Cerebrum Winter 2022

EMERGING IDEAS IN BRAIN SCIENCE • WINTER 2022

Covid + Addiction

Cheryl St. Onge’s mom, Carole, cared for horses while living with vascular dementia. For more images and the full story, turn to page 20.

FEATURES

14 A Perfect Storm

Our authors, who direct the Addiction Institute for the Mount Sinai Health System, address the substance-abuse avalanche brought on by the Covid-19 pandemic.

By Yasmin Hurd, Ph.D., and Timothy Brennan, M.D.

20 In Her Own Words

Her photographs won the annual Bob and Diane Fund award—a grant that increases the understanding of Alzheimer’s and dementia.

By Cheryle St. Onge, M.F.A.

28 Imaging’s Groundbreaking Discovery: 30 Years Later

Randy L. Buckner, who was ranked among the top ten most influential brain scientists by Science magazine in 2016, answers questions about his role in the discovery of a brain network that is triggered by thinking when the brain is at rest or imagining possibilities.

By Bill Glovin

34 The Great Telemedicine Experiment

Covid precautions have led to a massive increase in treatment from screens and phones. Is it worsening health disparities—and changing medicine permanently?

By Brenda Patoine

40 Brain Bee Alumni: Where Are They Now?

FROM THE EDITOR

Thank You, Carolyn

BY BILL GLOVIN Editor-in-Chief

Our content looked like it might finally be gradually drifting away from pandemic-related articles through the fall when, suddenly, Covid-19 came roaring back with the Omicron variant. Many of us have been infected or live in fear—who doesn’t know someone who has died or come down with one variant or another? And then there’s the endless controversies surrounding mandates, protocols, booster shots, virtual vs. in-person instruction, traveling—you name it.

And while Covid has certainly had a huge impact on brain research, its implications are even more impactful in the area of neuro-related disorders and mental health treatment.

That’s mainly why we decided to feature two related topics in this issue. Yasmin Hurd and Timothy O’Brien—both on the frontlines of addiction research and treatment at Mount Sinai’s Addiction Institute— address the reasons for an alarming rise in alcohol and drug abuse in our cover story, “A Perfect Storm.” Their article tells us how the brain reacts to stress and increased isolation, and the ways public policy and addiction treatment has shifted. And you’ll be glad to read that it’s not all “doom and gloom.”

The rise in telemedicine, and some of the disparities that have come along with it, are the focus of freelance writer Brenda Patoine’s “The Great Telemedicine Experiment.” Telehealth comprised a third of all visits to behavioral health specialists in 2020, a massive increase over 2019. And new datasets not yet available will tell us it has continued to rise in 2021. Turn to page 34 to find out what it all means.

There’s also a lot of non-pandemic content that we hope is of interest. Randy L. Buckner, professor of psychology and neuroscience and principal investigator of the Cognitive Neuroscience Laboratory at Harvard University, tells us about the accidental discovery of the default network and what we know about it 30 years later. Freelance writer Kayt Sukel looks back at the impact that the International Brain Bee has had on the lives of five finalists. Finally, photographer Cheryl St. Onge—winner of this year’s Bob and Diane Fund grant—writes about the images she took of her mom and the impact Alzheimer’s disease had on their relationship.

Lastly, with this issue, we bid a fond retirement to Carolyn Asbury, our in-house scientific adviser and a leading voice on the Cerebrum advisory board since I first joined the Foundation in 2011. Her wisdom, guidance, considerable patience, and sense of humor always kept complex, scientific principles clear and accurate, and on track. We wish her the very best as she begins this next chapter of her life.

Happy new year to all, and stay safe out there! l

EMERGING IDEAS IN BRAIN SCIENCE

Bill Glovin Editor-in-Chief

Bruce Hanson Art Director

Seimi Rurup Associate Editor

Brandon Barrera Staff Writer Carl Sherman Copy Editor

Carolyn Asbury, Ph.D. Scientific Consultant

Cerebrum is published by the Charles A. Dana Foundation, Incorporated. DANA is a federally registered trademark owned by the Foundation. © 2022 by The Charles A. Dana Foundation, Incorporated. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher, except in the case of brief quotations embodied in articles.

Letters to the Editor

Cerebrum Magazine

10 Rockefeller Plaza, 16 Floor New York, NY 10020 or cerebrum@dana.org

Letters may be edited for length and clarity. We regret that we cannot answer each one.

CONTRIBUTORS

Covid and Addiction: A Perfect Storm

> Page 14

YASMIN HURD, Ph.D., is a professor of psychiatry, neuroscience, and pharmacological sciences at the Icahn School of Medicine at Mount Sinai in New York City; director of the Addiction Institute at the Mount Sinai Behavioral Health System; Ward-Coleman Chair of Translational Neuroscience at Mount Sinai; and a member of the Dana Alliance for Brain Initiatives. She has conducted pioneering research on the neurobiology of opioid abuse, the neurodevelopmental (and crossgenerational) effects of cannabis, and potential treatments for opioid addiction. A member of the National Academy of Medicine, Hurd and her research have been featured on NPR, ABC, and CNN, and in the New York Times, Time, and Discover

TIMOTHY K. BRENNAN, M.D., is the chief of clinical services for the Addiction Institute of Mount Sinai in New York City and oversees addiction services across all campuses of the Mount Sinai Health System. He is also the director of the Fellowship in Addiction Medicine Program at the Icahn School of Medicine. Brennan completed his Fellowship in Addiction Medicine at The Addiction Institute, a Fellowship in Medical Ethics at Harvard Medical School, a residency in pediatrics at New York Presbyterian Hospital/Weill Cornell Medical College, and internship in Internal Medicine at Georgetown University Hospital.

In Her Own Words

> Page 20

CHERYLE ST. ONGE’s work has been featured in the New Yorker, the New York Times, Time magazine, Photograph Magazine, and been exhibited at London’s National Portrait Gallery, the Guggenheim, Princeton University, etc. The mother of three children, she divides her time between Durham, N.H. and coastal Maine. Her featured work, "Calling the Birds Home," was this year’s winner of the Bob and Diane Fund, an annual photographic award dedicated to photography that increases the understanding of Alzheimer’s and dementia.

Imaging’s Groundbreaking Discovery: 30 Years Later

> Page 28

RANDY L. BUCKNER, Ph.D., is Sosland Family Professor of Psychology and Neuroscience and principal investigator of the Cognitive Neuroscience Laboratory at Harvard University and member of the Center for Brain Science, where he is affiliated with the Center for Biomedical Imaging at the Massachusetts General Hospital and Harvard Medical School. Buckner earned his Ph.D. from Washington University in 1995, trained as a postdoctoral fellow at Massachusetts General Hospital, and returned to Washington University in 1997 as a faculty member. He moved to Harvard as a full professor in 2005 and, from 2005-2012, was an Investigator for the Howard Hughes Medical Institute. Buckner’s research applies neuroimaging techniques to explore brain areas involved in human memory.

The Great Telemedicine Experiment

> Page 34

BRENDA PATOINE is a freelance science writer, reporter, and blogger who has been covering neuroscience research for more than 30 years. Her specialty is translating complex scientific findings into writings for the general public that address the question of “what does this mean to me?” She has interviewed hundreds of leading neuroscientists over three decades, including six Nobel Laureates. She founded ScienceWRITE Medical Communications in 1989 and holds a degree in journalism from St. Michael’s College. Other areas of interest are holistic wellness, science and spirituality, and bhakti yoga. Brenda lives in Burlington, V.T., with her cat Shakti.

Brain Bee

Alumni: Where Are They Now?

> Page 40

KAYT SUKEL‘s work has appeared in the Atlantic Monthly, the New Scientist, USA Today, the Washington Post, Parenting, National Geographic Traveler, and the AARP Bulletin. She is a partner at the award-winning family travel website Travel Savvy Mom, and is also a frequent contributor to the Dana Foundation’s science publications. She has written about out-of-body experiences, fMRI orgasms, computer models of schizophrenia, the stigma of single motherhood, and why one should travel to exotic lands with young children. She is the author of Dirty Minds: How Our Brains Influence Love, Sex and Relationships and The Art of Risk: The New Science of Courage, Caution & Chance

ADVANCES

Notable brain-science findings

BY NICKY PENTTILA

In 2020, researchers found great success in treating nearly two dozen people who had INTRACTABLE DEPRESSION by using a five-day, intensive course of transcranial magnetic stimulation (TMS) called Stanford Neuromodulation Therapy (SNT). That study was “open label,” which means doctors and patients knew they were getting the experimental treatment. Now the researchers have repeated the procedure as a randomized, controlled test, with some patients receiving the treatment and some receiving something that looked just like it (holding a figure-8 shaped handset close to their heads) but did not send the signal; neither they nor their doctors knew who was getting what. Patients received ten treatment sessions per day for five days. Many patients reported their mood lifting within days, and within a month of treatment, 79 percent of the patients no longer scored as clinically depressed. Current TMS methods use lower magnetic intensity, are given once daily, and go on for six weeks; they show far less success than the new method but also do not require that patients stay in a hospital or treatment center for the course of their treatment. If this method continues to shine in clinical studies, it will be especially useful for emergency care. l

People with serious mental illness represent a quarter of all police shootings and account for more than two million jail bookings a year.

Margaret E. Balfour, M.D., Ph.D., and colleagues recently published a paper that addresses the composition of response teams, the need for collaboration across systems, and offers an alternative to the current 911 number. The alternative, 988, would offer a new number to call in the event of mental health emergencies. The approach would dispatch a team of using some combination of nurses, social workers, EMTs, and behavioral health technicians, rather than armed police officers in a patrol car. l

Researchers have found evidence that there may be a “critical window” for recovering motor skills after a person has had a STROKE. In a randomized, controlled study of 72 older people (83 percent African American, 50 percent women), those who added 20 hours a week of specific motor-skills training to the usual therapies at 2-3 months after their stroke showed a significant increase in motor function compared with controls (who were doing just the usual therapies). Those who did the additional training in the first month after stroke and then stopped also showed significant improvement over controls, but not as much as the 2-3-month group. Those who started the additional training at 6 months or more post-stroke looked like the control group. This matches what other researchers have learned from animal studies and suggests that the increased neural plasticity seen in post-injury brains behaves in some ways like the plasticity in childhood, which also has sensitive periods. l

Nolan Williams demonstrating their SNT treatment on an unnamed patient.

