Dr. William Newsome, Co-Chair of the BRAIN Intitiative

( Music )

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret , another state has posted some interesting financials
regarding health insurance rates on thei r insurance exchanges set up to provide
coverage options under the Affordable Care Act . In a while it may be too soon to call it
a trend, its promising news.

Margaret Flinter: That's right Mark , the State of New York which is setting up its own
insuranc e exchange has listed the rates for the 17 insurance providers who are
participating in the exchanged and the rates are on average 50% lower than present
rates on the individual market. The Governor of New York, Andrew Cuomo issued a
statement that folks current paying a $1 , 000 .00 a month for health insurance could pay
as little as $300 .00 for coverage on the exchange. That's really quite remarkable.

Mark Masselli: That is great news and of course we saw the same story in California
which already is lis ted rates for, it's insurance exchanges, so both coast have good
news.

Margaret Flinter: It looks like market forces are doing what they expected, applying
downward pressure on the cost of insurance and that's certainly a positive.

Mark Masselli: Yes i t is but something that's not so positive according to a recent
survey of the nation’s doctors, show there are largely clueless about how the health
care law is going to work.

Margaret Flinter: Well the survey showed also some real skepticism about how t he law
will be implemented on the 11% felled at the insurance exchanged would be ready for
customer by the October first deadline and an amazing 65% still had no idea how those
being insured through the exchange s would impact their own practice.

Mark Mass elli: And this poll shows there hasn’t been an effective enough information
campaign to inform those on the provider side but I see that the president is out on the
(1:38 inaudible) around the country talking about the Affordable Care Act.

Margaret Flint er: Well you know Mark it's not so surprising people who deliver health
care pretty busy delivering health care, they may not have been able to master all that
information for themselves or their patients and we hope there’s a really affective
communicati on strategy that will continue to unveil over the couple of months. We know
the states and federal government are spending a lot more time doing that in the
coming months and a lot to wrap your arms around.

Mark Masselli: The y are, certainly is. Speaki ng of brainpower Margaret, that's
something our guest today knows quite a lot about. Dr. William Newsome is co - chair of
st
President Obama’s 21 century “ BRAIN ” initiative whose goal is to ultimately map the
human brain.

Margaret Flinter: Deeply complex test that some say could take years even decades
but will revolutionize our approach to all disorders of the brain so pretty exciting work.

Mark Masselli: That it's is. Lori Robertson from Factcheck.org checks in with another
uncovered mistruth about he alth reform but no matter what the topic you can hear all of
our shows by going to chcradio . com

Margaret Flinter: And as always, if you have comments, email us at www.chcradio.com
or f ind us on Facebook or Twitter because we love to hear from you. Now we’ll get to
our interview with Dr. William Newsome in just a moment.
Mark Masselli: But first, here is our producer Marianne O'Hare with this week’s Headline News.
( Music )
Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines. Detroit’s
Money vows and healthcare since the bankruptcy filing of the Motor City retirees living on a city pension including health insurance coverage are bracing for a hit. Officials handling the city’s $18 billion bud get shortfall are considering pension cutbacks, the question is how much? The pension shortfall accounts for $3.5 billion of the $18 billion shortage. Many retirees faced with the prospect are thinking they’ll have to find a job to offset those loses. D etroit’s Emergency City Manager is calling for significant cuts.
Significant cuts in insurance rates have been revealed in New York State which
unveiled some of the pricing for the insurance exchanged being set up in the Empire State . Governor Andrew Cuo mo announcing rates for those seeking coverage on the
exchange on New York will average about 50% less than rates on the open individual market but analyst warn that dramatic drop may not be repeated elsewhere like it has in California and New York.
And o ne state’s coverage vacuum has created a business opportunity. Humana is going to cover those parts of Mississippi left uncovered in that Southern State .
Mississippi is neither setting up an exchange or expanding Medicaid to include more
coverage for tho se living close to the poverty line leaving tens of thousands of residents without any other option thus having them remained uninsured. Humana says it will sell
subsidized coverage to the 36 counties that would have been left out of the game.

