Empathy and Alzheimer's

          In our fast paced world today, it is difficult to believe in the apparent empathy of those strangers around us. Walking down Michigan Avenue, I have seen many people react to the empathy others have had for them, most probably out of suspicion which can arise for many reasons: crime rate, a tourist defense mechanism or sheer disregard of the fact others can be empathetic to strangers. Dr. Decety spoke about empathy in his lecture at the neuroscience seminar course at Loyola University Chicago and there he touched on the developmental aspects of empathy. Dr. Decety noted the prefrontal regions were involved in the control and response to inhibition of one’s empathy as they age. A recent study expanded on this in Alzheimer’s disease (AD) patients; specifically, how do AD patients experience empathy differently than any other individual. The correlating point in both papers was strong, in that there is a high developmental trend in strengthening empathy. It was observed among AD patients, who had answered questions regarding their various feelings in an interview, similar levels of empathy; so long as the emotions were consistent throughout the interview and presented unambiguously. When the emotions varied and were expressed in different tones throughout the interview, the AD patients exhibited far less empathy relative to the average individual.

            From this data, it can be observed that cognitive control in the prefrontal regions in normal individuals when compared to those with frontotemporal dementia AD patients, though developmentally linked, is strongly affects by the amyloid built up present in Alzheimer’s disease. Yet the rigid developmental correlation is not overcome by AD when strong, clear emotions are expressed. The underlying details which connect our many regulatory networks and how they relate in times of high stress or disease, such as Alzhemier’s, is marvelous in that our unique developmental trends are not completely disregarded. I would be interested in researching further how the dementia observed in AD prevents proper empathetic connections in its patients across genders and ranges of ages.

References: 

Decety, Jean, and Margarita Svetlova. "Putting Together Phylogenetic and Ontogenetic Perspectives on Empathy." Developmental Cognitive Neuroscience (2011): n. pag. Print.

Diego Fernandex-Duque. "Empathy in frontotempoeral dementia and Alzheimer's disease." Journal of Clinical and Experimental Neuropsychology (2010)

Concept of excitotoxicity applied to patient care

            One of the guest speakers presenting at our Neuroscience Seminar that caught my particular attention was Dr. Ye. In his research paper "Early ischemia enhances action potential-dependent, spontaneous glutamatergic responses in CA1 neurons", Dr. Ye discusses the processes occurring in the brain following a cardiac ischemia. It has been a longstanding supposition that the damage caused to the brain as a result of inadequate blood supply was primarily due to lack of oxygen or glucose thus causing mass cell death. It has been fairly recently ( in the middle of the 20th century) proposed that it is actually the spike in glutamate that is most lethal to the cells during that process. In his paper, Ye discusses that following ischemia, glutamate- an excitatory neurotransmitter- accumulates extracellularly and causes neurons to go through apoptosis. It is therefore the phenomenon of "excitotoxicity" that is the primary cause of damage to the neurons during ischemia.

           

            Numerous studies have been done in the same area of interest as Dr. Ye's. They led to the development of protocols regarding care for patients with different types of ischemia. One of the changes that resulted from the research findings is the cooling of patients following a myocardial infarction, for instance. The logic behind this practice is that lower temperature slows the process of glutamate release. As one might assume, hospitals are well equipped to efficiently and effectively decrease the body temperature of a patient. However, it was interesting to read in one article (here is a link: http://www.sciencedaily.com/releases/2012/06/120629120326.htm) that this special handling of patients- the cooling of the patient's body - can also be done prior to being received in a clinical setting. It is hoped that cooling pads that require no electricity will be used in pre-hospital handling of patients who need their body temperature to be decreased. The article reminds the reader that the presence of defibrillators  in public places is required by the law. Maybe in the near future cooling devices will also be available and commonplace just like the familiar defibrillator?

 

 

References:

 

" Help for Cardiac Arrest Patients -- Fast and Without Electricity."ScienceDaily. ScienceDaily, 29 June 2012. Web. 11 Dec. 2012.

 

Ye, Hui, Shirin Jalini, Liang Zhang, Milton Charlton, and Peter Carlen. "Early Ischemia Enhances Action Potentialdependent,." Journal of Cerebral Blood Flow & Metabolism (2009): 1-11. Print.