PHOTO: STANFORD UNIVERSITY / STEVE FISCH

PHOTO: SHUTTERSTOCK

Most BRAIN-COMPUTER INTERFACES (BCIs) depend on a few sensors implanted on the cortex, reading—and sometimes transmitting— signals among a few hundred nearby neurons. Researchers at Brown University have developed a network using independent, wireless microscopic neural sensors, which they call “neurograins,” that can be distributed all around the cortex, recording and transmitting information from far more neurons. They have successfully tested it with a rat, placing 48 grains on the animal’s cerebral cortex, the maximum they thought a rat brain could handle. Theoretically, they say, the system could support up to 770 grains in a human. Now, they are trying to make the grains even smaller and trying to find ways to avoid problems with the body rejecting foreign material and the surgical scar tissue that causes implants to fail after a few years. l

People who go through MENOPAUSE experience a range of symptoms, including a decline in the volume of the brain’s gray matter in regions that are also affected by Alzheimer’s disease. A new observational study at Weill Cornell suggests that the more estrogen a person has been exposed to during their life, the more likely it is these volumes will return to pre-menopause levels, which could mean less danger of developing dementias. Some ways to increase estrogen exposure are environmental—bearing more children, taking oral contraceptives, or being on hormone replacement therapy—and some are genetic—having a longer timespan between menarche and menopause and not having an APOE-4 gene variant. Past studies have suggested that hormone replacement therapy was not helpful postmenopause; more research is needed. l

A dose of familiar, beloved MUSIC can help people with mild cognitive impairment and early dementia score better on tests of cognition. To see how, and whether there were differences between musicians and non-musicians, researchers scanned the brains of six musicians and eight non-musicians as they listened to music they’d chosen themselves, and to music they’d heard for the first time, one hour before the scanning. In all the listeners, the “long-known” music fired up areas involved in autobiographical memory, which can fade with dementia, but also subcortical, emotion-regulating regions, which do not so quickly fade. They did find subtle but distinct structural differences in response between the musicians and non-musicians but need a larger sample to verify those differences. “Music is an access key to your memory, your prefrontal cortex,” says lead researcher Michael Thaut at University of Toronto. “Keep listening to the music that you’ve loved all your life.” l

Scientists from Purdue University and Jinan University have developed a way to use GENE EDITING to transform glia—cells in the brain that usually support neurons— into neurons themselves. In studies using mice, the researchers damaged neurons in the visual system and then used their editing technique to convert some nearby glia into functional neurons. These new neurons remade connections in a way that seems to mimic regular circuit development, and three weeks later, the mice started to see again. Should this technique prove stable, another possible use would be restoring connections in motor system areas. l

PHOTOS: BROWN UNIVERSITY / JIHUN LEE

BY THE NUMBERS

Percentage of people developing eye or ear symptoms after Covid. 1 %

17

studies are the result of five years of work by a huge consortium of researchers to identify the myriad of different cell types in the primary motor cortex.

One Half of all mental health disorders show first signs before a person turns 14 years old, and three quarters of mental health disorders begin before age 24.

54 clinical sites were used in a Phase 3 clinical trial to test lumateperone, a promising new antipsychotic drug to treat bipolar disorder.

THREE HUNDRED FIFTEEN

brains of National Football League players have been diagnosed, posthumously, with chronic traumatic encephalopathy, or C.T.E., a progressive disease in which symptoms can arise long after hits to the head have ceased.

30,000 post-9/11 vets and service members have died by suicide, 4 times the number that have died in combat.

20 MILLION WOMEN & 10 MILLION MEN...

in America will have an eating disorder at some point in their lives.

BRAIN IN THE NEWS

Links to brain-related articles we recommend

> Washington Post: Is there really such a thing as ‘mommy brain’?

> Molly Wright: How every kid can thrive by five/TED

> The New Yorker: The Science of Mind Reading

> The New York Times: Cognitive Rehab: One Patient’s Painstaking Path Through Long Covid Therapy

> NBC News: Surgeon general issues rare public health advisory over youth mental health crisis

> The New York Times: Nation’s First Supervised Drug Intervention Centers Open in New York

> Scientific American Mind: How Brains Seamlessly Switch between Languages

> MindSite News: Multilingual learning good for the brain

> The New York Times: Why 1,320 Therapists Are Worried About Mental Health in America Right Now

> Fast Company: Neuroscientists are using virtual reality to unlock a whole new world of brain research

> Washington Post: Is artificial intelligence about to transform the mammogram?

“

“Neuroethicists need to provide a stronger voice about what is neuroethics. Most of the populace in many countries are not very clear about neuroethics—are not even aware that something like this exists.”

— Nandini Chatterjee Singh, a cognitive neuroscientist and senior project officer at UNESCO at the Gandhi Institute of Education for Peace and Sustainable Development in New Delhi, India

BOOKSHELF

A few brain-science books that have recently caught our eye

BY BRANDON BARRERA

Projections: A Story of Human Emotions

by Karl Deisseroth, M.D., Ph.D. (Random House)

In a chapter from his memoir Projections, psychiatrist and researcher Karl Deisseroth tells the story of a former patient, Winnie. Trained as both a lawyer and engineer, Winnie was admitted into emergency psychiatric care one day after accosting her law firm’s senior partner in his office and accusing him of conspiring against her. Under Deisseroth’s care, Winnie would develop a keen interest in the biological utility of schizophrenia, the brain disorder altering her thinking and sense of reality. Projections weaves together a trio of threads— Deisseroth’s journey as a psychiatrist, his patients’ stories, and the leaps in neuroscientific knowledge made possible by technological breakthroughs (e.g., optogenetics)— to explore what mental illness can teach us about human emotions. The recipe, as it turns out, is compelling. Within the case studies of patients living with eating disorders, autism, dementia, and other psychiatric diseases, Deisseroth illuminates the neural mechanisms of behavior and emotions while lacing the threads into a vibrant, tapestry, buzzing with humanity.

From Survive to Thrive: Living Your Best Life with Mental Illness

by Margaret S. Chisolm, M.D., with John Hanc (Johns Hopkins University Press)

Distilling years of experience and evidence-based research into this practical guidebook, professor of psychiatry and behavioral sciences

Margaret S. Chisolm believes that a healthy and fulfilling life is achievable for everyone. It is in this spirit that From Survive to Thrive markets itself as a resource to anyone finding themselves (or their loved ones) juggling personal problems and anxieties, those currently on antidepressants, and, of course, those who have been diagnosed with psychiatric illness. Chisolm admits the guide is not a panacea— each one of us has variables such that the road to well-being will be singular to our conditions. That is why the guidebook emphasizes the perspectives/pathway approach— four perspectives through which mental distress should be professionally assessed and four pathways of action (family, work, education, community) to wellbeing—as the analytical and practical toolset that will ultimately enable one to flourish. Will it take time? Yes, says Chisolm. The model she outlines is one shown to have borne positive results for not only many of her patients, but also herself. She hopes it will enable readers to live their best lives, too.

Feeling & Knowing: Making Minds Conscious

by Antonio Damasio, M.D., Ph.D.

(Pantheon)

Antonio Damasio, David Dornsife Professor of Neuroscience, Psychology, and Philosophy at the University of Southern California, returns with another addition to his formidable catalog of works exploring consciousness. Feelings, Damasio says, are integral to the subjective experience, and in Feeling & Knowing, he explores the converging biological processes—in both brain and body—that produce consciousness. Encouraged by his editor to create a concise and focused volume, Damasio distills his ideas and theories on what constitutes the “mental experience” in a compact 180-plus pages, using recent findings across biology, psychology, philosophy, and physics as supporting evidence. His efforts make for an approachable text spanning the difference between feelings and emotion, the distinction between sensing and being conscious, the pivotal role homeostasis plays in creating our subjective experience, and why investigations of consciousness should probe beyond the brain and include the body. For Damasio, consciousness is a difficult, aweinspiring problem, but it’s a problem with a solution, nonetheless. l

Unlocking the Mystery of Brain Injury

BY MICHAEL L. LIPTON, M.D., Ph.D.

Charles was age 23 when he walked into my clinic looking for answers. It was a year after a terrible car accident on an icy winter night during his final year in graduate school. His vehicle had slid off the road, hit a tree, and left him trapped and alone. Charles was awake but confused when firefighters extracted him from the vehicle, and he was still somewhat disoriented in the small rural hospital emergency department (ED).

Immediately following the accident, a computerized tomography (CT) scan of his head “ruled out significant injury.” Charles, who was observed until morning, complained of a headache, fatigue,

concussion during the crash, would “recover over time,” and should follow up with his personal physician “if needed.”

Charles checked in with his doctor the next week, who ordered a magnetic resonance imaging (MRI) scan, “to confirm that there was no injury to the brain that would have been missed by the CT scan.” Although neither the MRI nor the doctor’s examination revealed any abnormality, Charles was not at all back to himself. His symptoms had worsened following the crash and now interfered greatly with his dayto-day functioning.

Charles was on a leave of absence from graduate school when I confirmed signs of his traumatic brain injury (TBI) by employing advanced MRI techniques that detected pathology to which prior testing was essentially blind. Charles would not complete his graduate degree. He ultimately came to understand his post-TBI “new normal” and, with much support and guidance, forged a new path that leveraged his strengths and minimized disruptions caused by his

concussion each year. Also termed mild TBI (mTBI), concussion is diagnosed based on symptoms of altered brain function following an impact or a jarring force to the head, in the absence of visible injury on CT.

The good news is that the vast majority of concussions produce only transient symptoms, followed by full recovery of function. But, in a miserable minority of concussion patients, perhaps 15-25 percent, symptoms persist for longer periods and may never fully remit. “Mild” in the case of mTBI/concussion refers to the relative severity and duration of acute symptoms, such as unconsciousness and confusion, and absence of CT signs of brain injury. mTBI does not preclude lasting difficulties due to the injury. However, persistent disabling brain dysfunction after concussion, as in Charles’s case, does present a major conundrum for patients and caregivers. They know something is wrong, but testing repeatedly shows their brains to appear normal.

As a medical student, I learned concussion was a functional

Trauma incites a cellular and molecular cascade, which, proceeding unchecked, will lead to permanent injury to the axons that form the network infrastructure of the brain.

resolved completely and in short order. We now understand that concussion symptoms do arise from a physical injury, though it occurs at the level of brain cells to which tests such as CT and MRI are essentially blind due to their limited resolution. We now understand to brain injury as a process, not an event—like a fracture, which occurs at an instant—in time.

Trauma incites a cellular and molecular cascade, which, proceeding unchecked, will lead to permanent injury to the axons that form the network infrastructure of the brain. On the other hand, injury might be minimized, and function thereby normalized, with early termination of the injury cascade.

The difference between two individuals who experience a similar head injury but sustain divergent outcomes—transient concussion in one and enduring, life-altering brain injury in the other—seems

implicates factors such as genes and biological sex in the divergence of outcomes among individuals who experience similar head injuries.

A decade ago, at a medical conference, a Veteran’s Affairs

to directly treat the evolving injury cascade and improve outcomes for patients like Charles. l

MICHAEL L. LIPTON, M.D., Ph.D., is a neuroradiologist and neuroscientist

The Fast-Moving Neuroprosthetics Frontier

BY PHILIP M. BOFFEY

The science and technology embodied in neuroprosthetics are progressing far faster than the law can keep up. It’s not even clear whether existing law can, with suitable adjustments, handle the problems or whether we need a whole new legal approach, possibly including a bill of rights for neuroprosthetics.

