Raise the Line

Dr. David Yaden’s interest in studying spiritual experiences started with one of his own. As he describes it, it was a totally spontaneous experience involving an intensely altered state of consciousness that left him with an enhanced, positive perspective on life. “This became an obsession, really, to understand this. I learned that these experiences have been studied throughout history by scholars and increasingly by scientists,” he tells host Shiv Gaglani. “As I learned more, it became more and more clear that this is what I wanted to study, and that's what I still do.” He happens to be in a perfect spot to do it as the Roland R. Griffiths Professor in Psychedelic Research on Secular Spirituality and Well-Being at Johns Hopkins, named for a leading figure in the modern renaissance in psychedelic research. The basic scope of the project he’s managing is non-clinical. Topics of study include better quantifying the risk-benefit ratio of psychedelics as a positive intervention; looking into how psychedelic experiences that have a spiritual character relate to similar experiences not triggered by psychedelics; and collecting data from non-Western population centers across the world to provide a more complete picture of how much cultural expectations play a role in influencing these experiences, as well as how similar they are across cultures. There is much to learn in this probing look at a fascinating dimension of psychedelic research.

Mentioned in this episode: https://griffithsfund.org/

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“I think we're doing something really special here to change the way healthcare is delivered in South Florida, so keep an eye on us,” says Dr. Julie Pilitsis, dean of the Charles E. Schmidt College of Medicine and Vice President of Medical Affairs at Florida Atlantic University. For one thing, class sizes in the medical and nursing programs are both increasing to tackle less than ideal access to health services. “If you get diagnosed with a lump on your breast in Florida, it takes you thirty days on average to see a doctor, while the national average is three to five days,” she notes. And just as FAU’s educational and clinical programs are supporting the communities they serve, Pilitsis tells host Shiv Gaglani that they need support in return.  “I think academic medicine and academic hospitals are essential. Everybody wants good healthcare, but I think sometimes they don't understand the economic impact that good healthcare brings to the area.” Shiv and Dr. Pilitsis also explore advancements in functional neurosurgery, the role of artificial intelligence in reducing burnout and her landmark career as the first female neurosurgeon to become a dean in this enlightening episode.

Mentioned in this episode: https://www.fau.edu/medicine/

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Shortly after starting his job as Dean of the USF Health Morsani College of Medicine in 2014, Dr. Charles Lockwood was presented with the exciting opportunity to help design a new medical education building. In contemplating requirements for the new space, he raised the challenge to colleagues that when the facility was completed in 2020, medical knowledge would be doubling every seventy-three days. “That fundamentally altered the way we thought about the building, and we accelerated the process of curricular reform that we had started,” he explains to Raise the Line host Shiv Gaglani. That reform included dramatically reducing the amount and length of lectures, substantially increasing active and problem-based learning, introducing more assessments and requiring students to learn how to be good researchers to help them discern what’s credible within the ever-growing amount of information available. But Dr. Lockwood also sensed a need to address the way students manage the rigors of a medical education and clinical practice. “What we've tried to do is to stress the need for grit and for embracing the classic stoic teaching about taking on obstacles and challenges as wonderful opportunities to grow and become more resilient.” Lockwood credits this perspective for the institution performing well through the worst of the pandemic. “I think the most surprising thing was the relative lack of burnout at the end of it. We're moving on to new challenges, but it didn't leave us hollowed out.” Tune in for a fascinating conversation about adopting an “anti-fragile” mindset, the dangers of overreliance on heuristics in making clinical decisions, and the implications of generative AI for medical education and patient care. 