Differences in Auditory Information Processing

Dr. Toby Dye's lecture on auditory information processing provided extremely insightful evidence about interaural differences of time and level discrimination. It is known how auditory nerves behave differently between those with impaired hearing, however, much of this vital research is conducted in quiet laboratories. Are there differences between how individuals with impaired hearing perceive auditory cues in an environment that is more noisy? If so, what are these differences?

Dr. Dye's talk began by laying out the foundation of knowledge needed in order to understand his research implications. We learned that since distance exists between the two ears, a sound wave must travel further in order to reach the ear that is further from the sound stimulus. From this concept, interaural delays of time (IDTs) arise for both ears that can be calculated by taking the difference in path length between the two ears and dividing it by the speed of the sound in air (the Woodworth formula). On the other hand, there are also interaural delays of level (IDLs) due to the fact that the head is a solid object between the two ears, creating a "sound shadow" for the distal ear. In his previous research, Dr. Dye has been able to conclude that threshold IDLs for 1-2 dB for 753 Hz tones in isolation are elevated to 6-9 dB by the presence of diotic 553 and 953 Hz components. A possible cause of threshold elevation could be due to the auditory system averaging binaural information from non-informative distractors, leading to a single fused intracranial "image" being heard. In order to further assess the extent to which listeners could segregate informative cues (targets) from non-informative cues (distractors), Dye and his colleagues created a new task, termed SALT (synthetic/analytic listening task). Analytic listening refers to target interaural differences that are independent of the distractor interaural differences. This requires listeners to form separate intracranial images of the target and distractor as well as to maintain information about the spectral composition of each. On the other hand, synthetic hearing could be identified as having judgments based on the target influencing distractor interaural values. Listeners fail to form separate images in this synthetic task, as well as fail to maintain compositional information for each. From the collected data, a weighted average of information from the target and the distractor were able to be determined. Dye and his colleagues found that more participants appeared to weigh the higher frequency component more than the lower regardless of which was designated as the target.

However, there were a lot of individual differences. As a consequence, they conducted another study in which being “analytic” was restricted to binaural tasks. To determine IDLs, the listener was presented with a three cues. The first interval presented the target frequency, the second presented the standard level, and the third tone was the tone which was judged. Listeners had to say whether they thought the third tone was greater or lower in level than the standard interval. A synthetic condition was also ran in which the listener indicated whether composite level decreases or increases between intervals two and three. It was found that listeners who were capable of adjusting weights in one task were able to also adjust them in the other task. It is widely accepted that IDTs are extracted by a process of neural cross correlation which is carried out between the outputs of matched frequency channels. The fact that many participants gave heavy high-frequency weighting in the monaural level discrimination task jeopardizes this commonly accepted composite cross correlation model.

Dye and his colleagues were able to discover this by questioning generally accepted concepts. Henry and Heinz were researchers that also made a very interesting discovery by taking a commonly accepted view one step further. In the article Hearing Impaired Ears Hear Differently in Noisy Environments, Henry and Heinz wanted to test how individuals with impaired hearing differed in auditory perception when factoring in noise. Most auditory information processing experiments take place in a quiet laboratory, but what about in real life when there is noise in the background? How do individuals with impaired hearing hear in these types of conditions? Henry and Heinz set out to find out this information, which found a physical difference in the way an auditory nerve fiber processes information. In this study, having impaired hearing was classified as participants with damaged sensory cells in the cochlea as well as damaged cochlear neurons. Chinchillas were used in this experiment because according to Henry and Heinz, chinchillas have a similar range of hearing to humans. Chinchillas with impaired hearing were compared to normal hearing chinchillas in a setting with noise, which was meant to represent what one would hear in a crowded room. What the study found was surprising and unexpected. Essentially, there was no difference for both groups in terms of how the cochlear neurons processed information in a quiet environment. The differences occurred in the noisy setting, where researchers found that hearing impairment reduced coding of temporal fine structures in chinchillas with hearing impairment. In other words, the neurons were not as synchronized in this task compared to the tasks without noise; the auditory nerves appeared to be distracted by the noise.