That was the overriding message I took away from Jennifer Chandler, a professor of law at the University of Ottawa in Canada, who delivered the David Kopf Neuroethics lecture on November 9, at the annual meeting of the Society for Neuroscience— conducted virtually this year in deference to the ongoing Covid pandemic.

Her topic: How the law is evolving to deal with neuroprosthetics, a fastmoving frontier in the long-standing practice to use artificial devices to replace or enhance body parts and functions.

The idea that science and technology are progressing faster than existing law is a recurring theme in many issues I have written about, including the ethics of conducting research on brain organoids in a dish and of linking brain signals to computers, the so-called braincomputer interface.

Professor Chandler elaborated on her views in a lengthy book chapter that she made available

and in emails exchanged with this columnist. Before definitively answering questions about a host of evolving legal issues, she wanted to first identify the central human interests at stake with the adoption of complex neuroprosthetics and the potential threats to those interests.

Although humans have a long history with prostheses of many types, neuroprostheses raise perplexing new issues. This is primarily because they stimulate the brain directly, thereby influencing its mental contents, and can be read outside the brain, allowing access to a person’s thoughts.

I had long considered this a privacy issue, which it clearly is. But Professor Chandler warned that such thoughts could also provide a potentially dangerous pathway to harm an individual.

For example, she wrote, Medtronic’s new deep brain stimulation device, known as Percept, simultaneously captures brain signals (using an implanted lead) that can be recorded, while delivering therapeutic stimulation— both inside and outside the clinic.

Since many devices and prostheses are networked, they not only transmit information about the person but present a portal through which harm could be done. In August 2017, for example, the Food and Drug Administration warned patients that a particular implanted pacemaker had a security vulnerability that might allow an intruder to harm them through hacking. Worse yet, with wide scale networking, the intruder could dole out harm en masse.

It is not far-fetched to think that a neuroprosthetic device could be similarly hacked and used to harm an individual, or many people, at once. All it would take

is one deranged malefactor bent on evil deeds. Or such harm might conceivably be caused by a technical malfunction or glitch or inadvertent human error.

Another ethical issue emerged when the initial spread of Covid-19 overwhelmed many hospitals and forced some to consider allocating the use of scarce ventilators for the sickest patients or those most likely to recover. In those cases, the ventilators were considered objects that could be transferred from one patient to another. But that understandably raised alarm among chronically ill patients who relied on ventilators to breathe. As one patient explained it, “My vent is part of my body—I cannot be without it for more than an hour at the most due to my neuromuscular disability. For clinicians to take my vent away from me would be an assault on my personhood and lead to my death.”

Even before the pandemic, one bioethicist argued that a ventilator used for chronic illness was part and parcel of the person, not subject to being commandeered in a crisis.

Neuroprostheses, like ventilators, can also be critical for the physical or psychological survival of a patient. A spinal cord stimulator to ease chronic pain may be lifesaving by preventing some patients from death by suicide. And, given that memories are crucial to knowing who we are, prosthetics being explored to improve memory formation in Alzheimer’s patients would seem literally indispensable for the survival of the person.

There is no doubt that tinkering with the brain can be therapeutically valuable. Deep brain stimulation with implanted electrodes is being used to alleviate conditions such as Parkinson’s disease and to treat

depression, OCD, eating disorders, aggression, and addiction.

A July 15 article in the New England Journal of Medicine describes how doctors were able to help a patient who had lost his ability to articulate words and sentences after a brain-stem stroke. They implanted a multi-electrode array over the part of the cortex that controls speech, recorded cortical activity while the participant attempted to say words—and eventually sentences—and were able to decode what he was trying to say without him actually saying it.

That raises the question of whether such imagined speech or thoughts should be made available to outsiders who might use it against a person. The possibility was raised in a case in Ohio in which a man was found guilty of arson and insurance fraud after a fire in his home. He claimed to have done all sorts of

vigorous things to escape the fire. Police obtained a search warrant for the electronic data stored on his pacemaker and a cardiologist found it “highly improbable” that he could have done all the things he claimed.

Sooner or later the same issue will arise with a neuroprosthetic device. Stay tuned to see whether the law and bioethics can find a way to resolve such perplexing issues as the field of neuroscience races ahead. l

PHIL BOFFEY is former deputy editor of the New York Times Editorial Board and editorial page writer, primarily focusing on the impacts of science and health on society. He was also editor of Science Times and a member of two teams that won Pulitzer Prizes

The views and opinions expressed are those of the author and do not imply endorsement by the Dana Foundation.

Our authors, who direct the Addiction Institute for the Mount Sinai Health System in New York City, address the substance-abuse avalanche brought on by the Covid-19 pandemic.

By Yasmin L. Hurd, Ph.D., and Timothy Brennan, M.D.

Illustration by Jarred Briggs

AS AMERICAN ADDICTION RESEARCHERS AND TREATMENT PROFESSIONALS WENT TO SLEEP ON NEW YEAR’S EVE 2019, they were likely feeling pretty optimistic. Overdose death rates involving heroin, while still high, had dropped for the third year in a row. Indeed, it seemed like the opioid crisis had not only plateaued but was slowly starting to improve. Access to medicationassisted treatment had increased around the country; and for the first time in history, a variety of health tech startups were looking to leverage their expertise in innovative ways to bring treatment to economically disadvantaged areas.

None of us knew that we would soon be facing an unprecedented storm. Indeed, it would be a perfect storm, particularly for vulnerable groups such as those suffering from substance-use disorders. On February 11, 2020, Covid-19 became the official name given by the World Health Organization for the highly infectious disease caused by infection with the SARS-CoV-2 coronavirus— and of a pandemic that would transform the world, creating a new norm of social distancing, isolation, and loneliness that exacerbated substance-use disorders.

The bedrock of modern addiction treatment is the fellowship gained by participating in group therapy, either in formal settings such as addiction treatment programs, or informal settings such as Alcoholics Anonymous (AA). When people first seek help for their addiction, they often feel impossibly alone and adrift. They can’t conceive that anyone else in all of human history has ever felt the way that they feel. They are lonely, ashamed, and terrified. But when they start meeting other people with the same condition, something magical happens; they realize that not only are they not alone but there is a way through their suffering, a light at the end of the tunnel.

The group setting, which at the outset may have felt absolutely terrifying, will frequently become their refuge—a place where they can be fully present, fully accountable, and fully accepting of their disease. The

oft-repeated mantra of “90 meetings in 90 days” exists for good, practical reasons: Active addiction takes up an extraordinary amount of time in people’s lives; the relentless pursuit of acquiring, using, and recovering from the effects of a substance can crowd out almost all of their other responsibilities. People in early recovery suddenly have a lot of time on their hands, and self-help and group therapy settings provide a safe place to spend it.

But as America entered the Covid lockdown in March of 2020, formal and informal addiction treatment settings were quickly forced to close down. A warm and welcoming AA meeting full of tears, laughter, and hugs, which previously might have felt like one of the safest places in the world, suddenly became one of the most unsafe. For people who had already established a network of recovery supports, the migration to online-only meetings was an annoyance, but not insurmountable. But for those who had not yet established themselves in recovery, an important lifeline now required a high-speed internet connection and involved the awkwardness of “meeting” people online when you have never met them in person.

Storm Clouds Form

Not surprisingly, the massive rise in unemployment, disruptions in work/life balance, and general stress and anxiety induced by the pandemic led to increased reliance on both healthy and unhealthy coping mechanisms. Just as sales of exercise bikes and yoga mats soared, so too did alcohol consumption. Prior to the pandemic, it was both socially unacceptable and unprofessional to consume alcohol while working. But as people became accustomed to the “work from home” lifestyle, the social boundaries of office culture started to melt away. Who would know if a bottle of wine that would have been uncorked at 6 p.m., was now poured at 4 p.m.?

Not only did alcohol sales increase dramatically during the pandemic, but so too did illicit drug consumption: Americans reported using substances like alcohol and cannabis more than ever to cope with anxiety and stress. There were also reports that the illicit drug supply chain became disrupted, which may have increased drug adulteration. What had previously been a steady flow of pure heroin became an unsteady supply of heroin adulterated with highly potent synthetic opioids like fentanyl and its analogues, which are more than 50 times more potent than heroin, and 100 times more potent than morphine.

Now, fentanyl contamination was being regularly detected in various drugs, including counterfeit pain pills and sedatives, such psychostimulants as methamphetamine and cocaine, and even cannabis. As overdose data started to trickle in during 2020, it soon became clear that all of the gains that had been made from 2017 to 2019 had been lost. Shockingly, overdose death rates in the US skyrocketed higher than they have ever been at any time during the opioid crisis—with synthetic opioids accounting for more than 60 percent.

This historic rise in overdose deaths was, of course, multifactorial—besides the turn to addictive substances to cope with Covid-related stress, the disruption in access to drug treatment, and adulteration with toxic synthetic opioids, more people were using drugs in isolation. This meant limited opportunity for others to provide lifesaving help by administering naloxone (an opioid antagonist also known as Narcan) when overdose occurred.

As more data became available regarding Covid-19 risks, disparity, and outcomes, it was evident that substanceuse disorders were a significant underlying medical condition associated with high risk for severe Covid-19 illness. Not only were individuals with substance use disorders (SUD) at increased risk of Covid-19, but they also experienced significantly worse outcomes than those without SUD. Knowing that they were at increased risk of bad outcomes from Covid-19 further heightened the already elevated anxiety of the addicted, causing more reactive substance use and more death. Overall, a perfect storm.

Stress: A Neurobiological Force

Though Covid-related stressors increased psychopathological states of fear, depression, and anxiety in most people, these were more elevated in individuals with SUD. Numerous factors associated with Covid—from social distancing and lockdown isolation to economic downturn—converge in the state of mental or emotional strain or pressure we call “stress.” Biologically, stress refers to the body’s response to change. Clearly, the pandemic involved profound changes and demands in all aspects of life. This development was not unexpected: It is well documented that individuals at risk for addiction

and those already suffering from it are particularly sensitive to stress—a reflection of the intricate links between the brain’s stress and reward systems.

Addiction neurobiology is an extremely complex system that involves numerous neurochemicals and interconnected circuits, all of which are influenced by both internal and external stressors. Each phase of addiction—intoxication, habitual compulsive drug-seeking, withdrawal, abstinence—can result in changes to our neurobiology. One of the most important chemicals in our brain’s “reward pathway” is the neurotransmitter dopamine. Most drugs of abuse will directly or indirectly increase dopamine in this pathway. Stress, especially acute or intense stress, boosts dopamine in these same brain areas, via the release of such compounds as corticotrophin-releasing hormone and cortisol. Consequently, stress can heighten reward sensitivity, potentiating the reinforcing effects of drugs. Conversely, drug use can sensitize the brain to stress.