And 3D pri nting and the old fashioned c ast break an arm or a leg and plaster cast six to
eight weeks, it becomes increasingly itchy, cumbersome, sticky, uncomfortable, enter the cortex a 3D printed custom cast seem simple enough. A person shows up at the
ER with a broken bone that doctor assesses the damage with an x - ray and then makes

a 3D scan of the limb. With a 3D printer the doc prints out a made order cast called the
Cortex , snaps it into place and viola off they go. Patients get a super hear wish
exoskeleto n. It's sleek, breathable, durable , and perhaps best of all shower ready,
although admittedly harder to sign .

I am Marianne O'Hare with these Health Care Headlines.

( Music )

Mark Masselli: We’re speaking today with Dr . William Newsome, Professor of
Neu robiology at Stanford University, School of Medicine. Dr. Newsome was just
appointed as Director of the newly created Interdisciplinary Neurosciences Institute at
st
Stanford University. As well as being name d co - director of President Obama’s 21
century “ BRAIN ” initiative which seeks to develop a framework to correlates scientific
efforts in a quest to map the human brain. Dr. Newsome is also an investigator at the
Howard Hughes Medical Institute . He’s a winner of numerous prestigious awards
including th e Distinguished Scientific Contribution Award for the American Psychological
Society and is an elected member of the National Academy of Science. Dr. Newsome,
welcome to Conversations on Health Care .

Dr. William Newsome: I am pleased to be here with you Mark.

Mark Masselli: Dr. Newsome congratulations on your selection by President Obama to
be a co - director of his $100 million 12st century “ BRAIN ” initiative which is seeking
multidisciplinary solutions to unraveling the mystery of the brain. The proj ect's been
likened in scope to the mapping of the Human Genome . We’re fortunate to have Dr.
Francis Collins and really describing that initiative but currently the nation spends about
$5 billion a year on all kinds of brain research. So I’ve got to assum e that this $100
million is going to have a synergistic effect. Te ll us a little more about what sort of
discoveries and pay offs you are hoping this project will yield.

Dr. William Newsome: Well it is really unique time in the history of neuroscience.
Those of us who’ve been in the field for a few decades really sense that the rate of
change is -- has been accelerating enormously in the last five years and we are -- it's
only the beginning of this acceleration and the real difference maker here is the
i nvention of new technologies that fundamentally allow neuroscientist to ask questions
that we had only been able to wonder about and reflect about in the past but now we
can really ask them experimentally and very new things are happenin g, there’s change
o f foot that it's making many of us who are experimental ist have to rethink what it means
to be an experimental neuroscientist and what questions we should be asking. And I
think what we’re shooting for here is really nothing less than a revolutionary kind of
understanding about how all of this electrical activity in our brains makes possible the
mental lives that we all have, our thoughts, our aspirations, our goals, our memories,
our ability to learn. We really want to understand the biological mechanism s that make
these things possible and these new fundamental technologies are going to be a
quantum leap a long the way here . A nd a charge from President Obama is really to try

to understand the brain at this very basic level. I ’ m sure that these are going to have
positive outcomes for our understanding of disease as well.

Margaret Flinter: Dr. Newsome , you’ve been I think quoted to saying that the complete
mapping of the human brain won't take years like the Human Genome Project did and I
of course I was prepared if you want to then say it will only take a year or two and
instead I think you said it might take decades which is why the President referred to this
st
as a 21 century initiative. Now I think you’ve also referred to the brain as a three
pound m assive goo between the ears.

Dr. William Newsome: Yes, exactly.

Margaret Flinter: But at the same time as the most complex known entity in the
universe so let's talk about the complexity. What are the challenges, why is it so hard,
why is it going to take decades do you think?

