SciTech Now Episode 237

In this episode of SciTech Now, the importance of clear medical communication; what can dental plaque tell us about our ancestors?; a new sketching technology for the 21st century; the best ways to reduce, reuse and recycle; and making health professions more diverse and equal.

TRANSCRIPT

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Coming up, the science behind clear communication.

What kinds of questions do you have?

And then starting to probe from those questions, 'cause, a lot of times, the patient will say, 'Oh, no, I don't have any questions,' because they're just so freaked out, they want to get out of there.

Uncovering secrets from our ancestors's teeth.

We can now go back to specific time points in the past and tell if someone -- a particular individual -- drank milk or not.

To bury or to burn?

Our best option is not to dispose of it but to get it -- You know, get the materials recycled, because we save from, oh, 20% to 90% of the energy when you recycle material.

And, finally, the next generation of science leaders.

I came in with, I guess, sort of a rough basis of anatomy and physiology.

Right.

And I was able to expand while I was here.

Like, I've learned so much.

It's all ahead.

Funding for this program is made possible by...

Hello. I'm Hari Sreenivasan.

Welcome to 'SciTech Now,' our weekly program bringing you the latest breakthroughs in science, technology, and innovation.

Let's get started.

A trip to the doctor can be confusing for patients unfamiliar with medical-industry terms.

In Southern California, doctors and educators are committed to bridging this divide by studying the science behind clear communication.

Here's the story.

'You have cancer' -- three of the most frightening words anyone can hear.

It was true for Patricia Darby when she was first diagnosed with breast cancer, in 2008.

It was really surprising and also scary.

Darby was just days away from a dream vacation to Italy when she got the news.

It sets off a bomb in your life with regards to your schedule, and, of course, you're afraid.

That's the most important thing is to take care of the health issue.

But all these things fly at once in your brain.

Just as important as her treatment plan was Darby's ability to communicate with her doctor.

Lawrence Wagman has been breaking bad news to patients for years.

He knows the pitfalls in patient-doctor communication.

I think the biggest error in communication is jargon.

I really do.

Abbreviations, words that you use with your colleagues but you can't use with your patients.

And those are the things where people just misinterpret it.

I mean, simple things, like benign and malignant can be misinterpreted.

Lisa Sparks is an expert in the field of health communication and messaging.

She teaches it as a leading researcher, even consults to the entertainment industry on medical messaging in Hollywood.

Sparks says 80% of medical errors are due to communication breakdowns.

And the science of communication begins with the doctor-patient relationship.

And what kind of cues are they getting back?

And hopefully they're paying attention to those feedback cues and then adjusting the message and maybe framing it in a different way and reading the nonverbal cues of the patient and the caregiver that might be with them or family member.

The cues are very, very important.

And the questions are very important, because a patient can ask you a question that tells you that you haven't really said something that they understand.

That's when, Sparks says, the doctors need to be well-versed in the science of communication.

Through asking questions, like, asking them what they understand -- 'Can you repeat back to me what you understand?

Can you explain?

What kinds of questions do you have for me?'

And then starting to probe from those questions, 'cause, a lot of times, the patient will say, 'Oh, no, I don't have any questions,' because they're just so freaked out, they want to get out of there.

'Do you understand?'

Wait and listen.

'You sure you understand.'

And, sometimes, you can see that doubt in somebody's face.

So before you move on, you say, 'I know you need to ask me a question before we go any further.'

Sparks says the science of communication can save lives, especially when patients take charge of the conversation.

You know, you need to be a savvy consumer of health information, as well, and you're responsible for your care and you're responsible for making sure that you're getting the information you need from your provider team.

And if you don't get it from one person, keep going down the chain of your provider team until you really are starting to understand the issue, 'cause it's definitely a two-way street.

For Darby, the rapport with Dr. Wagman gave her the confidence to fight and survive.

You felt like you were most important patient, when, rest assured, my small, small cancer is definitely not Dr. Wagman's biggest case.

He gave me a very wonderful feeling of confidence, and I just felt, you know, comfortable to talk and to be heard.

I do feel grateful for that.

As small children, we learn the importance of brushing and flossing our teeth, but, as it turns out, a little tartar may be a good thing, at least for anthropologists studying early modern humans.

Plaque contains genetic information that offers clues about how early humans lived millions of years ago.

Joining us is Professor Christina Warinner, a pioneer in this field of study.

I didn't even know that it existed until we were preparing for this conversation.

Oral microbial ecology?