In its attempt to protect the brain against the effects of acute stress, the body recruits neurobiological processes that feedback to increase neurochemicals that reduce dopamine levels and normalize other neurobiological systems (e.g., production of stress hormones). With repeated drug use or chronic stress, however, the biological picture changes: the brain is highly plastic and attempts to return neurobiological systems to “normal,” can lead to adverse pathological states.

For example, chronic use of drugs can result in reduced baseline dopamine release, decreasing the drug’s rewarding effects and increasing negative emotions. This phenomenon, “tolerance,” can have two effects: the user requires more and more of the drug to achieve the high experienced initially; and now he or she also needs the drug to provide relief of the negative mood state. The result: transition to uncontrolled compulsive drug use. By reducing dopamine levels, chronic stress also increases neurochemicals that promote stress, such as the neuropeptide called dynorphin, in brain areas such as the amygdala, which is involved in emotional regulation and drug-seeking behavior. Negative emotional states induced by these changes also drive compulsive drug-seeking behavior.

A vicious cycle is likely to occur. In trying to cope with stress, people begin to use drugs, thinking this will alleviate their negative mood. But during extended stressful periods, occasional self-medication readily escalates to regular use. This boosts output of stressrelated hormones and neurotransmitters, contributing to heightened stress responsivity and negative emotional states, which in turn increase the motivation for continued drug use. Even individuals maintaining drug abstinence prior to Covid were at great risk for relapse during the pandemic, since withdrawal is dominated by negative affect and activation of the stress and anxiety systems that contribute to drug-craving.

The Vulnerable Brain

A particularly challenging dynamic of the pandemic has been the lack of in-person socialization for children and adolescents. The human brain has evolved to maximize social interaction and connectivity, which are dependent on the precise orchestration of complex neurodevelopmental processes. Forced isolation, lack of peer support, and minimal teacher oversight created a perfect storm for heightened stress and risky decisionmaking. Although restrictions have eased considerably with new variants, the support of peers and schools that is a central part of children’s daily lives, could disappear again. Friendships, cliques, sports, and extra-curricular activities may again be fundamentally altered. An entire social structure might once more be disrupted.

For many children, school is the only predictably safe and nurturing place in their lives. In the 2020 academic year, they were uprooted from this stabilizing force and required to attend school virtually. We know from developmental neurobiology that the adolescent brain is uniquely vulnerable to addiction due to a genetically programmed increase in risk-taking and anxiety-related behaviors driven by the amygdala, coupled with a relatively immature “executive” cognitive control center in the brain (the prefrontal cortex), which does not reach full maturity until the third decade of life. Differences in the development of executive versus emotional networks in the adolescent brain make adolescents more sensitive to rewarding and stressful stimuli than adults. So, as challenging as Covid lockdown was for most adults, it was more difficult and neurobiologically perilous for most teens.

Significant neurodevelopment continues well into adolescence, as is evident in various brain structures. Particularly relevant to stress, social connectivity, and

addiction is the profound functional and structural maturing of the amygdala, prefrontal cortex, and ventral striatum. For instance, activation of the ventral striatum in response to reward (including social reward) is stronger in adolescents than in adults and children, which parallels the adolescent maturation of the dopamine system.

Adolescence is also a period of enhanced activity in the hypothalamic-pituitary-adrenal (HPA) axis—the neuroendocrine regulator of stress—and hormone levels following puberty enhance the stress response and increase the motivation and value of reward. Another critical maturation process during adolescence is in amygdala-prefrontal cortex connectivity, a key neural circuit for the generation of negative affect and its regulation. The peak in social drive that occurs during adolescence coincides with this period of prefrontal cortex-amygdala maturation. Adolescence is a sensitive period of enhanced amygdala reactivity when emotional stimuli, stress, and social interactions are extremely important.

It should be emphasized that this period is also characterized by a relatively immature prefrontal cortex that is responsible for cognitive function. Indeed, cognitive control via inputs from the prefrontal cortex to the amygdala does not fully mature until early adulthood, leaving the ability of the prefrontal cortex to inhibit amygdala activity significantly low during adolescence. Stress further weakens this moderating process. Altogether, the neural signatures of adolescence parallel heightened reward sensitivity, stress sensitivity, and risk-taking as compared to other age groups. It’s not

surprising then that social environment or high-stress exposure at this time produces heightened vulnerability to anxiety-related disorders, a factor that is linked with a rise in alcohol and drug use associated with increased likelihood of addiction later in life.

Out of the Storm

While the emergence of new variants and uncertainty prolongs our fragile state, the pandemic has not been all doom and gloom. The Covid storm, like any crisis, has also provided opportunities—including a chance to develop new strategies to help individuals suffering from substance use disorders.

Perhaps one of the most unexpected outcomes of the pandemic has been the profound relaxation in regulatory laws that govern addiction treatment, particularly for the use of buprenorphine, a medication for opioid-use disorder. Buprenorphine, like heroin or oxycodone, is an opioid, but it is nowhere near as euphorogenic or intoxicating. Substituting a very safe medication like buprenorphine for a very unsafe drug like heroin dramatically lowers the risk of overdose. Before the pandemic, it was very difficult to enroll someone onto buprenorphine over the phone or internet due to regulatory laws requiring in-person assessment for treatment. During the pandemic, virtual therapy became commonplace. Hard-to-reach areas that required a long drive for personal contact could now be accessed via an internet connection.

Another silver lining of the regulatory relief that occurred during the pandemic was the relaxation of laws regarding methadone maintenance treatment. Prior to Covid, many patients enrolled in methadone programs had to come to the clinic six days a week to pick up their dose. During Covid, they were able to stay safe in their homes and visit the clinic on a weekly or bi-weekly basis in order to pick up several doses at one time.

While it is still too early to judge the epidemiological impact of these liberalized policies, they have been very well-received by patients. In addition, accessing self-help groups like AA was easier during the pandemic people, as connecting through the phone or computer provided a protective layer of anonymity that overcame concerns about attending in person. Networks expanded, and new connections were made as people in New York City could suddenly join groups in Los Angeles or London. There is quite literally an AA meeting happening online every hour of every day—great news for those in recovery.

What remains to be seen is how long regulatory relief measures will stay in place. Will they become permanent, or will we backslide? As Americans return to the office and its associated etiquette, will alcohol consumption return to pre-pandemic levels, or has a new—and elevated—normal been created?

With new and perhaps future variants delaying any hope of an abrupt end to the pandemic, it remains critical that we leverage the insights that have been gained about disparities and vulnerable groups into new preventative and proactive measures. This is particularly true in regard to teenagers. Given the heightened stress reactivity of adolescence, and the possibility of long-lasting neural changes linked to Covid experiences, we must focus attention and support not only to help affected teens today, but to mitigate the development of addiction-linked psychopathologies in the future. Stay tuned. l

IN HER OWN WORDS:

Calling the Birds

“CALLING THE BIRDS HOME” is a photographic exchange of the energy of life—the give and take of the familial between mother and daughter who lived side-by-side on the same New Hampshire farm for decades.

Our love was mutual and constant. In 2015, my mother developed vascular dementia, and with that began the loss of her emotions and her memory and the relationship of mother and daughter as we have known it for nearly 60 years.

Birds

Home

In my mother’s earlier life, she was a painter, and then in the final decades she began to carve birds. A carving would begin with her vast knowledge of birds, her research, and then her whittling away at chunks of wood. My mother would eventually offer up an exquisite painted chickadee or barred owl, life-size and life-like.

Ibegan to photograph her with any camera in reach—an iPhone or an 8x10 view camera—as a distraction from watching her fade away, as a counterbalance to conversation with her about death, as a means to capture the ephemeral nature of the moment and of life. I needed happiness and light, and to share the images with others I love.

Since her death, I have come to so better understand just how much of a collaboration this work was. Just how much she suggested, aided, and just every damn day was enthusiastically willing to spend time with me and to make pictures together. I continue to be devastated by her absence, but the profound loss is because of our love of one another. l

Imaging’sGroundbreaking Discovery: 30 Years Later

In 2016, Science magazine ranked RANDY L. BUCKNER among the top 10 most influential brain scientists of the modern era. He explains the road to discovering the default network, the pattern of brain activity triggered as we think about the past and the future.

BY BILL GLOVIN

Illustration by Franziska Barczyk

“The network was first found whe were at rest, so the

BILL GLOVIN: Why don’t we begin with a brief description of what the default network is, how and when it was discovered, and why it’s important.

RANDY L. BUCKNER: In the 1990s, neuroscientists were just starting to do functional imaging studies. For the first time, we had brain scanners that could see the mind at work. We were like kids in a candy store in the sense that we no longer needed a scalpel to see the brain; the new technology allowed us to safely discern information out about what parts of the brain people used when given different tasks and different kinds of visual or auditory stimuli.

I was a graduate student at the time at Washington University and one of my mentors, Marcus Raichle, was at the forefront of positron emission tomography (PET), an imaging technique that measures physiological changes in the brain and shows where blood flow is increasing due to brain activity. This is when many of us first became aware of the Dana Foundation, which was helping fund our work. I was a Dana fellow in those early days, and this was an exciting time in neuroscience.

In early studies, we often asked participants to perform very simple tasks: read and say words, detect colors in pictures, or try to recognize whether a viewed word was on an earlier studied list. The imaging revealed the parts of the brain involved in their responses. But what jumped out at us was something unexpected: When people weren’t asked for a response or given a specific task, much of their brain still remained active.

There were skeptics, but Raichle argued that the brain activity seen in the scanner that was not related to specific tasks or responses was—in and of itself—a groundbreaking phenomenon. At the time we didn’t know what to make of the activity pattern that occurred when people were intended to be at rest. The pattern was anatomically specific involving the highest-order association regions of the brain and recurred across many separate studies. Nancy Andreasen, the renown psychiatrist, also early noted the rest pattern of activity and suggested that the brain was at work—spontaneously thinking—when left undirected.

The considerable irony was that when we stopped instructing people to do tasks in the scanner, we saw that the human brain imagines, constructs, and explores mentally.

Look at your own task with this interview, for example. You have the difficult challenge of trying get content from a scientist so that you can communicate it to the public. You’re imagining my perspective, all the ways I’m

struggling to explain this, and thinking of a plan to engage me based on what you believe. You also have this sort of imagined audience in the reader and you’re able to listen and hear my words and then mentally construct a plan to deliver it clearly and effectively to a reader. The default network may be helping you do all this, which is extraordinary.

How did the name “default network” come about?