This experiment demonstrates the importance of not just testing individuals in quiet environments, but also in more realistic noisy environments as well in order to gain a full perspective on how the auditory system is really processing sounds. A lot of research is conducted in order to learn more about the auditory system, however, by taking these discoveries and testing them in more realistic, noisy environments, we have the potential to learn a great deal more on exactly how the auditory system transmits sounds to our brain. In both of the experiments, the researchers took the Jefress model of cross correlation and found differences in IDTs, and coding of temporal fine structures in hearing impairment. Both studies suggest that the cross correlational model of auditory processing can vary, depending on these types of factors.

Dr. Toby Dye's lecture on auditory information processing provided extremely insightful evidence about interaural differences of time and level discrimination. It is known how auditory nerves behave differently between those with impaired hearing, however, much of this vital research is conducted in quiet laboratories. Are there differences between how individuals with impaired hearing perceive auditory cues in an environment that is more noisy? If so, what are these differences?

Dr. Dye's talk began by laying out the foundation of knowledge needed in order to understand his research implications. We learned that since distance exists between the two ears, a sound wave must travel further in order to reach the ear that is further from the sound stimulus. From this concept, interaural delays of time (IDTs) arise for both ears that can be calculated by taking the difference in path length between the two ears and dividing it by the speed of the sound in air (the Woodworth formula). On the other hand, there are also interaural delays of level (IDLs) due to the fact that the head is a solid object between the two ears, creating a "sound shadow" for the distal ear. In his previous research, Dr. Dye has been able to conclude that threshold IDLs for 1-2 dB for 753 Hz tones in isolation are elevated to 6-9 dB by the presence of diotic 553 and 953 Hz components. A possible cause of threshold elevation could be due to the auditory system averaging binaural information from non-informative distractors, leading to a single fused intracranial "image" being heard. In order to further assess the extent to which listeners could segregate informative cues (targets) from non-informative cues (distractors), Dye and his colleagues created a new task, termed SALT (synthetic/analytic listening task). Analytic listening refers to target interaural differences that are independent of the distractor interaural differences. This requires listeners to form separate intracranial images of the target and distractor as well as to maintain information about the spectral composition of each. On the other hand, synthetic hearing could be identified as having judgments based on the target influencing distractor interaural values. Listeners fail to form separate images in this synthetic task, as well as fail to maintain compositional information for each. From the collected data, a weighted average of information from the target and the distractor were able to be determined. Dye and his colleagues found that more participants appeared to weigh the higher frequency component more than the lower regardless of which was designated as the target. However, there were a lot of individual differences. As a consequence, they conducted another study in which being “analytic” was restricted to binaural tasks. To determine IDLs, the listener was presented with a three cues. The first interval presented the target frequency, the second presented the standard level, and the third tone was the tone which was judged. Listeners had to say whether they thought the third tone was greater or lower in level than the standard interval. A synthetic condition was also ran in which the listener indicated whether composite level decreases or increases between intervals two and three. It was found that listeners who were capable of adjusting weights in one task were able to also adjust them in the other task. It is widely accepted that IDTs are extracted by a process of neural cross correlation which is carried out between the outputs of matched frequency channels. The fact that many participants gave heavy high-frequency weighting in the monaural level discrimination task jeopardizes this commonly accepted composite cross correlation model.

Dye and his colleagues were able to discover this by questioning generally accepted concepts. Henry and Heinz were researchers that also made a very interesting discovery by taking a commonly accepted view one step further. In the article Hearing Impaired Ears Hear Differently in Noisy Environments, Henry and Heinz wanted to test how individuals with impaired hearing differed in auditory perception when factoring in noise. Most auditory information processing experiments take place in a quiet laboratory, but what about in real life when there is noise in the background? How do individuals with impaired hearing hear in these types of conditions? Henry and Heinz set out to find out this information, which found a physical difference in the way an auditory nerve fiber processes information. In this study, having impaired hearing was classified as participants with damaged sensory cells in the cochlea as well as damaged cochlear neurons. Chinchillas were used in this experiment because according to Henry and Heinz, chinchillas have a similar range of hearing to humans. Chinchillas with impaired hearing were compared to normal hearing chinchillas in a setting with noise, which was meant to represent what one would hear in a crowded room. What the study found was surprising and unexpected. Essentially, there was no difference for both groups in terms of how the cochlear neurons processed information in a quiet environment. The differences occurred in the noisy setting, where researchers found that hearing impairment reduced coding of temporal fine structures in chinchillas with hearing impairment. In other words, the neurons were not as synchronized in this task compared to the tasks without noise; the auditory nerves appeared to be distracted by the noise.