Microbiomes from people that used to live 1,000 -- How do we figure out what people 1,000, 2,000, a million years ago ate?

It's a great question.

And, actually, we've only started to unravel this in the last couple of years.

It's only with recent advances in genetic technologies that we can even do this work.

So the field's very, very new.

But it turns out there are two substrates that preserve in the archaeological record, which give us insights into our ancient microbiome.

One is paleofeces, or preserved human feces.

They don't preserve very often.

They mainly preserve in things like very very dry contacts, like dry caves or underground mines, for example.

The other one is a little bit more common and, I think, quite interesting, and that's dental calculus.

Although, most people might know it by its other name, dental tartar.

This is calcified plaque on the surface of your teeth.

It preserves just like the rest of the skeleton for tens of thousands of years.

So, when you're scraping that, what could you possibly get out of that plaque that helps you figure out something about the person or the environment that they lived in?

It turns out that calcified plaque is like a time capsule that retains all sorts of things that you put in your mouth over the entire course of your life-span.

So, we find an amazing diversity of things.

We find human DNA from yourself.

We find dietary DNA and dietary proteins, as well.

Also, plant microfossils, tiny starch granules, phytolites, which are a type of plant glass, pollen granules.

We find all sorts of information in addition to the bacteria themselves, who lived on your teeth or transiently passed through your mouth -- for example, when you had a respiratory infection.

Wow. Okay.

So, the importance of brushing.

So, obviously, these people didn't brush, and that's why they had this build-up, right?

Yes.

So, is there a surprising discovery that you didn't expect in somebody's mouth or on their teeth?

We have had so many surprising discoveries.

One was -- until a few years ago, no one thought that anything was really even retained in dental calculus.

It was widely believed to have no DNA and no proteins.

We now know it's actually the richest source of ancient DNA and proteins known in the entire archaeological record.

We get as much DNA out of dental calculus as we can from fresh human liver, for example, which is one of the richest sources of DNA in the human body.

We've learned all sorts of information.

So, for example, one surprising discovery, for me, is -- we were looking at dental calculus from different populations around the world.

And I was focusing on Norse Greenlanders.

These are the famed Norse Greenlanders who died out in their colonies during the medieval period.

And we started seeing milk proteins over and over and over again.

And what we realized was -- dental calculus actually preserves traces of milk consumption.

Milk is otherwise almost entirely invisible in the archaeological record, as you might imagine.

It spoils very, very quickly.

And so we know very little about the origins of dairy and how it spread throughout the world.

We can now go back to specific time points in the past and tell if someone -- a particular individual -- drank milk or not.

And we've applied this throughout Europe and we're now starting to apply it even further back in time and into the Middle East to try to understand when people first started changing their use of livestock from just for meat and hides to also incorporating dairy.

When you're saying that you can figure out when people drank milk, you can also figure out what kinds of diets they were on, right?

So there was, obviously, the fad a few years, the Paleo diet.

Mm-hmm.

'Let's go back to eating like cavemen and cavewomen.'

Are we actually doing that?

Were they eating the same thing?

The popular Paleo diet is a little bit different than what people actually ate in the past.

It's actually almost impossible for us that live in modern, industrialized societies to eat like our Paleolithic ancestors, and that's because our foods have been so incredibly, radically changed by the process of domestication during agriculture.

There's very few foods in a grocery store that you can buy that's truly from the Paleolithic.

Probably the only thing that you could find would be something like wild-caught fish.

Everything else is a product of agriculture.

We can learn from what our ancient ancestors ate and take some lessons from that.

It's clear that what they ate were fresh foods, in season.

They had a high degree of roughage and fiber.

All of those things are dietary components that we are evolved to eat and are quite healthy for us and promote good, healthy bacteria in our bodies.

All right, so, let's talk about that bacteria.

We've had conversations about the gut bacteria before on this program.

But how has that changed over time?

That's a great question, and it's one that we have an active research project on right now, looking at paleofeces specifically to try to understand these changes.

But what I can say is -- our research group at the University of Oklahoma has been focusing on this question, and we recently published a study where we looked at this question of, 'To what degree does subsistence, the type of diet you have, affect your gut microbiome?'

And this study was conducted on three populations -- the Matsés, which are a hunter-gatherer group in the Peruvian Amazon, the Tunapuco, who are a traditional agriculturalist society that lives high up in the Andes Mountains, and Americans living in urban cities.