BUCKNER: The network was first found when people were at rest, so the idea caught on that the network was the default state of the brain. It is the idea that people default to their own processes and make their own mental explorations when not given a test or task in a scanner. However the name is also a bit misleading because we now know the network is active when people intentionally remember and plan. It’s not just used during rest. It’s a network that can be called upon to do many forms of focused mental exploration.

How does the network part fit it?

BUCKNER: The network refers to different parts of the brain—the hippocampus, specific regions along the midline of the cortex, for example—acting together, presumably because they are anatomically connected parts of a large, distributed brain system. As study of the default network has progressed, we’ve learned that there are likely multiple separate networks next to one another. There is one network that seems to be involved when people use memory systems to remember especially, if their memory involves constructing a mental scene. Another network physically next to it becomes active when people imagine what other people are thinking.

How has your research evolved?

BUCKNER: It’s amazing what’s happened over the last two decades. For the first time, we’re really starting to get a handle on the networks that humans use to mentally explore. When we began using neuroimaging to learn about the brain, we targeted seeing, hearing, and attending to the outside world. What has emerged is the beginning of an understanding of how the brain helps us to be mental explorers. We have an incredible capacity to imagine beyond the present—to think about possible futures, what ifs, and how others who are not ourselves might be perceiving a situation. Our research has evolved to study the networks of the brain responsible for these extraordinary human abilities.

when people he idea caught on that the network was

the default state of the brain.”

What inspired you to devote your career to studying the default network, or should I say “networks?”

BUCKNER: In graduate school, I was more interested in targeted memory functions and using imaging to compare brain functions of people doing tasks. Marcus Raichle was the person going around the lab, saying, ‘You folks, look at this stuff. You should pay attention to it.’ He was referring to the pattern of activity we now know as the default network, but at the time, I personally was slow to appreciate the significance.

One of my earliest papers in graduate school demonstrated this. We had data in 1992, ’93, but it wasn’t until my paper in 1995 that the default network was shown. It wasn’t because of any special insight, but more due to my eagerness to present all the data from an experiment. So just the tendency to describe our methodology and results very thoroughly made for one of the first presentations of the network. In retrospect, it was mother nature saying, ‘Here I am.’ When I’m asked, ‘How was it discovered?’ The answer: Serendipitously. It was just in all the study data.

Imaging has certainly changed neuroscience in so many ways. But how in particular have the default network revelations changed neuroscience?

BUCKNER: It’s relevant to psychiatry in particular. Tracking the competition and boundaries between networks may lead to some of the more profound symptoms you see in mental illness. This is a hypothesis. In active psychosis, for example, one can confuse reality with

internal constructions. We have these networks and brain systems that allow us to tend to the external world, act, and survive the here and now. But we have other networks—default networks—that may be used when we detach from the outside world and mentally explore. When networks or interactions between them break and seem to be fragile, one might see devastating, cognitive dysfunction.

It’s also the case that we might have stumbled into seeing some of the networks that are highly expanded and evolved in the human lineage, networks that allow us to do these extraordinary human faculties, such as remember, or imagine what we’re going to do tomorrow, and work in social groups, where we can envision what somebody else might be thinking.

Another key insight is that higher-order networks involved in mental thought may be specialized for specific domains of information. It’s easy to appreciate the idea if we begin by thinking about parallels in sensory brain systems. We have different domains and specializations for sensory processing. For example, specialized visual regions deal with where things are, and others with what they are. It’s easy to translate that and tell people that there are parts of the brain’s visual system that become particularly specialized when taking in different bits of sensory and visual information. I suspect that the higher-order networks that we uncovered in our journey to understand the brain’s default network are also specialized, but in more abstracted domains—such asfor remembering and, separately, for making social inferences.

The default network in healthy adults is shown in blue, and the regions with amyloid plaque in Alzheimer’s disease is shown in red. They are overlaid on top of a histological view of plaques in postmortem tissue from a patient with Alzheimer’s. Of historical significance, the data included are the original data that illustrated the default network at rest in people scanned with PET Neuroimaging.

Can you change your default mode, or maybe train it?

BUCKNER: The short answer is I don’t know. But this clinically relevant question drew my attention when we began studying how the default network is different in older individuals, including those with dementia. An observation is that amyloid, the protein that pathologically builds up in Alzheimer’s disease, deposits preferentially in the default network, which caught our attention in multiple ways.

By better understanding these networks, it might help us to understand why Alzheimer’s disease is so

devastating. Since the higher order circuits that people use to remember are so adversely affected, we are seeing neurodegeneration in the pathways used for higher order, internal thought.

When we pointed out that the default network might be vulnerable in Alzheimer’s disease, the immediate question became: ‘Well, then how do you change it? Can meditation, exercise, or diet change it? If we use our networks less for higher order thought, might this delay the accumulation or prevent the spread of amyloid? My hunch is no.

“For the first time, we’re really starting to get a handle on the networks that humans use to mentally explore.”

How about memory versus stimulus from the outside world? Does that play into studying default mode?

BUCKNER: Absolutely. I think that is a potentially critical bit that we need to understand. It seems that there are predominant constraints on what drives networks, such as sensory stimulation from the retina that drives the activity in the visual system. There are other networks that may be built not off of external stimulation but of things that are generated internally from mnemonic associations, which are the bits and snippets we’ve captured and stored in our brains to help us with memory. This mnemonic information, in part, may be providing the driving information that these other networks elaborate on.

I find that to be potentially critical to this distinction. The brain networks that are expanded and able to utilize internally generated information from mnemonic systems, at their essence, may be different from some of the other networks that we think of as being driven by external events in the world around us, or that we think of in terms of sensory motor function that are primarily driven by taking in sensory stimulation from the outside world and acting upon it. Instead, these networks that utilize internally generated information are about taking information from internal mnemonic systems and elaborating it.

Could further understanding of the default mode help treat autism, Alzheimer’s, or psychiatric problems? What’s the goal?

BUCKNER: Many forms of illnesses affect high-order cognition, whether it be neurodegenerative illness or psychiatric illness. Differences in high-order faculties seems to be a common outcome of many routes to atypical brain development and degeneration. Sometimes I wonder—from a clinical perspective—if we focus too much on the default network and problems with highorder mental functions, at least insomuch as we think the origins of the illness result from selective dysfunction in these networks.

It’s true that we notice dysfunction of the default network in illnesses like psychosis associated with schizophrenia. I don’t know if that necessarily means that the illness is due to a specific dysfunction in these networks, as much as it is that you notice the difficulties in the higher order functions first when network coordination or development hasn’t gone in

the typical trajectory. That said, being able to measure how someone’s brain works when it’s working well, and knowing how the networks are interacting and competing, might be a window into whether therapies are working.

That’s important, because as we try to mitigate brain dysfunction, we need ways of measuring and seeing the working brain and restoring the working brain. That’s one kind of path I think this work has taken. There are ways of potentially measuring typical interactions between networks and having that knowledge and being able to make those measurements that are part of the translational research effort.

The fact that, in Alzheimer’s disease, we can see the amyloid pathology building up in these networks makes one wonder what it is about these networks—and about their metabolic levels—that is conducive to the pathology and sets up the vulnerability. That’s much more of a direct insight, measuring pathology, which can be now be made with molecular PET scans and eventually, potentially blood biomarkers. In thinking about the mechanisms there, I’ve started to wonder why the metabolic activity sets up risk for Alzheimer’s in your eighth and ninth decades.

But when you ask the question, ‘What should we be prioritizing for clinical translation, I think that our ability to see these networks may lead to ways of looking and seeing if therapies, or behavioral interventions, are having positive effects—even if they’re not intimate and mechanistically linked to the origins of the illness. l

Covid precautions have led to a massive increase Is it worsening health disparities—and changing

BY PATOINE

Illustration

increase in treatment from screens and phones. changing medicine permanently?

The Great Telemedicine Experiment

ABY BRENDA PATOINE

Illustration by Miguel Montaner

MONG OTHER THINGS, 2020 MIGHT GO DOWN IN HISTORY as the year of the Great Telemedicine Experiment. After decades of being largely ignored or relegated to a few subspecialty areas, telemedicine has burst onto the healthcare scene as a force to be reckoned with. Not surprisingly, the sharp rise in its use raises issues around access, efficacy, privacy, costs, and more—as medical

systems, care providers, and patients grapple with how best to use this new tool of modern medicine.

Data are pouring in from multiple fields, parsing the huge natural experiment that saw a sudden, unprecedented pivot to virtual medicine in all its forms when Covid hit. As in healthcare generally, many factors contribute to the uneven use of telemedicine for psychological and neurological treatment within certain populations and geographical areas, including disparities in access.

A report released in December from the US Department of Health and Human Services (HHS) confirmed massive increases in the use of telehealth in 2020 compared to 2019, with behavioral health providers seeing the highest telehealth utilization relative to other providers. Telehealth comprised a third of all visits to behavioral health specialists, a much larger share than for primary care physicians or other medical specialists. The report, produced by researchers in HHS’s Office of the Assistant Secretary for Planning and Evaluation, analyzed data from 34.9 million Medicare beneficiaries, making it the largest telemedicine dataset so far. Medicare’s relaxed rules around reimbursing healthcare providers for digitally delivered care were crucial to the 63-fold increase in telehealth visits during this period.

It is perhaps unsurprising that behavioral health was the top user of the modality, as these clinicians were early adopters of telemedicine well before Covid made it a necessity. Individual mental health care in the form of counseling or talk therapy is particularly amenable to this format. Psychological care providers across the country have come up with innovative ways of using technology to stay in touch with their patients, many of whom are struggling with pandemic-fueled stressors and increased anxiety or depression.

Like many others, Tufts child psychiatrist John Sargent pivoted to telemedicine when Covid hit. His patients, who generally have to travel an hour or more for care and deal with traffic and parking in downtown Boston, cancelled fewer appointments. “It was incredibly freeing to all of us and turned out to be amazingly do-able—as long as we weren’t thinking about the people who don’t have internet access.”

Paradigm Shift In Neurologic Care?

Neurology, for its part, has incorporated forms of telemedicine for 25 years or more, typically to facilitate subspeciality care. Barbara Giesser, a multiple sclerosis (MS) specialist now with Pacific Neuroscience Institute in Santa Monica, California, was part of the MS telehealth program established at the University of Arizona in the 1990s to increase access to specialized care in the rural Southwest. “Neurological therapeutics can be very complicated, especially in areas like MS, Parkinson’s disease, epilepsy, and headache,” Giesser says. “People with these disorders may be better served by subspecialists, and there may not be any in their area.”

Stroke is the classic application of telehealth in

THIS IS TELEMEDICINE

TELEMEDICINE HAS EMERGED as an important tool for tracking progressive neurologic diseases such as Parkinson’s. In one initiative, a collaboration of researchers is using smartphones to collect real-world data on symptom progression and treatment response in people with Parkinson’s disease (PD). Within the first six months of the study, 960 participants had performed at least five selfadministered active PD symptom assessments. The authors concluded: “Although remote assessment requires careful consideration for accurate interpretation of real-world data, our results support the use of smartphones and wearables in objective and personalized disease assessments.”