This experiment demonstrates the importance of not just testing individuals in quiet environments, but also in more realistic noisy environments as well in order to gain a full perspective on how the auditory system is really processing sounds. A lot of research is conducted in order to learn more about the auditory system, however, by taking these discoveries and testing them in more realistic, noisy environments, we have the potential to learn a great deal more on exactly how the auditory system transmits sounds to our brain. In both of the experiments, the researchers took the Jefress model of cross correlation and found differences in IDTs, and coding of temporal fine structures in hearing impairment. Both studies suggest that the cross correlational model of auditory processing can vary, depending on these types of factors.    

Dye, R., Stellmack, M. and Jurcin, N. (2005). "Observer weighting strategies in interaural time-difference discrimination and monaural level discrimination for a multi-tone complex". Journal of the Acoustical Society of America (117)5, 4079-3090.

http://www.sciencedaily.com/releases/2012/09/120911151934.htm

   

Is Your Doctor Empathetic?

After working in a hospital for a short period of time, you realize what is meaningful to patients and what makes one hospital “better” than another. Patients rarely complain about the level of care they receive. Obviously, there are hospitals that specialize in certain things; however, every medical facility follows similar procedures and protocols. The biggest complaint or compliment from patients is how well the staff can connect with them, make them feel comforted, and the amount of trust that they have for their team assisting them.  Jean Decety, in his presentation, focused on the idea of empathy, touching on the idea that studies have shown that medical students have their highest level of empathy when first entering medical school and their lowest when graduating. The necessity to fix the problem of an emotional disconnect between individuals, especially in the field of medicine, is a problem that needs to be addressed.

Recently, the New York Times published an article written by Dr. Pauline Chen about the research that has been done to show both the disconnect that sometimes exists between doctors and patients and the ultimate effect that disconnect has on medical care, and more importantly, on a way to combat this issue. Dr. Chen spoke about one of her colleagues, a surgeon, who is renowned for his love and passion for what he does, but also for his inability to empathize with patients. No matter the skill set of a physician, an inability to relate to patients and an inability to effectively communicate those feelings, can lead to the downfall of a patient’s evaluation of quality treatment.

Empathy, for many years, has been incorrectly treated as an innate quality that one has as an integrated part of their personality. Dr. Helen Riess has shown that through carefully designed training modules you can, in fact, teach individuals to be more empathetic. Through methods such as watching videos of tense exam rooms that show measures of electrical skin conductance, a measure that can be directly related to empathy and emotions, of both the patient and the doctor, physicians became aware of what makes patients emotionally uncomfortable. Another lesson had doctors view images of patient’s emotions. After analyzing patient evaluations of the doctor’s empathy from before the training and comparing it with their empathy after the training, Riess found that doctors who went through the training program handled patient interaction in a much better way. From eye contact to remaining calm when a situation got heated, doctors were much more competent in connecting with patients and making them feel cared for after the training.

As both Dr. Reiss and Dr. Decety have indicated, the fact that we have access to data quantifying intangible, yet very important factors such as empathy, provides us with a unique opportunity to make a change in the way that we evaluate quality control. Health care professionals need to take advantage of the opportunity to have a glimpse into what their patient is actually thinking, and make a change. As Dr. Chen wrote, greater physician empathy has been correlated with fewer medical errors, more satisfied and happy patients, and better outcomes for the patient. If these reasons aren’t sufficient enough, do it for yourself. As Dr. Decety said, empathy is just as beneficial for the individual as it is for the patient. 

http://well.blogs.nytimes.com/2012/06/21/can-doctors-learn-empathy/

Empathy and Wellness

How essential is empathy to survival?

Dr. Jean Decety, neuroscientist and Irving B Harris Professor of Psychiatry and Psychology at University of Chicago, speculates on the correlation between empathy and enhanced survival.  He asserts that not only is empathy found throughout evolutionary history, but that it has deep biological and neurological underpinnings.  Many various species of animals exhibit some kind of altruism and Dr. Decety’s research suggests that even the most advanced manifestations of empathy seen in humans are associated with fundamental, core mechanisms.   Some contend that this progressive form of empathy is what makes humans the dominant species.  But how imperative is one person’s empathy in another’s well being? Researchers at Thomas Jefferson University conclude that patients of more empathetic doctors have fewer medical complications and more positive outcomes.   But before discussing the results of the study, a better understanding of empathy is needed. 