And what we found was that the traditional societies -- it doesn't really matter if they're hunting and gathering or traditional agriculturalists, they have quite a similar gut microbiome.

Where we see a tremendous difference is in industrialized societies.

This suggests to us that although agriculture and this transition from the Paleolithic to the Neolithic had some impact on our gut microbiota.

The huge change has likely been much more recently.

So, our teeth might be shinier because we have all kinds of toothpaste and whatever, but what's happening inside might be very different.

That's right.

Where we're kind of focusing on right now is -- it appears that many of these changes that have occurred in our gut microbiome and our microbiome more generally are probably on the order of the last few centuries and don't necessarily stretch all the way back 10,000 years ago.

So, this makes it a little bit easier to eat a healthy diet.

We don't need to go back 10,000 years, even just a few centuries, taking some notes from our more recent ancestors could be very helpful for improving our health.

All right, Christina Warinner, University of Oklahoma.

Thanks so much.

Thank you.

Mental Canvas is this new technology which sits, really, between a 2-D drawing and a 3-D CAD model.

It preserves the hand of the artist but allows for these very new interactive 3-D capabilities.

In the digital age, things like text, photography, and music have been totally revolutionized by digital technologies, but drawing is still, even by computer, not so different from when Leonardo was drawing.

So, I was really struck by the problem of architectural design, particularly the design of kind of Gehry-esque-like forms, very complicated curvilinear forms.

And I was struck by the fact that you could model such forms with computer-aided design systems, but you really couldn't ideate and sketch such complicated geometry.

So, I was really struck by the idea of, 'What if you could actually experiment with very complicated forms in the very conceptual stages of design?'

So, our audience is really anyone who sketches as a part of their work flow.

It could be a scientist trying to do an analysis of a molecule.

It could be someone studying the human brain.

It could be an ad director trying to do a storyboard for a campaign, or industrial designer, architectural designer.

Anyone who, you know, really uses sketching on a day-to-day basis to solve problems.

When it comes to waste management, there's a lot of misinformation to sift through.

To get to the truth, scientists perform life-cycle analyses.

The LCAs follow the entire chain of events, from the manufacturing of a product to its disposal.

Reporter Andrea Vasquez learned more from environmental consultant Jeffrey Morris via Google Hangout.

Jeff, thanks so much for being with us.

Oh, glad to be here.

Thank you.

Can you tell us about these life-cycle analyses and how they're performed and what you're really looking at?

So, we have to look at all those stages of the life cycle of a product and, at each stage, evaluate what the emissions are, the environmental impacts.

So we look at, you know, greenhouse-gas emissions, criteria-air-pollutant emissions, toxic emissions, carcinogenic emissions, things that affect ecosystems, all that.

And then we have to figure out a way to roll all that up into indicators of environmental impact.

Carbon-dioxide equivalence is an indicator for climate-change impact.

And we have those kinds of indicators for other environmental impacts, like human respiratory disease or human toxicity or human carcinogenicity, also, ecosystems toxicity, nitrification of waterways, acidification of the air, and trying to start the develop ways to have indicators of habitat impact.

That's much harder, but people are working on that.

So, after we finish with a product, we have a choice.

Sometimes, it's throwing something away that's gonna end up either in a landfill or, in some places, in an incinerator.

Can you explain some of the pros and cons of landfills and incinerators for our trash?

When you get to the bury-or-burn statement, it depends on what the composition of the material is that's going into the incinerator or the landfill.

If you had all food waste, then it would probably be better to burn it, because, in a landfill, you would have to have a methane -- a landfill-gas-capture efficiency that's very high, like up in the 89%, to make carbon emissions from the landfill lower than the carbon emissions from the incinerator, which releases all the carbon, but in the form CO2, which is less of an impact than methane.

But food waste is really the exception.

If you're talking about wood as the other end of the biogenic-material spectrum, then you only need to capture about 10% of the landfill gases for your carbon profile or footprint of the landfill to be better than the incinerator.

So, in general, for the mixed garbage that you talk about putting into the landfill or the incinerator, even though you're producing electricity, that offset or that benefit is not great enough to offset the air emissions from the incinerator, because you're basically burning everything.

And even though you have a good pollution-control system, you still produce more emissions than if you landfilled that garbage with a decent landfill-gas-capture rate.

So, that's the kind of thing that you have to be aware of.

And if you're gonna build new facilities, like a new landfill or a new cell at a landfill versus a new incinerator, then, when you take into account the costs of those two and what you can do in terms of capturing the emissions, I think the landfill's probably better.