Dr. William Newsome: Well you said the keyword Margaret. The keyword there is
complexity. So this three pounds of goo inside our head and I refer to it as goo because
that literally is inconsistently if you -- neurosurgeons k now that you know it's about the
consistency of Jell - O or toothpaste but inside that three pounds that you say is the most
complex entity in the universe that we know about. So in each on e of our head s that
three pounds contains 100 billion neurons, okay , s o these are nerve cells that
communicate with each electrically and it's that electric communication and that circuit
activity that somehow underlies our mental lives so you have 100 billion nerve cells and
then each of those nerve cells is making 1 , 000 synaptic connections, little chemical
connections with other cells and these synaptic connections are sort of the points of
information transfer.

So you’ve got 100 billion neurons each with a 1 , 000 synaptic connections that means
you have a 100 trillion o f these synaptic connections and just to map that kind of
complexly interconnected network is incredibly daunting and we’ve done calculations
that say in a human brain you know if we really map these connections carefully and
thoroughly, we would fill up m any terabytes worth of disks with information just to one
brain and we don’t know how to even handle data cyst (10:04 inaudible) . Okay this is
right out of the hairy edge of what computer science is able to handle at this point.

So our ability to actuall y get the information out, what is that anatomically meant
network and what is the electrical activity in each one of those cells is daunting and then
if you could imagine techniques that allow you to do that, just the massive amount of
data and how we wou ld handle, how we would analyze it and how we would mind is
itself daunting. So I think you know when you look at those three things chained
together, you can start seeing why we say this is not something that's going to be done
st
in a year or two years or even 10 years but this really is a grand challenge for the 21
century.

Mark Masselli: You know Dr. Newsome you say this is a spectacularly good time to
embark on the quest of mapping the human brain and because of the recent
technological breakthroughs . I wonder if some of those technology breakthroughs are
in the sort of big data capabilities that we have because the -- is the technology on the
mapping capabilities is also the technology on the neuroscience side.

Dr. William Newsome: The technology is on all of these fronts. I mean that's one
reason I say it's a spectacularly appropriate time for this. I mean the Obama
administration, they got this one right. Okay this really is the right time, it's the right
topic at the right time and the techno logies really do create the potential for revolution
over the next couple of decades. I kind of like in this too trying to understand traffic
patterns around New York City and information for around New York City. So we could
take out a road map and we c ould look and we could see all the connections of the
roads and exactly where each road runs. We need that in the human brain and in
animal's brains and that's sort of what I call neuro - anatomy, just knowing where the
cells are, where they make their syna ptic connections to other cells so that you have the
static roadmap. But that road map if you look at it of New York area, doesn’t tell you
what traffic is flowing on each road at any moment of the day, right. That's a dynamic
property, that is informati on flow within that network approach and it's the same way in
the brain, just knowing the map doesn’t tell you what sorts of information is flowing in
circuits at different times. So there’s no one answer to the -- this questions about
activity and dynami c activity. It depends on what you are doing.

So we need the new technologies but we also are developing new technologies,
unprecedented new technologies to get hat dynamic activity, to measure the traffic on
the roads, to measure the traffic in the neur ons. And then you need to develop, if you
have all of these -- this information you need to develop a theory, right how are the
things working and so now we have statisticians and physicist and mathematicians
coming in to help us develop theories about th ese new data sets that we’re acquiring
and why don’t you develop a theory really want to be able to perturb the system you
know you say aha I have a theory now how this work you know. I want to go in and I
want to change the traffic on this one road and s ee if I can predict the changes that will
happen on other roads. And we’re developing new technologies for perturbing the
activity in the nervous system. So on all of these fronts we have really new
technologies that are enabling us to do these things th at we’ve never been able to do
before.

Margaret Flinter: Well Dr. Newsome, I ’ m struck into your comments how clearly the
importance of the interdisciplinary teams comes forward. This does not appear to be an
area where siloed research is going to get yo u very far and you’ve got now an
interdisciplinary neuroscience institute that you are directing at Stanford which is going
to help provide a framework for the national BRAIN initiative. Tell us what the new
research paradigm looks like and tell us specif ically about the institute.