One big question is emerging prominently above myriad others: Are virtual visits reaching the PEOPLE WHO NEED THEM MOST?

neurology. “Telestroke” grew out of an effort to bring people having a possible stroke to the attention of a stroke specialist quickly, in order to enable appropriate treatment with the clot-busting drug tPA within its short therapeutic window. The program became a model for using technology to link patients to the specialists who can best help them. Perhaps because of this history, the neurological exam by video has been fine-tuned to the degree that one can have a near-complete workup entirely virtually, excluding certain sensory, vestibular, and neuromuscular tests.

That history served neurology well when Covid hit, and the proportion of neurologists using telemedicine jumped from 1 percent to 56 percent. The transition to telemedicine drove “a paradigm shift in the delivery of neurologic care in 2020,” Giesser said in a commentary in JAMA Neurology

Who’s Using Telemedicine, and Who’s Not?

One big question has emerged prominently from the telemedicine data: Are virtual visits reaching the people who need them most? Several recent studies—along with observations from experts in fields as diverse as psychiatry, dermatology, family medicine, and OB/GYN raise troubling doubts.

For example, the HHS report found that telehealth services were accessed more in urban areas than rural communities (55 percent vs. 44 percent), and Black Medicare beneficiaries were less likely than white beneficiaries to utilize telehealth, according to a press release In both urban and rural areas, the data suggest evidence of racial and ethnic disparities in uptake of telehealth, especially when comparing the number of Black patients to white, regardless of location.

In an earlier study that analyzed data on 16.7 million private-insurance and Medicare enrollees, Michael Lawrence Barnett and colleagues at Harvard T.H. Chan School of Public Health found a distinct inverse relationship between poverty and telemedicine, with the lowest telemedicine use in counties with the highest poverty rates. They also found age differences, with older people ages 65 and up accounting for a quarter of telehealth visits compared to nearly 40 percent of visits among people aged 30-39. Geographically, 30 percent of visits originated in urban areas compared to 24 percent rural. Overall, the data suggest a skew toward younger, wealthier urban dwellers.

A separate analysis of data on 6.8 and 6.4 million

employer-based health plan beneficiaries in 2020 and 2019 found similar results: disproportionately higher use by younger age groups, in counties with lower poverty rates, and in urban vs. rural areas. A third study, a random survey of telehealth use and satisfaction in 3,454 US households published in October, also found lower use in rural areas and highest use in households earning $100,000 or more. The authors say the results suggest that uneven access and equity remain potential threats to effective implementation of telemedicine going forward.

Of course, none of these data prove that the people who need telehealth the most aren’t getting it. “I think the jury is still out on who needs it most,” says Barnett. “I could argue that it may be more important to see those folks who are on the other side of the digital divide in person. There’s no clear answer.”

Richard Restak, a professor of neurology at George Washington University School of Medicine and a practicing neurologist and neuropsychiatrist, sees this disparity play out in his own older patients. Many have some form of sensory impairment that makes digital communication challenging or are simply not comfortable with or equipped for it. They may consider a visit to their doctor a social occasion, and person-to-person interaction may be a critical piece of their healthcare in such instances.

“Invariably, when I do a teleconference with anyone over 50 or so, their son or daughter is there in the background doing all the tech work,” Restak says. “We should keep these factors in mind before blaming everything on inequities.”

Health Disparities and the Digital Divide

To some degree, the issue boils down to a new iteration of an old problem, the so-called digital divide. The term refers to the fact that technological innovations generally reach certain segments of the population sooner than others, driving inequities in healthcare and other areas. Those left behind are often impoverished, elderly (as in Restak’s patients), disabled, BIPOC, or otherwise marginalized communities.

“Anyone with limited digital literacy to engage in the health system is going to lose out,” Barnett says. “Telemedicine is most likely going to follow the pattern of almost every new healthcare delivery change, which are primarily taken up by populations that have the resources and the money to use them, and the rest will fall behind. I’d love to be proven wrong,” he adds.

The problem is less about telemedicine, per se, than it

is about how the healthcare system works, Barnett points out. “There are many important structural factors that limit health care access in ways that telemedicine won’t fix all on its own. It’s only one piece of what is needed to reform healthcare to address the long-standing disparities we have.”

Access to broadband is the most solvable part of the problem. According to the Federal Trade Commission, some 46 million Americans don’t have high-speed

To some degree, the problem boils down to a new iteration of an old problem, the so-called DIGITAL DIVIDE.

wireless internet. That makes video visits a lot more challenging. Cell phone wireless signals might suffice but doing a visit on a smartphone is less than ideal. A hot spot, then? Maybe, but video calls eat up data. Not everyone has unlimited data. These kinds of technological barriers may seem minimal if you’re tech savvy—but seniors who weren’t raised in the digital age may have difficulty trying to figure it all out.

“The whole device thing is a barrier,” says Tanner Nissly, a family practitioner at a Minneapolis clinic run by the University of Minnesota, where he is an assistant professor. The clinic serves a population of predominantly Black and Asian immigrants, the majority of whom are “under-resourced” and receive federal or state-aided health insurance. When Covid hit, he could only connect with patients remotely. Since many lacked either a proper device or access to internet, telephone visits became the norm even before government insurers paid for them.

Nissly, who co-authored a commentary on achieving equity in telehealth based on his practice’s experiences, believes that “if you really care about equity, then you need to start with groups that have traditionally been marginalized and let it trickle out to the people who are less vulnerable.”

THIS IS TELEMEDICINE

A93-YEAR-OLD MALE SUFFERED a six-inch laceration when a tree he cut down grazed his head. He refused to go to the E.R., so his daughter emailed a photograph of the injury to his doctor. Within five minutes the doctor called and strongly urged the patient to get to the E.R. immediately. Patient complied and received stitches and a CT scan before being released. A week later, the doctor removed the stitches in a “curbside” appointment in the parking lot of his clinic.

Camille Clare is an obstetrician/gynecologist at SUNY Downstate in Brooklyn, NY. Her patients, who have government-based health insurance, often lack access to broadband or wifi, making virtual visits logistically challenging if not impossible. In the last year, access to high-speed internet has thus become an aspect of “social determinants of health”—the circumstances in which we are born, live, age, and die, that impact the kind of care we receive and, in turn, our health and well-being.

“Telehealth is a social determinant of health,” Clare argues, just like food security, housing stability, transportation, and other situations that pose day-to-day difficulties in marginalized communities.

Telemedicine in All its Variants

The popular image of telemedicine is a doctor on a big screen chatting with the patient in real-time interactive audio and video. But the reality encompasses other, simpler modalities. The Centers for Medicare and Medicaid Services (CMS), which sets payment guidelines for federal healthcare programs (and are usually followed by private insurance payers), acknowledges and pays for a suite of services under the umbrella of telemedicine. These include “telehealth visits,” “virtual visits” and “e-visits,” each with its

own tightly defined parameters.

There’s a battle afoot surrounding the recognition of the simple, old-fashioned telephone call as a form of telemedicine and make it subject to “parity”—insurance reimbursement equal to that for a video call. Neil Busis, a neurologist at NYU Langone Medical Center, says telephone visit payment policies have to change if we are to make telehealth—in its broadest definition— truly accessible to all. Busis is the founding chair of the American Academy of Neurology’s new subcommittee on telemedicine, formed in April.

The phone call is arguably the most accessible healthcare tool of all, he says. While a phone call can’t replace an office visit and is inferior to an interactive video visit, he contends that in some instances it is both necessary and sufficient and should be reimbursed as such. Nissly of Minnesota agrees: “Telephone communication is an effective means to get care to a lot of people.” His group’s practice relied heavily on telephone visits to maintain connections with the community it serves during the lockdown, even when they weren’t getting reimbursed for them.

Even in the new era of unleashed telemedicine, doctors don’t generally get paid for phone calls. Only recently did CMS agree to pay for phone visits in behavioral health, such as a psychotherapy session, outside of the Public Health Emergency that was declared when Covid hit. “That’s a start,” Busis says hopefully. Outside of that specialty, phone calls can’t be billed as visits unless specific conditions are met, one of which is that an attempt at a video visit failed.

THIS IS TELEMEDICINE

ATHERAPEUTIC CASE MANAGER at United Counseling Services, a community-based mental health agency in Bennington, VT, created “Flat Becky” to connect with the children she could no longer see in person. She sent all her program participants a paper doll lookalike of herself wearing her usual scrubs and asked them to bring Flat Becky along on their adventures and snap pictures to send back to her and talk about in their video calls.

The myriad rules around how telemedicine services are reimbursed are just one of the barriers to greater use, and a primary reason it was so underused pre-pandemic. In a nutshell, if health insurers don’t pay doctors for televisits, then televisits won’t happen. Telemedicine became the new norm almost overnight only because state and federal restrictions to reimbursement for telemedicine were suspended when the Public Health Emergency began. These restrictions excluded visits originating from the patient’s home, for example. Also suspended were malpractice insurance and state licensing rules governing cross-state practice.

While some of those measures have been extended— in November, CMS announced it would continue telemedicine reimbursement through at least 2023— others, like interstate rules on insurance “portability” and licensure, have not. This leaves the future of telemedicine in limbo. No less than 23 bills currently before Congress address telemedicine issues in one way or another, from building broadband infrastructure to making permanent changes to how telemedicine is paid for.

Silver Lining of Covid?

“Covid is here to stay and hopefully, so is telemedicine,” Geisser says. “I think it’s been one of the silver linings of the pandemic. It’s forced us to be creative, to think outside of the box, and to develop new resources. And it’s showed us how effective telemedicine can be.”

“We found out that telemedicine could potentially bring great benefit,” adds Nissly. “But the question is: Is it just for those who already have access?” l

BRAIN BEE A LUM N I

Where Are They Now?

Since the first Brain Bee in 1998, the competition has grown into an international annual event that engages more than 50,000 students from six continents. It has also inspired many of its top finishers to pursue careers in neuroscience and related fields.

By Kayt Sukel

Illustration by Boris Séméniako

ORE THAN TWO DECADES AGO,

Norbert Myslinski, Ph.D., a neuroscientist at the University of Maryland in Baltimore, wondered how he could better foster young students’ interest in the brain—and potentially encourage more young people to pursue careers in neuroscience. As they matriculated to university, he realized the vast majority of high school students got little, if any, education on the nervous system. After some brainstorming, Myslinski came up with the idea for a competition, much like the National Spelling Bee—but this event would focus solely on the brain.