When we talk about these facilities, these landfills, and incinerators that are designed to efficiently capture and produce energy from that trash, how many of the existing facilities that we have -- landfills and incinerators -- would meet those standards?

The smaller landfills -- you might have an issue there, in terms of whether they're capturing the landfill gases and whether they're lined underneath to capture the leachate.

With the newer ones, they're required to have landfill-gas-capture systems and to be lined underneath so that the leachate doesn't percolate out.

Incinerators are required to mean the clean-air standards, so they should be doing a pretty good job.

So, what's our best option?

Our best option is not to dispose of it but, you know, to get the materials recycled, because we -- You save from, oh, 20% to 90% of the energy when you recycle material versus making a product out of virgin materials, you know, all the oil wells or the coal mines or the iron-ore mines, oxide mines, or the whatever you have to do to extract raw materials and refining them.

You avoid that when you recycle.

So, you save from 25% to to 95% of the energy that you would ordinarily expend if you made those products out of virgin content, instead of recycled content.

And then, environmentally, if you look at the climate impacts, you save from 50% to 90% of the greenhouse-gas emissions if you make your products out of recycled materials.

So, these are valuable resources and shouldn't go to the landfill or the incinerator.

They should be recycled.

So, I mean, I think it's a devil's bargain to talk about, you know, is it better to recycle or burn?

It's better to do neither and to set up your solid-waste-management system so that you can avoid disposing of things and, instead, reuse and recycle and reduce their use.

Right. And cut down on what's actually making it to that landfill or incinerator or --

Correct. Correct.

Thank you for breaking it down for us and thanks for being with us.

Oh, you're welcome.

I hope that this has been informative for your viewers.

According to the Association of American Medical Colleges, or AAMC, blacks and African-Americans comprise 13% of the nation but only 4% of the physician workforce.

In order to improve the percentages of under-represented minorities in the healthcare field, AAMC has partnered with Rutgers University on an innovative solution.

Reporter Michael Hill has the story.

Teenagers in the middle of summer in hot pursuit of exploring their passion in the New Jersey Medical School's SMART Program, or Science, Medicine, and Related Topics.

I came in with, I guess, sort of a rough basis of anatomy and physiology.

Right.

And I was able to expand while I was here.

Like, I've learned so much.

13-year-old Angelica Rivera discovered what she wants to dive into.

I had an idea of marine biology or forensics, and now I'm, like, deciding like, 'Oh, I want to go in marine biology.'

This is a five-week program that thrusts these teenagers into real-world medical problems so they can come up with real-world medical solutions so they can get a real sense of what it is to be doctors and scientists.

I'm in love with this program.

I feel like this program gives you such exposure to the medical field and it shows you that you can do whatever you want.

And it's very hands on, and I'm a hands-on learner.

The hands-on program sends these teens on field trips and exposes them to biological lab work.

90-plus teens, most of them African-American, Asian, and Latino, a large number from Newark, and that's deliberate, says Newark native Mercedes Padilla-Register, who recruits these 7th through 12th graders.

You know, when people hear that you're from Newark, especially those from outside of Newark, they say, 'Oh, you don't speak like you're from Newark.'

So they don't expect much from you.

And I like to believe the total opposite.

Dr. Maria Soto-Greene is the vice dean of the medical school.

She says this is about creating more diversity in the medical profession.

That's why diversity matters, because we do know that individuals are most comfortable in terms of caring for the communities from which they come, and that our body of literature has supported.

Dr. Soto-Greene says it was an assistant dean who influenced her to pursue medicine, and she's doing the same, especially now that the Association of American Medical Colleges says the number of black males in a physician pipeline is at 1978 levels.

She says intervention needs to happen as early as third grade.

And it needs to be with positive role models and it needs to be in an educational environment, even if it's a school that doesn't have resources where the teachers themselves and the counselors are not indirectly, intentionally, or unintentionally, limiting a child's ability.

These students say they welcome the encouragement from here and at home.

You always need that one person to believe in you, and my mother has been that one person.

She always pushes me to be the best that I can be and she's behind me 100%, no matter what.

And so is the SMART Program.

And that wraps it up for this time.

For more on science, technology, and innovation, visit our website, check us out on Facebook and Instagram, and join the conversation on Twitter.

You can also subscribe to our YouTube channel.

Until next time, I'm Hari Sreenivasan.

Thanks for watching.

Funding for this program is made possible by...