Dr. William Newsome: Well the institute here at Stanford is a new attempt to integrate
bring research across the entire campus and we have a lot of traditional neuroscience

re se ar ch here in the School of Medicine at Stanford a nd in the department of biology
and to some extent in the department of psychology but we all realize and we’re
fortunate that our president and provost here at Stanford realize that the brain is not
longer just a problem in biology. I mean it may never h ave been. We were just too
clueless to know it in the old days but today we realize you know that these new
technologies that are transforming our understanding or coming from all different
directions.

So the latest technologies that give us the best map ping, this new clarity technique that
is fundamentally coming from chemist, it's coming from chemical treatment of the brain
that render an animal brain for example transparent so that we can look all the way
through it in and trace these fiber pathways al l the way through it without having to cut
the brain up into little pieces and analyze the pieces individually. So chemistry a playing
a big part. In terms of the large scale activity recoding optics and physics are playing a
large part. We’re actually now monitoring the activity of tens of thousands of neurons at
a time through optical means and new microscopes that have been invented by
physicists and engineers. Perturbation ability to perturb results from genetic
manipulation of certain cells and put ting in sensors in the certain cells that allow us to
shine light on those cells and create excitation or inhibition on those cells and that
technique was just invented seven or eight years ago here at Stanford, it's called
Optogenetic.

But that's coming from genetics and molecular biology and when we get these realms of
data we have to involve the engineers, the electrical engineers help us make better
electrical measurements and then the electrical engineers and the computer scientists
are teaching us ab out algorithms and about how to sync so we’re trying to raise
philanthropic funds and create pools money that will incent our faculty t get out of these
disciplinary silos as you say. We want to create a new culture of brain science where
by electrical en gineers and molecular biologist and then traditional neuroscientists are
working together in an iterative loop so that ideas flow from the theorists into the
experimental labs. They get tested in the experimental labs, the results go back to the
theorist and the experiment say hey you guys were wrong about those, what's the deal
and have these iterative loops going back and forth between the physical scientist and
the engineers and the experimental neuroscientist and we need you know we need to
prime that part so no matter how interested they are, if there’s not some money to fuel
the process, it's not going to go forward and that incidentally pla ys right into national
Obama BRAIN initiative, right. This is the kind of thing that the BRAIN initiative shoul d
do nationally.

Mark Masselli: We’re speaking today with Dr. William Newsome, Professor of
Neurobiology at Stanford University, School of Medicine. Dr. Newsome was just
appointed as Director of the interdisciplinary neurosciences institute at Stanford
st
University and also named co - director of President Obama’s 21 century BRAIN
initiative which seeks to develop a framework to correlates scientific efforts in a quest to
map the human brain consider the last frontier of modern science.

Dr, Newsome I'd li ke to talk about the president’s “ BRAIN ” initiative that you talked
earlier about pulling together the best and the brightest and you are a co - director in this
project as Dr. Cori Bargmann noted neuroscientist from Rockefeller University and the
President referred to the two of you, it's a dream team and she said it's a daunting even
monumental task so tell us if you would , how your team is planning to undertake the
challenges and where are you in the process at this moment.

Dr. William Newsome: So Cori and I are chairs of a committee, a planning committee
for the NIH. It's our task to sort of survey whatever the field is now, where the big
opportunit ies lie, where are the new technologies are creating opportunities that
absolutely have to be exploited a nd make recommendations to the US government
agencies about how to exploit this and where to go. We have a great committee of 12
people in addition to ourselves representing all areas in neuroscience and this is what
Collins referred to as the dream team . It's an outstanding team, so one of the main
things that we’ve done is realized we don’t have all the answers on our committee and
we are opening this up to an outside process so we’re holding a series of workshops
over the summer where we’re inviting a dozen or so experts and each of four individual
fields in to talk with us. so these experts give us talks about what do they think their
part of the field is and where it should go and then we two or three hours for afternoon
discussion where we really s ort of get into and debate and what are the merits of this
approach versus the other approach.