Mentioned in this episode: https://health.usf.edu/medicine/

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After battling chronic illness as a child, Dr. Janelle Sokolowich swore she’d never step foot in a hospital again and started pursuing a different path in college. But life had a way of bringing her back to the world of medicine. “I started thinking back to all the nurses that made such an impact on me as a child and helped me to grow up to be a functioning adult,” she explains to host Michel Carrese. Now as academic vice president and dean of the Leavitt School of Health at Western Governors University, Dr. Sokolowich is in a position to help many others like herself pay it forward by becoming healthcare providers. The school serves 20,000 to 30,000 students per month and seventeen percent of all BSN holders in the country are graduates, but Sokolowich is keenly aware this can be an unattainable dream when cost and other factors come into play. That’s why Leavitt strives to keep tuition low and her performance as Dean is evaluated based on how much debt students have when they graduate, and if they are earning a livable wage two years post-graduation. “We want to be the most inclusive university in the country and we see ourselves as personally responsible for advancing health equity through education.” Check out this thoughtful conversation about competency-based education, strategies for meeting health needs in rural America and the importance of mentoring. “I want to build that next set of nurse leaders and I take it personally, because I have been gifted and blessed with many that have done it for me.”

Mentioned in this episode: https://www.wgu.edu/online-nursing-health-degrees.html

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Major depression, smoking, anorexia nervosa, obsessive-compulsive disorder, Alzheimer’s disease...is it possible for psychedelics to play a positive role in all of these conditions? There are indications the answer may be yes, which is why Dr. Al Garcia-Romeu and his colleagues at The Johns Hopkins Center for Psychedelic and Consciousness Research are so busy. “We're learning more, but as we learn more, the rabbit hole gets deeper and so it's a really fascinating time to be involved in this work and to see the expansion in all these different areas.” As he explains to Raise the Line host Shiv Gaglani, this is not about research for the sake of research. “A big part of the end goal here is to get this in a place where anybody who wants to quit smoking in the country can go to a clinic and get this type of treatment because we’ve shown that it seems to work.” Garcia-Romeu recognizes there are many steps to be taken before that’s a reality --including, of course, FDA approvals if clinical trials are successful -- but there is also a need to train a national corps of providers to guide psychedelic-assisted therapy sessions, a better system for recruiting diverse populations for studies, and insight into how current and future providers perceive psychedelics and their potential utility, a topic the Center is also researching. Don’t miss this in-depth look at the challenges and opportunities in a fascinating area of medical research.

Mentioned in this episode: https://hopkinspsychedelic.org/

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When Deepak Thomas contracted Lyme disease in his twenties, he quickly discovered how difficult it can be for a person to navigate the healthcare system, particularly when filling prescriptions. “When it came to accessing medications that could keep me healthy and eventually kick this condition, I found myself making three to four trips to the pharmacy every week, despite being covered by a generous healthcare plan.” So, by drawing on many years of experience working for leading tech companies such as Oracle and eBay, Thomas co-founded Phil, which offers a platform designed to remove provider and patient barriers to starting and continuing prescriptions. It’s an important problem to tackle because 50% of treatment failures and 25% of hospitalizations in the U.S. can be attributed to people failing to take their medicines. Thomas says a differentiating feature of Phil’s system is it works with the electronic health record or prior authorization programs the provider already uses while the automation runs behind the scenes. “The prescriber gets the benefits of automation without having to learn a new set of tools.” As for patients, they are sent a link -- often while still in the prescriber’s office - which takes them through the process.  "The enrollment rates into the patient access programs offered by the manufacturers are easily 90% on average across all of our programs." Check out this episode of Raise The Line with host Michael Carrese to learn about a new approach to solving a vexing problem in healthcare, and the other areas of pharma services Thomas wants to focus on next.

Mentioned in this episode: https://phil.us/

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As our Year of the Zebra focus on rare diseases continues, we’re putting several neurological conditions in the spotlight whose symptoms include neck pain, vertigo, swallowing issues, memory trouble and many more: idiopathic syringomyelia; idiopathic scoliosis; and the Arnold-Chiari Syndrome type 1 caused variously by cavities in the spinal cord and brain herniation. Fortunately, our guide is one of the world’s leading experts in this area, Dr. Miguel Bautista Royo-Salvador, Director of the Institut Chiari & Syringomyelia Escoliosis de Barcelona, and President of the Chiari and Scoliosis and Syringomyelia Foundation.  In his fifty-plus years of focus on these conditions, Dr. Royo-Salvador has alternated between research activity and clinical practice in which he applies a treatment method he developed called the Filum System.  Inventing this new approach was sparked by a patient who experienced very little improvement from what was the standard surgical treatment at the time. “I have come to the conclusion that an abnormally intense caudal traction of the entire central nervous system is the cause of the descent of the cerebellar herniation in Chiari Syndrome type 1, as well as of scoliosis and syringomyelia and others. To speak figuratively, it's like a pull from below on the whole central nervous system,” he explains to host Michael Carrese. After 2,100 procedures with a subjective improvement rate of 95%, Dr. Royo-Salvador and the Institute are working to broaden awareness of this minimally invasive approach.  Tune-in for an educational journey into these rare conditions and a proven technique to relieve patient suffering.