 Jean Decety lectured on what defines empathy during his visit to Loyola on October 30^th.  He described empathy as an identification and concern with the thoughts and feelings of others.  Not only do empathetic individuals recognize the emotions of others but actually match them – in other words, empathy blurs the line between self and other.  Empathy is the social nature of pain – behaviors like crying provide crucial signals to others to recognize the distress and work to alleviate it.  Which brings us back to the central question – for physicians, whose primary concerns are to restore and maintain good health, how vital is empathy in this process?

A team of Thomas Jefferson University and Italian researchers determined that it is in fact quite significant.  “This new, large-scale research study has confirmed that empathic physician-patient relationships is an important factor in positive outcomes,” affirms Mohammadreza Hojat, Ph.D., research professor at the university (Thomas Jefferson University).   The study included 20,961 diabetic patients and 242 physicians in Italy and showed how doctor empathy affects patients; more specifically, it compared empathy measured objectively using the Jefferson Scale of Empathy with the presence (or absence) of acute metabolic complications, including hyperosmolar state, diabetic ketoacides, and coma, in patients.  Results showed that doctors that scored in the higher empathy group had lower rates of patients with complications (29 out of 7,224 patients were hospitalized in 2009 compared 42 out of 6,434 patients treated by lower empathy doctors).  This link between doctor empathy and patient wellness exemplifies Dr. Jean Decety’s research that empathy is both innate and imperative in human survival.  

"Physician's Empathy Directly Associated with Positive Clinical Outcomes, Confirms Large Study." Thomas Jefferson University, 10 Sept. 2012. Web. 12 Dec. 2012.; http://www.monitor.upeace.org/images/empathy.jpg; http://i951.photobucket.com/albums/ad355/LorenzoSteed/empathetic_doctor.jpg 

Lack of empathy across party lines?

We all know that elections bring a lot of pent up tensions to the surface. Elections tend to distance people from opposite parties. Have we ever considered why this may be? Could clashing political affiliations really influence our ability to empathize with one another? 

A recent study at the University of Michigan took a look at factors that contribute to our ability to empathize with others. The construct of focus in this study was political affiliation. Dr. Decety defines empathy as an "affective response stemming from the understanding of another's emotional state or condition similar to what the other person is feeling or would be expected to feel in a given situation" (Decety & Svetlova, 2011). He goes on to explain that empathy is deeply rooted in evolution and the way in which humans have adapted over time. He elaborates on several factors that influence empathy such as oxytocin, caregiving and especially the way we develop.

In the first experiment of this Michigan study, half of the participants were interviewed in the cold and the other half in a comfortable environment, a library. The participants were given a short story describing a hiker who was either a Democrat or Republican. In order to decrease confounding variables, females were given stories describing females and vice versa. They were then asked which condition, being thirsty, hungry or cold, was most unpleasant for the hiker as well as what item he or she most regretted not packing.

The results of study were as follows. If a person believed that the hiker in the story was similar to them, then the location that they were interviewed, their physical state, influenced their response. In other words, if a person was interviewed in the cold and held congruent political beliefs to that of the hiker, they were far more likely to stress that the hiker was cold. However, if the hiker belonged to the opposite political party, their physical state did not influence their perceptions of the other person's state (i.e. people focused on the cold condition equally, regardless of the location of interview).

When the participants' political affiliations matched the hiker's and they stood in the cold, they much more frequently said that the hiker regretted not bringing more clothing. However, if a Democrat read the story about a Republican, their personal state did not contribute to their response about what they thought would be the most regretted item.

These findings alongside Dr. Decety's comments about how similarities to others become much greater factors in interpersonal relationships as we develop, suggest that prejudices have large effects on our ability to empathize with others. It is much harder for us to put our differences aside when we are trying to put ourselves in another person's shoes.

In the political world, this has poor implications because it suggests reasons for why compromise and seeing eye to eye becomes much more difficult even if both sides suggest policies that an outsider could see as extremely similar. In our daily life, this questions other unconscious discrimination we may make when empathizing or communicating with others.


http://healthland.time.com/2012/04/04/why-republicans-and-democrats-cant-feel-each-others-pain/

Cerebral Creations

Art captivates. Art speaks. Art moves.  And recently art's profound effect of human culture and society is getting a new platform in Neuroscience. 