So we’re getting this input from a large community, we’ve also got blank site setup
where we can information from individuals, late during the coming year we’ll be getting
input from potential fou ndation and company partners , private company partners, that's
one part of our charge. So we’ll be looking carefully at that. We’ll be hearing from
patient advocate groups because I think that's a very important perspe ctive to get you
know to really hold our feet to the fire about disease and you know for a lot of patients
and a lot of your listeners on this radio station, this is not abstract, this is not fun and
games, this is really -- this is real life. I was kind of skeptical about this and -- but I was
inspired by Cori to actually be a part of this . Cori finally said, she just look, if this is what
President Obama’s time and he thinks it's worth his time to push this thing then we
simply have an obligation to go a long and produce the very best plan that we can do. I
said Cori you are right, we’ve got to do this thing together. So she about the best co -
chair I can imagine working with but we have a fantastic committee and I can assure
you we are all working very h ard this summer t oward our prelimin ary report, that's due
in September.

Margaret Flinter: As you’ve spoken it's s ou n ds like the charge is really more at the
hundred thousand foot level if you will of understanding what's normal before one dives
into what doesn’t work and what's not normal. Is that safe to say?

Dr. William Newsome: That is out charge and out charge is more specific than that
actually I mean one misconception out there is that somehow we’re doing some master
plan for all of neuroscience and that is not true. Our charge specifically talks about the
dynamics of brain activity, all this sort of firearm of electrical activity that's going on in

your brain right now and going on in Mark’s brain and going on in my brain and those
are all your listeners, I mean there’d be millions of neurons firing off these millions of
actions potentials and our charge is really to understand how the dynamics emerging
out of that densely connected network gives rise to that mental life. Okay that's what
the NI H charge and publically available on the NIH website. Now of course much
psychiatric disease is related to experience, right that's the way we feel it, that's why
people come into the clinic because they have alerted experiences whether we’re
talking abou t depression or whether we’re talking about schizophrenia or people have
altered experience and we need to understand how the nervous systems gives rise to
experience in the first place and then how disorders in the nervous system give rise to
these disord ers of experience. Now my gut feeling is that the answer to some
neurologic disease is that we all care about.

My gut feeling is that the answers for those disease are going to come at the molecular
and cellular level and then maybe that the global brain activity is not highly relevant to
Alzeihmer ' s and Parkinson’s , I don't know. But there are other diseases like the autism
spectrum disorders and like schizophrenia that are probably -- my hunch is they are
going to come down to disorders and connections between the neurons, right. So I
think that the brain activity map that we’re sort of you know honing in and here is this
dynamical activity will be highly relevant to some of the diseases and might be less
relevant to others but we’re not going to know and we’re not going really be able to
make that call until we start making progress on this with the new tools at our disposal.
From much psychiatric and neurological disease right now we’re just stumbling around
in the dark. And my father died about 10 years of Alzeihmer's and I know we’re largely
stumbling around in the dark and Cori says our job, the job of this BRAIN Initiative is to
turn on some lights, okay. So you know when we start turning on lights, some of this
darkness hopefully will be dispel led.

Mark Masselli: Well and there are number of people who are trying to do that. We’ve
had Representative Patrick Kennedy on and Patrick’s certainly working with his group
on the one mind for research. We can love to hear your thoughts on those colla boration
and sort of it as aside more of a geeky questions but there’s a lot happening with 3D
Imaging of the brain and I also know that the 3D Printing is really taking some gigantic
steps forward. Do you see at a time where this is going to play a role in terms of trying
to print out element of the brain that you’ve been able to map through imaging?

Dr. William Newsome: Yeah well I think that's an incredibly fascinating area and there
are these pockets that's really bright people out there who are layi ng the --- you know
they are taking neurons, nerve cells that are grown in tissue culture and they are trying
to assemble them into actually functional circuits inside of you know petri - dishes and
artificial situation. So using particular molecules to gui de the axons to hook up with
other cells in creating little neural circuits so this is the kind of things, it's kind of like
pointing a printed circuit board expect we’re actually using live cells and trying to get
them hooked up in ways that not do elemen tary computations and that -- you know the
long term implications of that research is that -- is to be able to recreate circuits inside
natural brain. So when some groups of cells does decide up and die maybe it ’ s not

enough just to put stem cells into th at place. Maybe those stem cells actually have to
instructions , molecular and chemical instructions about how to wire up together and if
we can understand what those molecular and chemical instructions are in the sort of
printing kind of thing in the lab then that that will obvious help us create those structures
and networks inside the brain.

