I am a professor of neurology at the University of Cincinnati, interested in the many ways in which we acquire impairments in movements, in cognition, or in both. I have sought to measure these behaviors, quantify their responses to different pharmacological treatments, and determine how they inform the biology of the aging brain. In publications along the way, I have increasingly questioned how we classify neurological diseases and treat those affected.
I wrote...
Brain Fables: The Hidden History of Neurodegenerative Diseases and a Blueprint to Conquer Them
The narratives we have chosen to understand abnormal brain aging have shaped what we have done to improve it. Among the most important narratives is this one: proteins become toxic to the brain and cause disease. Billions of dollars and dozens of randomized trials later, not one of the promising anti-protein therapies have slowed the progression of neurological symptoms. This book reviews the milestones of Parkinson’s and Alzheimer’s stories from the sources, with fresh eyes. When the data are reviewed without our age-old biases, a different story emerges.
This book's ideas inspired the first biomarker study of aging (the Cincinnati Cohort Biomarker Program or CCBP), designed to match people affected with neurodegenerative disorders to available therapies from which they are most biologically suitable to benefit, regardless of their clinical diagnoses.
This book explains the tight connection between Alzheimer’s disease and education, health, income, and environment, and why the rate of Alzheimer’s disease in the population actually decreased in the decades following the most important societal changes enacted after World War II. Social safety, environmental protections, and income inequality have had far greater impact than any of the pharmacological approaches ever attempted. The authors make the compelling case that brain health is intimately connected to societal health.
Have the social safety nets, environmental protections, and policies to redress wealth and income inequality enacted after World War II contributed to declining rates of dementia today-and how do we improve brain health in the future?
For decades, researchers have chased a pharmaceutical cure for memory loss. But despite the fact that no disease-modifying biotech treatments have emerged, new research suggests that dementia rates have actually declined in the United States and Western Europe over the last decade. Why is this happening? And what does it mean for brain health in the future?
This classic book is relevant to anyone interested in the brain. Our teachers told us that our knowledge evolves linearly, small discoveries accumulating over time. But Kuhn (1922-94), a theoretical physicist, reviewed the history of discoveries and concluded they happened after “crises.” He defined and popularized many of the terms we still use today. A “paradigm” creates the boundaries within which “normal science” can operate to answer “puzzles.” Normal science does not aim at novelty but at discovering what it expects to discover based on a hypothesis. Any “anomalies” that cannot be resolved with further studies lead to a “crisis” of the prevailing paradigm, whose “revolution” contains the seeds of a new paradigm and, with it, new boundaries for “normal science” to ask questions it could not with the prior paradigm. This book convinced me that the current protein-toxicity paradigm of neurodegeneration checks all of Kuhn’s boxes for a scientific revolution.
A good book may have the power to change the way we see the world, but a great book actually becomes part of our daily consciousness, pervading our thinking to the point that we take it for granted, and we forget how provocative and challenging its ideas once were-and still are. "The Structure of Scientific Revolutions" is that kind of book. When it was first published in 1962, it was a landmark event in the history and philosophy of science. And fifty years later, it still has many lessons to teach. With "The Structure of Scientific Revolutions", Kuhn challenged long-standing…
This book offers a captivating tale of how the increasing knowledge of one disease, syphilis, created the foundations to understanding that the brain and mind are one and the same. The authors narrate the stories of patients whose “hysteria” (today referred to as functional neurological disorder) were traced to degenerative brain lesions that only belatedly were understood to be complications caused by remote infections with the bacterium Treponema pallidum. Several chapters follow the story of the important characters depicted by André Brouillet in the Une leçon clinique à la Salpêtrière (A Clinical Lesson at the Salpêtrière), one of the most recognized paintings by neurologists, as it depicts Jean-Martin Charcot, shown among many of his disciples, demonstrating a “hysteric” seizure in one of his patients. The authors illustrate how we have gotten away with conceptualizing behaviors without biological basis and put the reader on notice that “mental illnesses” are neurological problems –with a solution somewhere in the brain, waiting to be found.
In 1882, Jean-Martin Charcot was the premiere physician in Paris, having just established a neurology clinic at the infamous Salpetriere Hospital, a place that was called a 'grand asylum of human misery'. Assessing the dismal conditions, he quickly upgraded the facilities, and in doing so, revolutionized the treatment of mental illness.