“It really was [Myslinski’s] vision to have the Bee evolve into a truly international initiative—and it’s become that now,” says Astrid Eberhart, executive director of the (IBB). “But, even from the very beginning, the mission was to encourage high school students to foster their interest in the brain and encourage them to continue their education and pursue a career in

With that primary objective in place, it’s easy to wonder if the IBB is meeting its mission to cultivate the next generation of neuroscientists. After all, there may be many reasons why students aged 13-19 might decide to compete

in such an event. Some may sign up for their local brain bee for extra credit in biology or to try something new and interesting with friends. Others may be thinking about finding a new activity to help jazz up their college applications. Yet, while there are no hard and fast statistics about how many IBB participants ultimately go into neuroscience, it’s clear that the IBB is helping competitors, at the very least, understand the possibilities of different careers in the sciences after taking part in the program. In fact, several of the IBB winners have gone on to pursue a variety of different careers with a neuroscientific bent. Here’s a look at five winners—and where they are now.

If you have ever competed in a regional or National Brain Bee—or made it to the big show, the International Brain Bee organization would like to hear from you. The IBB is looking to gather more data on how the competition may influence later career choices. But reconnecting with the organization does more than just take note of whether you ultimately pursued a job in neuroscience; it also helps to foster a more comprehensive online community as well as potential networking opportunities for everyone involved. While the IBB is planning to create a IBB website soon, you can reconnect with the IBB community today by creating . You can also reach out directly to Astrid Eberhart, executive director of the

NEURAL CIRCUITS INVESTIGATIONS

Arjun Bharioke

2001 Champion

New Jersey

Arjun Bharioke, Ph.D., 34, didn’t know the Brain Bee existed until his school superintendent at Winston Churchill Junior High School in East Brunswick pulled him aside one day and suggested that he look into the competition. “We had spoken at some point, I’m not even sure when, and he knew I was interested in the brain,” says Bharioke. “So, when he got the notification about the event, he pulled me out of class and asked, ‘Hey, would you like to participate in this?’”

Bharioke was intrigued and immediately said yes—even though his local Brain Bee event was only a week away. He says he immediately started studying Society for Neuroscience’s Brain Facts book to prepare and was pleasantly surprised when he won the state and went on to Nationals.

“I think that was the second year that the competition was technically international because the winner the year before had been from Canada,” he says. “We were in Baltimore, and I really enjoyed the competition. But I also enjoyed that we got to go visit the National Institutes of Health, the National Library of Medicine, and then also got to see some actual anatomy dissections. I had never seen a real human brain before.”

In the years since, Bharioke has taken a traditional academic career path. Today, he is a post-doctoral fellow in Botund Roska’s laboratory at Switzerland’s University of Basel,

focusing on systems neuroscience research. Bharioke says he’s known for some time that he wanted to pursue some sort of career in neuroscience—ever since his aunt had surgery to remove a brain tumor when he was a young child—but the ability to try out a variety of different research projects as an undergraduate and graduate student eventually led him to concentrate on more comprehensive systems and circuits work.

“As an undergrad, I actually worked in a couple different research labs at the University of Toronto, doing not only neuroscience but also quantum mechanics,” he says. “Then I did my graduate work at Janiela Research Campus [a Howard Hughes Medical Institute site], doing more computational neuroscience because I wanted to understand more general

When not exploring the brain, Bharioke explores ancient ruins. Here, he navigates through the Greek "Temple of Concordia" in Sicily.

questions, like how the connections between neurons, that specific structure, translate into actual function.”

Once Bharioke completes his fellowship, he hopes to start his own laboratory, pursuing more basic research to better understand how the brain does computations in order to promote function. When asked about advice for future Brain Bee participants, Bharioke spoke highly of the event and encouraged everyone interested to give it a go.

“The Brain Bee gives you an opportunity to meet people and do things which are very different than what you do in your general day-today activities in school,” he says. “It also gives you opportunities to try new things and really open up your mind to the possibilities of what neuroscience can offer.” l

BRAIN POLICY CHAMPION

Julianne McCall

2002 Third Place

Ohio

Julianne McCall, Ph.D., 37, considers the Brain Bee a transformative event in her life. Despite the fact that she did not win the national contest—she came in a “very proud third.” McCall says the event inspired her to start organizing her own Brain Bee events as a student at Denison University in Ohio.

“Central Ohio didn’t have its own Brain Bee, so we pulled together their first one,” she says. “Then, when I graduated from college and went to graduate school at the University of California, San Diego, I started the San Diego Brain Bee. Then my professor moved us to Germany partway through my doctorate, so I started the German National Brain Bee. Once I got my Ph.D., I moved to Sacramento and started another one there. It’s in its third or fourth year now. It sort of took on a life of its own; but I saw where there were opportunities for growth and was happy to help make them happen.”

McCall’s degrees are both in neuroscience—in fact, after graduating from Chagrin Falls High School, she lobbied for Denison University to create its first neuroscience major while studying there—but instead of taking a more traditional academic path, she now works in a public policy role.

“After getting my doctorate, I was dead set on making an impact,” she explains. “With IBB, I was exposed to so many different cultural approaches to STEM education in different countries. I realized it wasn’t just a matter of promoting

education but also looking at the education policies so we could figure out how to fill in the right gaps. It’s hard to be a scientist and not see the discrepancies between where the public is going with science and where science is going with science.”

After getting her Ph.D., McCall was selected to participate in a seven-year fellowship program with the California Council on Science and Technology and was assigned to the state senate office for research. There, she worked on projects to bridge the gaps between science and governance. Since then, she has taken on the role of co-director of the California Initiative to Advance Precision Medicine in the California Governor’s Office of Planning and Research. Yet,

After 16 years in neuroscience research labs, McCall pivoted to a career in science policy at the California Council on Science and Technology in 2016. McCall has also helped organize several World Championships.

as busy as she is, McCall is still an active volunteer with the IBB and heartily recommends any interested students that she meets to sign up.

“I think it’s crazy how in high school we are learning the physics formulas for the trajectory of a ball through space, but we still don’t study how our brain works,” she points out. “The priorities of STEM education are a little out of step with where modern science has taken us. So, I remain very passionate about bringing students into this realm, whether they choose to pursue neuroscience or medicine as a career, or just learn more about the brain. There are so many different approaches to understanding science. But you have to start somewhere.” l

MICROBIOTA MANIA

Elena Perry

2008 IBB Champion Maryland

Elena Perry, Ph.D., 29, doesn’t remember how, exactly, she first heard of the Brain Bee. That said, as a student at Bethesda-Chevy Chase High School, she had a blossoming interest in neuroscience. Yet, her studies were limited by what information was being offered in her science classes. “[Neuroscience] was not something we were being taught

in our normal biology classes,” she recalls. “I loved reading and learning about new scientific areas, especially in biology. So, once I did hear about the Brain Bee, I decided to take a shot at it.”

After memorizing what she could of Society for Neuroscience’s Brain Facts book, she took home first prize at both the local and national levels. But she quickly realized she would need to up her game for the international competition held in Montreal, Canada, and do more than just memorize the basics.

“There were a lot of practical exams, which were very challenging,”

she says, regarding the parts of the competition that involve patient diagnosis and neuroanatomy. “But I really enjoyed the challenge, actually, as it helped me really apply the knowledge I had learned in earlier competitions.”

Perry was already considering a career in research when she decided to participate in the Brain Bee. But after completing an internship with Barry Kaplan, Ph.D., after her win (that coup was part of her prize), consideration turned into certainty. “That was my first real research experience in a biology wet lab,” she says. “I decided I wanted to pursue a career in lab-based research after that.”

As a student at Yale University, she contributed to undergraduate research in neuroscience until, after a study abroad experience, she was introduced to the wonders of microbiology. “The researchers there were looking at compounds made by bacteria and microorganisms that could be used as new antibiotics,” she says. “I started pursuing microbiology after that. I did my Ph.D. in microbiology at the California Institute of Technology and am now working as a postdoctoral research fellow at Genentech in the Bay Area, looking at host microbe interactions in the context of the human gut.”

After a study abroad experience, Perry switched her focus from neuroscience to microbiology.

While Perry may not be working in neuroscience research per se, she believes the IBB is a great way for students to get introduced to emerging new fields—and understand the realities of working in a research environment: “The Brain Bee, like research, requires a lot of self-direction and self-motivation. It’s great preparation for college and beyond, especially for people who may be interested in going into the sciences.” l

At Brown University, Wagle studied psychiatric epidemiology when he wasn't tossing leaves in the air.

PSYCHIATRIC EPIDEMIOLOGIST

Sojas Wagle

2017 IBB Champion

Arkansas

Sojas Wagle, 20, was taking a summer course on Alzheimer’s disease at Duke University when the instructor mentioned a unique neuroscience competition called the Brain Bee. At Har-Ber High School in Springdale, Arkansas, he had been previously involved with the Geography Bee and took first prize in the Whiz Kids’ Edition of Who Wants to be a Millionaire—Wagle’s ears immediately perked up as the instructor described the event.

“The instructor said if brain science interests you and you want to apply your knowledge in a competition, you should find out about your local Brain Bee. I thought, ‘Wow, this looks like a new outlet where I can engage in my competitive interests,’” he says. “The first time I tried out was my freshman year of high school, and I got second in the state. It was just one spot away from Nationals. So, I

immediately set my sights on going to Nationals the next year.”

He not only won the Arkansas Brain Bee and the national competition that year—he then proceeded to take the top prize at the International Brain Bee as well. He credits reaching out to different researchers as what really helped make a difference as he prepared for the event.

“Identifying different brain structures was what got me out during my freshman year,” he says. “So, I made sure to get a brain model and know it inside out before going back. For Nationals, there was a lot of new information to cover so I would seek out neurologists or other neuroscience experts in my state to learn more. They let me visit them, and I was able to get into a laboratory where there were physical brain specimens and histological slides. It gave me a lot of exposure to the more practical side of things.”

After his win, Wagle admits he wasn’t entirely sure what his career ambitions were. He was still very interested in cultural geography, but what he learned about the brain while prepping for the Brain Bees definitely helped him to “prioritize neuroscience more” as he started to think about college.

Now an undergraduate student at Brown University, he created his own independent concentration (Brown’s term for major) that he calls psychiatric epidemiology.

“I created the concentration in collaboration with a professor from the School of Public Health,” he explains. “I specifically wanted to focus on health inequities in mental illness—and how the incidence and prevalence of mental illness is quite different in minority communities. It gave me the perfect outlet to get into research and apply my skills while also getting good training in the classroom with classes ranging from history, sociology, psychology, and the hard sciences.”