So I think you know when you think about that kind of research, 10, 20 years down the
road, it's about getting cells ultimately into real brains and helping the, ho ok up with their
proper partners to actually recreate circuits. It's not enough just to throw cells into the
brain. It would be like you know your computer’s broken and if the repairman came out
and just took the top of your computer and he took a bunch of tra nsisto r s and just
sprinkled them in there randomly and close the computer and say well let's see if that
fixes the problem, you’d think he was an idiot right. So it's kind of like that we can just
take a diseased brain and sprinkle cells in there ra ndomly and say let's say if it fixes
itself. We actually have to know how to get to those cells integrated into the circuitry in
a way that will the thing work. So that's the long term goal that kind of research and I
think it's a very promising one.

Ma rgaret Flinter: We’ve been speaking today with Dr. William Newsome, Professor of
Neurobiology at the Stanford University, School of Medicine and Co - Director of
st
President Obama’s 21 century “ BRAIN ” Initiative which seeks to correlates scientific
efforts in the quest to map the human brain. You can learn more about Dr. Newsome’s
ground breaking work by going to monkeybiz.stanford.edu. Dr. Newsome Thank you so
much for joining us on Conversation on Health Care today.

Dr. William Newsome: You are welcome Margaret and Mark, nice to talk with.

( Music )

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and policy. Lori
Robertson is an award - winning journalist an d managing editor of FactCheck.org, a non -
partisan, non - profit consumer advocate for voters that aim to reduce the level of
deception in US politics. Lori, what have you got for us this week?

Lori Robertson: Well President Barrack Obama recent spoke in glowing terms as how
Americans could save money on premiums thanks to the Affordable Care Act but he left
out several details increase in law. Obama said that 8.5 million rebates are being sent
out to consumers averaging about a $100 each. He’s referring to a requirement in the
law that insurance companies spend at least 80% of premiums on health cost as
opposed to things like marketing and profits or overhead. If insurers don’t need that
80% mark, they have to refund part of the premiums.

This is a sec ond year for such refunds but 8.5 million Americans aren’t going to receive
rebate tax of a $100 this summer. For one thing the administration says the plan
benefits 8.5 million Americans but the $100 figure is per family not per individual. All

told $50 0 million is being sent out. Also not everyone gets a cheque. Americans who
buy their own insurance will and 2.7 million of consumers who will benefit from this
aspect of the lot due by their own insurance b ut the rest are on employer plans a nd the
rebat es for these plans go to the employer. If employers pay part of the premium, they
are entitled to part of the rebate and any benefit for workers would have to be passed
along through the employer. It's not exactly the same. It's receiving in the mail.
Obama is ready to say that this is a clear benefit of the law. Consumers will get rebates
and insurance companies are limited and how much premium dollars they can use for
non health related costs but the president doesn't quite tell the whole story. And that’s
my fact check for this week. I am Lori Robertson, managing editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy Cente r at the
University of Pennsylvania. If you have a fact, that you would like checked, e - mail us at
www.chcradio.com . We will have FactCheck.org’s Lori Robertson check it out for you
here on Conversations on Health Care.
( Music )
Margaret Flinter: Each week, Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. Of the roughly 2.3 million American soldiers who’ve returned from multiple tours in Iraq bad Afg hanistan as many
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Dr. Barbara Van Dahlen : We’re a national networ k of mental health professionals. We
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service using that net work to better train future clinicians to treat these disorders, now
that's a bright idea.
( Music )
Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli. Peace and health.
Conversations on Health Care, broadcast from the campus of WESU at Wesleyan
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