     Art has been around since the time of the caveman and arguably since the dawn of humans consciousness began.  What makes art so spectacular is the creativity humans are capable of and the ability for humans to understand art.  Both of these feats can take place no where else but within the brain.  The brains role in art is a recent interest not only to the neuroscience community, but to all lovers of art whether an artist creating or a philosopher striving to understand beauty.  Bruce L. Miller, M.D. from the University of California, San Francisco recently gave a talk at Loyola University Chicago about his findings of renewed creativity in some of his patients with degenerative brain diseases.   Within his presentation he not only marveled about the remarkable art skills some of his patients exhibited, but Dr. Miller also speculated on the origins of art with in the brain.  Besides Dr. Millers fascination with the connections of brain and creativity, CNN new recently published an article giving an overview neuroscience findings in relation to the human brain and art.  Since art has been rooted in human culture for centuries it is easy to study the progress art has made and how art reflects innate features of the human mind and its creative faculties. 

     Dr. Miller's research with patients who have primary progressive aphasia, PPA, which is a degenerative disease that affects the language networks in the brain, showed structural changes with in the brain particularly an increase in grey matter in the right posterior neo-cortical areas of the brain.  The posterior neo-cortical is not a dominating part of the brain, but when lesions take place in more dominating areas of the brain such as left temporal regions, as they do in PPA, the plasticity of the brain allows for structural and functional changes.  Dr. Miller draws a connection to some of his PPA patients and their increased creativity due to the fact that the less dominant parts throughout their lives have suddenly gained dominance because of their brain disease and with this new structural and functional change comes an increased visual creativity.  Though not all PPA patients are drawn to the arts, this visual creativity in patients help those who are loosing and have lost words express the world around them - possibly eluding to the pureness expressed through creating and expressing through art. 

     Within the article "What the brain draws from: Art and Neuroscience," one important theme is about visual circuity in the brain and how it perceives art.  Scientists have studied how human visual neurons perceive lines and colors; it is fascinating how something drawn within two dimensions can reflect something in the three dimensional world and the brain can distinguish with ease.  What is even more amazing is the brains ability to take in simple representations of the external world from art and know fully what it portrays.  The perceptions art creates is not just as straightforward as lines and colors shaping a representation of the world, but abstract art is striking in that it triggers our emotional responses.  When looking at faces within art the aymgdala responds - even this ":)" signals a face in the brain, and the amygdala also responds to the emotions a work of art tries to portray, even in a lifeless painting the brain tries to illuminate it.  Art doesn't have to be an accurate portrayal of the external - it actually more or less plays tricks on the neural networks and visual sensitivities to achieve the goals of art.

     Dr. Miller's talk showed his interest in trying to understand where within the brain art comes from; he ended by drawing conclusions that art uses both brain hemispheres maybe even some sort of double consciousness.  Art, though its creative powers may appear once the brain becomes ill within patients, uses all part of the brain to create and enjoy.  The study of art and neuroscience as stated by both Dr. Miller and the article see art as a new way to study the brain.  Dr. Miller uses art to find new sights into the degenerative processes in his patients and in PPA patients to help see associations the left hemisphere might have in art.  The article talks about the emergence of a possible new branch of neuroscience called neuroesthetics which would focus on the neural networks involved in the appreciation of beauty and art; this field though does draw criticism since this new branch has nor produced new insights. 

     The future of studying art in neuroscience looks bright since human nature ceases to lack in its affinity for the arts and is continuously breaking the grounds of creativity.  Art has much to teach about the brain since it is so tightly incorporated into both hemispheres and there are many medias of art to study.  Art is a trait that is uniquely human and the study of art will help neuroscience to even further understand what makes the human mind distinctively human and maybe even lead to further under standing of human consciousness.

Sources:
Landau, Elizabeth. "What the Brain Draws From: Art and Neuroscience." CNN. Cable News Network, 15      Sept. 2012. Web. 12 Dec. 2012. <http://www.cnn.com/2012/09/15/health/art-brain-mind/index.html>.