As for his next steps, Wagle plans to attend medical school and work in child/adolescent psychiatry, finding avenues beyond medication to help these vulnerable patients. “The field is opening up to non-pharmaceutical interventions,” he says. “There’s a lot of room for mindfulness as well as group and individual therapy. And through internships and exposure to other research, I’m also learning about possible future ways to deinstitutionalize psychiatric treatment.” l

COMPUTATIONAL NEUROSCIENTIST

Yidou (Gwen) Weng

2019 IBB Champion China

Yidou (Gwen) Weng, 19, thinks that neuroscience remains a niche subject in China. But when she learned about the competition from her friends at Jiangxi Normal University, she was very interested in participating. After winning both the regional and national events in China, Weng spent more than six months preparing for the international competition that was held in Daegu, South Korea.

“The IBB has different sessions than the China Brain Bee,” she explains. “You need to do a written test but also do neuroanatomy and patient diagnosis tasks. There was not a lot of resources at my school to help with this, so I watched a lot of YouTube videos.”

After winning the IBB in 2019, Weng participated in several research projects that helped to foster her interest. She is currently a first-year student at the National University of Singapore, where she is studying computational biology.

“I have spent a lot of time exploring neuroscience and figuring out what I want to do. And I think the IBB definitely influenced my career plans,” she says. “I feel like research is probably the way for me. My plan is to continue studying here and then go into a graduate program in computational neuroscience.”

Certainly, Weng says, the IBB inspired her intellectually. But she says one of the greatest aspects of participating in the international level

was to become part of a “smart, supportive community of like-minded people.”

“It was a once-in-a-lifetime experience to meet peers who have the same passion. They are all so talented and have achieved so much at a young age,” she says. “I can’t say

that I’ve ever been in a circumstance where I’ve met such a high density of talented people. Honestly, I don’t recall the excitement of my win or the questions that I answered, but I remember the people and how we asked questions and exchanged ideas and had a lot of fun together.” l

During a visit to Chengdu City in Sichuan Province, Weng wore her Mulan costume while meditating in the gardens at the Wuhou Shrine.

ADVISORY BOARD

JOSEPH T. COYLE, M.D.

Joseph T. Coyle is the Eben S. Draper Chair of Psychiatry and Neuroscience at Harvard Medical School. A graduate of the Johns Hopkins School of Medicine in 1969, he was a research fellow at the National Institute of Mental Health with Nobel Laureate, Julius Axelrod. After psychiatric residency at Hopkins, he joined the faculty in 1975. In 1982, he became the director of the Division of Child and Adolescent Psychiatry. From 1991 to 2001, he was chairman of the Department of Psychiatry at Harvard Medical School. His research interests concern the causes of neuropsychiatric disorders. He is the past-president of the Society for Neuroscience (1991), a member of the National Academy of Medicine (1990), a fellow of the American Academy of Arts and Sciences (1993), a fellow of the American Association for the Advancement of Science (2005), and the former editor of JAMA Psychiatry

MARTHA J. FARAH, Ph.D.

Martha J. Farah is the Walter H. Annenberg Professor of Natural Sciences at the Center for Neuroscience & Society, University of Pennsylvania. She is a cognitive neuroscientist who works on problems at the interface of neuroscience and society. Her recent research has focused on socioeconomic status and brain development. Farah grew up in New York City, was educated at MIT and Harvard, and taught at Carnegie-Mellon University before joining the University of Pennsylvania. She is a fellow of the American Academy of Arts and Sciences, a former Guggenheim Fellow and recipient of honors including the National Academy of Science’s Troland Research Award and the Association for Psychological Science’s lifetime achievement award. She is a founding and current board member of the International Society for Neuroethics.

PIERRE MAGISTRETTI, M.D., Ph.D.

Pierre Magistretti is the dean of the Division of Biological and Environmental Science and Engineering at King Abdullah University of Science and Technology and professor emeritus in the Brain Mind Institute, EPFL and Center for Psychiatric Neuroscience, Department of Psychiatry–CHUV/UNIL, Switzerland. Magistretti received his M.D. from the University of Geneva and his Ph.D. from the University of California at San Diego. Magistretti’s research team has made significant contributions in the field of brain energy metabolism. His group has discovered some of the cellular and molecular mechanisms that underlie the coupling between neuronal activity and energy consumption by the brain. This work has considerable ramifications for the understanding of the origin of the signals detected with the current functional brain imaging techniques used in neurologic and psychiatric research.

HELEN S. MAYBERG, M.D.

Helen S. Mayberg is a neurologist renowned for her study of brain circuits in depression and for her pioneering deep brain stimulation research, which has been heralded as one of the first hypothesis-driven treatment strategies for a major mental illness. She is the founding director of Mount Sinai Health System’s The Nash Family Center for Advanced Circuit Therapeutics. Mayberg received an M.D. from the University of Southern California, trained at the Neurological Institute of New York at Columbia University, and was a post-doctoral fellow in nuclear medicine at Johns Hopkins Medicine. Immediately prior to joining Mount Sinai, Mayberg was Professor of Psychiatry, Neurology, and Radiology and held the inaugural Dorothy C. Fuqua Chair in Psychiatric Neuroimaging and Therapeutics at Emory University School of Medicine. She is a member of the National Academy of Medicine, The American Academy of Arts and Sciences, and the National Academy of Inventors. She is on the board of the International Society for Neuroethics and won the society’s Steven E. Hyman for Distinguished Service to Neuroethics (2018).

ADVISORY BOARD

RICHARD M. RESTAK, M.D.

Richard Restak is clinical professor of neurology at George Washington Hospital University School of Medicine and Health Sciences, a member of the clinical faculty at St. Elizabeth’s Hospital in Washington, DC, and also maintains a private practice in neurology and neuropsychiatry. A graduate of Georgetown University School of Medicine, Restak has written over 24 books on the human brain and has penned articles for the Washington Post, The New York Times, the Los Angeles Times, and USA Today; and presented commentaries for both Morning Edition and All Things Considered on National Public Radio. He is a past recipient of the Claude Bernard Science Journalism Award, given by the National Society for Medical Research.

HARALD SONTHEIMER, Ph.D.

Harald Sontheimer is I. D. Wilson Chair and professor and founder and executive director of the Virginia Tech School of Neuroscience. He is also Commonwealth Eminent Scholar in cancer research and director of the Center for Glial Biology in Health, Disease & Cancer and the Fralin Biomedical Research Institute. A native of Germany, Sontheimer obtained a master’s degree in evolutionary comparative neuroscience, where he worked on the development of occulomotor reflexes. In 1989, he obtained a doctorate in Biophysics and Cellular & Molecular Neuroscience form the University of Heidelberg. He moved to Yale University for post-doctoral studies and later founded Transmolecular Inc., which was acquired by Morphotec Pharmaceuticals. He is the author of Diseases of the Nervous System (Elsevier, 2015).

STEPHEN WAXMAN, M.D., Ph.D.

Stephen Waxman is the Bridget Flaherty Professor of Neurology, Neurobiology, and Pharmacology at Yale University, and served as chairman of neurology at Yale from 1986 until 2009.  His research uses tools from the “molecular revolution” to find new therapies that will promote recovery of function after injury to the brain, spinal cord, and peripheral nerves.  A member of the National Academy of Medicine, Waxman has been honored in Great Britain with the Physiological Society’s annual prize, an accolade that he shares with Nobel Prize laureates Andrew Huxley, John Eccles, and Alan Hodgkin. In 2018, Waxman received the Julius Axelrod Prize from the Society for Neuroscience.

CHARLES F. ZORUMSKI, M.D.

Charles Zorumski is the Samuel B. Guze Professor and head of the Department of Psychiatry and Professor of Neuroscience at Washington University School of Medicine in St. Louis. Zorumski is also Psychiatrist-in-Chief at Barnes-Jewish Hospital and founding director of the Taylor Family Institute for Innovative Psychiatric Research. Zorumski’s laboratory studies synaptic transmission in the hippocampus. Since 1997, he has served on the steering committees of the McDonnell Center for Cellular and Molecular Neurobiology and the McDonnell Center for Systems Neuroscience and was director of the Center for Cellular and Molecular Neurobiology from 2002 to 2013. Zorumski has also served on the editorial boards of JAMA Psychiatry, Neurobiology of Disease, and served on the board of Scientific Counselors for the NIMH Intramural Research Program from 2009 to 2013. Since 2011, he has also served on the scientific advisory board of Sage Therapeutics, a publicly-traded company developing neurosteroids and oxysterols as treatments for neuropsychiatric illnesses.

CAROLYN ASBURY, Ph.D.

In-House advisor

Carolyn Asbury has worked in health philanthropy for more than two decades, directing neuroscience-related health programs at the Robert Wood Johnson Foundation and directing the Pew Charitable Trusts’ Health and Human Services Program prior to consulting with the Dana Foundation. Her own research, through the University of Pennsylvania’s Leonard Davis Institute, concerns policies to facilitate development and market availability of drugs and biologics for “orphan” (rare) diseases. She undertook pro bono research and helped to design the Orphan Drug Act; authored “Orphan Drugs: Medical vs Market Value,” and has authored several journal articles and book chapters on these topics. She has served on the boards of several non-profit health-related organizations, including the National Organization for Rare Disorders, U.S. Pharmacopeia, College of Physicians of Philadelphia, and Treatment Research Institute.

Bill Glovin Editor-in-Chief

Glovin has been a working journalist for more than 30 years. He is executive editor at the Dana Foundation and hosts the Cerebrum Podcast. He has served as editor of Cerebrum since 2012. Previously, he was senior editor at Rutgers Magazine, managing editor of New Jersey Success, editor for New Jersey Business and a staff writer for The Bergen Record. Glovin graduated from George Washington University with a degree in journalism. He sometimes escapes from in front of the monitor to enjoy basketball, biking, and guitar.

Seimi Rurup Associate Editor

Rurup oversees the production of all digital and print content at the Dana Foundation. She previously served as editor of Brain in the News, which was the Foundation’s longest running print publication, and utilizes her background in fine arts to contribute to current publications and social media. She also contributes to the Foundation’s Neuro News section. Rurup graduated from Sarah Lawrence College with a degree in writing. When she is not in the office, she can be found in one of NYC’s many museums, Brooklyn cafés, or at home cooking with friends.

Brandon Barrera Staff Writer Barrera is a New York City journalist, born and raised in Queens and living in Manhattan. A public affairs assistant at the Dana Foundation, he is the host of the Dana Foundation’s Communicating Brain Science podcast and writes about books for the magazine. Before coming to Dana, he helped produce content for Bronx Net, a public access television channel. When not enthralled by all things sci-fi, Barrera is fond of cycling, film, and arguing the finer points of tabletop gaming.

Bruce Hanson Art Director

Hanson is responsible for the design and production of Cerebrum. A graduate of Rutgers University’s journalism program, he has worked in a variety of capacities in publishing and media for more than 30 years. In 1991, he founded EGADS, a studio which specializes in graphic design for education, arts and culture, publishing, and technology. When away from his desk, he'll most likely be playing guitar in a live music venue or plotting with his wife about how to book cheap flights to distant destinations.