Many of Charcot's patients had neurosyphilis (the advanced form of syphilis), a disease of mad poets, novelists, painters, and musicians, and a driving force behind the overflow of patients in Europe's asylums. A sexually transmitted disease, it is known as 'the great…
Stan Prusiner received the Nobel Prize of Medicine in 1997 for identifying what at the time was considered a novel mechanism of neurodegeneration: the prions. These “infectious proteins” were responsible for ravaging the brains of animals suffering from scrapie and mad cow disease, and of humans with Creutzfeldt-Jakob disease. Although I have come to doubt that prions are a cause of rapidly progressive dementia and may instead represent a consequence, Prusiner’s memoir is filled with moments of skepticism, self-doubt, adversity, and intellectual rivalries –the ingredients for a gripping drama in neurosciences.
A first-person account of a revolutionary scientific discovery that is now helping to unravel the mysteries of brain diseases
In 1997, Stanley B. Prusiner received a Nobel Prize, the world's most prestigious award for achievement in physiology or medicine. That he was the sole recipient of the award for the year was entirely appropriate. His struggle to identify the agent responsible for ravaging the brains of animals suffering from scrapie and mad cow disease, and of humans with Creutzfeldt-Jakob disease, had been waged largely alone and in some cases in the face of strenuous disagreement.
This collection of essays blew my mind. Researchers in a range of disciplines were asked to elaborate on why a given idea in their field should be put to rest. There is a chapter dedicated to big data, nature versus nurture, cause and effect, race, Linnaean classification, etc. The book’s essays inspired me to shape a section on “Reductionism and related ideas that will die” as part of a solicited article I wrote with Tony Lang in 2018 aiming to predict the future of Parkinson’s disease research in the 2020s (Ben Stecher credited it as his reason to relocate to Cincinnati to work with us in our CCBP study). This book is also a reminder that progress requires new ideas, and most cannot emerge without first abandoning outdated ones (as Kuhn articulated).
An idea that must die in neurology is the clinico-pathologic model of classifying neurodegenerative diseases: abnormalities on brain autopsies (clumps of abnormal protein, or pathology) are most likely a consequence of disease, not their cause (or pathogenesis). By trying to clean the brain from pathology, we have thought we can end the diseases they define –to no avail.
The bestselling editor of This Explains Everything brings together 175 of the world's most brilliant minds to tackle Edge.org's 2014 question: What scientific idea has become a relic blocking human progress? Each year, John Brockman, publisher of Edge.org-"The world's smartest website" (The Guardian)-challenges some of the world's greatest scientists, artists, and philosophers to answer a provocative question crucial to our time. In 2014 he asked 175 brilliant minds to ponder: What scientific idea needs to be put aside in order to make room for new ideas to advance? The answers are as surprising as they are illuminating. In : *…
Coming from the perspective of a neurosurgeon, I have witnessed many successes and failures over more than four decades. I recognized decades ago that communication with patients at a level that involves emotions is a necessary part of being a complete physician. This involves being empathetic and, henceforth, digging deep to find the strength to be transparent, vulnerable, compassionate, understanding, and, when needed, forceful (some would call this paternalism). Although the five books I have chosen to highlight vary widely in content, they have one common theme – finding within us the will and wherewithal to succeed.
My book is a collection of monthly Editor-in-Chief letters to the readership of World Neurosurgery, a journal that I edit. Each essay is short and sweet. The letters were written for neurosurgeons but have been re-edited so that they apply to all human beings. They cover topics such as leadership, empathy, vulnerability, stress, burnout, and on and on…. These essays are relevant for all who strive to craft a better version of themselves.
Life lessons learned by the author during his 40+ year neurosurgery career are shared and translated into real-life scenarios. Between the covers are many lessons that are derived from the experiences of the author and then applied to all humans. The mastering of these lessons should translate into a sense of pride and satisfaction. In keeping with the theme of the book, this process should culminate in the feeling at the end of the day that ‘Today was, indeed, a good day.’
Today Was A Good Day: A Collection of Essays From The Heart Of A Neurosurgeon
About the Book Today Was A Good Day: A Collection of Essays From The Heart Of A Neurosurgeon features many topics that pertain to how neurosurgeons interact with others and how each of us can use introspection to modify how we are using tools and strategies such as empathy, respect, stress management, and much more. This book provides some insights into leadership, effective communication, and fulfillment from the perspective of a neurosurgeon, and it causes the reader to think about and consider many, many attributes of a leader. We all want to have a good day. This book provides strategies…