Seeley, William W., Brandy R. Matthews, Richard K. Crawford, Maria L. Gorno-Tempini, Dean Forti,           Ian R. Mackenzie, and Bruce L. Miller. "Unraveling Bolero: Progressive Aphasia, Transmodal Creativity     and the Right Posterior Neocortex." Brain 131 (2008): 39-49. Print.

Empathy's Effect of Health, Whether You Believe It or Not

When I moved from Arizona to Chicago my senior year of high school, along with finding schools, a house, and planning out my life, I had to find a new primary care physician. Typically, when you pick, your insurance carrier gives you a list of physicians and you are given their credentials etc, but is that totally what matters? I had a list of several doctors and went for consultations just to get a feel for what type of person they are.

           This stems back to the human behavior that we all show empathy and see empathy from everyone around us. This helps foster a positive nurturing environment, and frankly, it is inborn. According to the research of Dr. Decety of the University of Chicago Psychology Department, empathy has a deep evolutionary, biochemical, and neurological underpinning associated with communication, social attachments, and parental care. Therefore, we are all built to care for others, and who other than physicians are specifically there to care for us. They nurse us back to health and keep us healthy all other times. However, many medical students when they start schooling are high on empathy, and then gradually they decline and it is associated with burned out personal distress. In other words, the people we trust most to advocate for our health and to whom we tell our deepest and darkest secrets have lost the ability to care.  But why does it matter if your physician shows greater empathy than another right? Isn’t it just the treatment that you are able to receive? According to research titled “The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy,” “studies have shown that physicians’ understanding of their patients’ perspective, a key feature in the definition of physician empathy, enhances patients’ perceptions of being helped, improves patients’ empowerment, and increases patients’ perception of a social support network.”

            The study hypothesized that higher empathy scores by physicians would positively be associated with lower “acute metabolic complications in diabetic patients.” After performing the experiment in Italy, a country that has a different healthcare system than the United States and measuring the physician empathy levels and associating it with low, moderate, and high levels of acute metabolic complications the results of the z-test showed that physicians in the high empathy score group had a lower rate of patients with AMC (4.0/1000) than did those in the moderate (7.1/1000) and low empathy (6.5/1000) groups.” So in theory, all these physicians should connect back to Dr. Decety’s empathy proposition that when we see others in pain, we are predisposed to find their distress aversive and learn to avoid actions associated with this distress.

            So in the end, does it really matter who your physician is? Well, although the statistical evidence isn’t overwhelmingly favoring the fact that a physician with higher empathy levels will likely lead to you bring less sick or recovering from illness, they will at least show you the basic human response of empathy when you need to confide in someone. But then after reading both of these studies, isn't it strange that we have physicians take empathy training courses despite it being in all of us naturally? Why do physicians lose their sense of empathy on such a high level and how can we counteract that?

The Relationship Between Physician Empathy and Disease Complications: An Empirical Study of Primary Care Physicians and Their Diabetic Patients in Parma, Italy

Doctor Empathy a Factor in Diabetes Care

Musicians Attention to Detail

Real-world listening situations provide many distractions whether it is a whisper between friends in the back of the classroom, the blaring siren of police cars driving by or an argument going on outside your door. Thousands of pieces of information enter our brain every hour, so it is a remarkable feat for our brain to be able to discriminate which pieces of information are the most important to pay attention to. When a listener is able to process a bunch of different sources of sound at the same time, they are synthetically integrating the stimuli, however when a listener is able to distinguish one sound or frequency from the others, they are said to be processing the info analytically.

Dr. Dye lectured about precisely this ability of listeners to segregate specific target pieces of information from information contained within distracters. He called this the stimulus-classification procedure. In his experiment, two signals of different frequencies were presented, and one was identified as the target signal (the sound the listener was to pay attention to) and the distracter signal. The two signals were also distributed at different angles from the midline of the body, so that interaural differences in time, or the time it takes for sound to reach one ear before the other, would vary and the brain would need to interpret the target info and distracter info as separate stimuli. The research found that some individuals were able to create distinct representations in the brain for the two signals while the vast majority weighed the two signals but still only formed one representation. Oftentimes, the individuals attended to the higher frequency regardless of which one was the target or distracter.

The discussion at the end of Dr. Dye’s lecture regarding a musician’s potential ability to better attend to different frequencies of sounds really intrigued me, having played the violin for 10 years, so I did some research. It turns out that musicians really can discriminate between different auditory stimuli better than non-musicians. The Kraus lab at Northwestern performed an EEG study and found that musicians had better auditory attention scores than non-musician counterparts when listening to various sources of speech. The main difference presented in the musicians’ prefrontal cortex. This makes sense because the prefrontal cortex is often associated with attention and control. It’s also interesting that the longer the individual had been a musician, the larger the response of the prefrontal cortex. This particular study had focused on an aging population, whose ability to distinguish between multiple auditory stimuli has typically started to decline. Age-related decline was combated in musicians. But perhaps this information can have an impact on the methods treatment of ADD and ADHD children, rather than just influencing adults behaviors. Playing music might alter the prefrontal cortexes of these youth and therefore influence their capabilities to pay attention in other activities in their life. I would also be very interested to see the EEG patterns of attention in musicians to various musical instruments compared to that of speech. I imagine for the type of instrument that that particular musician plays, there would be a more fine tuned or stronger response than other instruments. 

Being able to attend to different auditory stimuli can be helpful for a multitude of people; students might better be able to focus in school, sports players might hear each other over the sounds of the stadium and ground crew at airports might be hear orders more accurately over the sound of airplane engines. So perhaps, in the coming years more individuals will choose to pick up an instrument in their spare time. 

Dye, R., Stellmack, M. and Jurcin, N. (2005). “Observer weighting strategies in interaural time-difference discrimination and monaural level discrimination for a multi-tone complex.” Journal of the Acoustical Society of America 117(5), 4079-3090.

Ojiaku, P. "Please Pay Attention to the Notes." Scientific American. July 2011. http://blogs.scientificamerican.com/science-with-moxie/2011/07/11/please-pay-attention-to-the-notes/

Empathetic Doctor

     During his talk about Empathy, Dr. Decety brought up the fact that many medical students tend to become less empathetic as they progress through their schooling.  As an undergraduate hoping to one day become a doctor this is of interests to me.  So I found a related systematic research review by Neumann, Edelhauser, Tauschel, Fischer, Wirtz, Woopen, Haramati, and Scheffer that looked at empathy though a combination of longitudinal and cross sectional studies. Both Decety and Neumann et al. discuss the importance of physician empathy as a way to deliver more effective treatment and to create a better environment for healing.  Similarly to what Decety said, Neumann et al. analyzed evidence showing that medical school students tend to have a decrease in empathy.   The define that Neumann et al. used for physician empathy was the ability to understand the patient’s feelings, communicate understanding of those feelings, and to help the patient in a helpful way.

      Another finding highlighted in Neumann et al. is that decreases in empathy are correlated to specific types of medicine.  Branches of medicine that require more patient interaction correlate to higher empathy scores than branches like surgery, which require less patient-physician interaction.  This makes sense because people who go into more relationship based branches of medicine would probably do so because the like understanding other people and building relationships.  These trends in empathy scores also correspond to differences in moral decision-making.  It is important that something be done to foster empathy and moral decision-making in medical students so that they provide the best care possible to their patients.

     It is important that medical schools focus on building empathy in their students so that patients can get the best care possible.  Neumann and her colleagues highlighted evidence that suggests that in order for someone to build their empathic abilities they must do so not by studying the philosophy behind empathy, rather, by experiencing situations in which empathy is needed.  One possible way to do this is to require students to dedicate part of their week doing service work.  By requiring service, medical students would get the opportunity to practice empathy before they are put into a clinical setting.  In all empathy is a unique part of being human, and an important ability needed by doctors.

Outside article:  http://ovidsp.tx.ovid.com/sp-3.8.0a/ovidweb.cgi?WebLinkFrameset=1&S=PLHOFPOGFNDDIDABNCPKBFIBLLDBAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.18.19%257c0%257c00001888-201108000-00024%26S%3dPLHOFPOGFNDDIDABNCPKBFIBLLDBAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCIBBFABFN00%2ffs046%2fovft%2flive%2fgv023%2f00001888%2f00001888-201108000-00024.pdf&filename=Empathy+Decline+and+Its+Reasons%3a+A+Systematic+Review+of+Studies+With+Medical+Students+and+Residents.&pdf_key=FPDDNCIBBFABFN00&pdf_index=/fs046/ovft/live/gv023/00001888/00001888-201108000-00024