

A successful vaccine requires a fine balance between efficacy and safety. Vaccines made from attenuated live viruses generally offer fast and durable immunity, but sometimes with the trade-off of reduced safety.

Shi’s study shows what he believes is sufficient safety testing to warrant further development of the candidate vaccine. There are dozens of Zika vaccines in the pipeline, but most require several rounds of shots—a potential obstacle in countries like Brazil where access and delivery may be difficult.

Such live-attenuated vaccine has the advantage of single-dose immunization, rapid and strong immune response and potentially long-lived protection. Therefore, a safe live-attenuated vaccine will be ideal in prevention of Zika virus infection, especially in developing countries.

In the U.S., nearly every state has at least one expecting mother with the disease. Now that we’re on our way into spring, many high-risk areas like southern Texas are taking extra precautions to defend against the mosquito-borne disease. This week, the Texas Department of State Health Services recommended testing all pregnant residents in certain counties and all residents showing certain symptoms of Zika infection.

Twice in the past month, President Trump has called for crippling cuts to the budget of the NIH, the primary funding agency for health-related research in the U.S. Research in medicine is patchwork, and the message of its results is often muddied by conflicting studies. But adequately funding these projects helps us to answer questions that give context and hope to Falkenberg’s images.

Image: Katie Falkenberg