Mentioned in this episode: https://institutchiaribcn.com/

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In this episode of Raise the Line, we dive into the fascinating story of a very old technology, EEGs, being mined for data using a very new technology, AI, that's changing the way treatments are being developed for disorders of the brain. Joining host Michael Carrese to explain is Dr. Jake Donoghue, co-founder and CEO of Beacon Biosignals, a startup that’s using AI to unlock precision medicine for various neurological, psychiatric and sleep disorders. “We utilize our AI tools to bring quantitative endpoints into clinical trials to see if the drugs are impacting brain activity,” Donoghue explains.  AI’s ability to quickly recognize subtle changes in electrical activity that might otherwise go unnoticed can accelerate the trial process and hopefully, approval of new therapies. Donoghue is also interested in the area of sleep medicine because of its connection to a wide variety of issues including depression, PTSD, Parkinson’s and Alzheimer’s disease. “We think there's a lot of opportunity to bring quantitative insights to this fundamental state that all humans go through and map some of these really robust features of brain activity to increase understanding of disease and health.”

Mentioned in this episode:  https://beacon.bio/

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If psychedelics are eventually authorized by the FDA for use in mental health treatment, much credit will go to The Johns Hopkins Center for Psychedelic and Consciousness Research which sparked a renaissance of interest in the compounds starting in 2006 under the guidance of Dr. Roland Griffiths. The first study was actually not about clinical applications of hallucinogens but rather it observed their impact on healthy people. “One of the most remarkable findings Roland Griffiths encountered early on was that people would endorse the statement that they had one of the top five or the single most personally meaningful and spiritually significant experiences of their lives,” says Associate Center Director Dr. Fred Barrett, who met host Shiv Gaglani in his office in Baltimore for this extended conversation. And while the Center is actively researching potential clinical use of psychedelics, which is promising, it remains interested in how they may improve the lives of those not in need of mental health treatment. “What are the opportunities for spiritual growth? What are the opportunities for increasing well-being? There's an opportunity for exploration here that, if we're very careful, may have utility and value outside of the medicalization of these compounds,” adds Barrett. Don’t miss this expansive (dare we say mind-expanding?) discussion of the possible reasons psychedelics may help people with depression, why they are not prone to misuse, and what they tell us about the nature of consciousness itself. 

Mentioned in this episode: https://hopkinspsychedelic.org/

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“The unifying theme across our portfolio is that whatever a company we invest in is building can make a population-level health impact. For us, that means that what they're doing is going to lead to innovation that is ultimately accessible to huge portions of the global population,” says Gurdane Bhutani, co-founder and managing partner of MBX Capital, a venture capital partnership dedicated to investing in early-stage companies focused on big public health problems. As he explains to host Shiv Gaglani, that ambitious mission is focused on three main themes: accumulated environmental exposure (exposome), biosecurity and biodefense, and healthcare infrastructure. “The majority of disease pathogenesis today is environmental in nature, not genetic. So we're looking at companies that are developing exposomic sequencing technologies that help us better understand these environmental exposures.” One such company is using human-relevant tissue models to test for environmental contaminants. Others include a nurse scheduling platform and a firm that’s localizing radiology systems for underdeveloped areas. Bhutani has a track record of investing in interesting and impactful companies in healthcare (in fact, he was an early backer of Osmosis!) so you won’t want to miss his insightful perspective on promising ideas for improving health and healthcare systems.

Mentioned in this episode: https://www.mbxcapital.com/

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast