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How To Cure What Ails You

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Now that we have the ability to see inside the brain without opening anyone's skull, we'll be able to map and define brain activity and peg it to behavior and feelings. Right? Well, maybe not, or maybe not just yet. It seems the workings of our brains are rather too complex and diverse across individuals to really say for certain what a brain scan says about a person. But Nobel prize winner Eric Kandel and researcher Cynthia Fu tell us about groundbreaking work in the field of depression that just may help us toward better diagnosis and treatment.

Anything that helps us treat a disease better is welcome. Doctors have been led astray before by misunderstanding a disease and what makes it better. Neurologist Robert Sapolsky tells us about the turn of the last century, when doctors discovered that babies who died inexplicably in their sleep had thymus glands that seemed far too large. Blasting them with radiation shrank them effectively, and so was administered to perfectly healthy children to prevent this sudden infant death syndrome...

Comments [34]

charlotte from tallahassee

I found a card with my birth certificate that said........
"Was thymus IRRADIATED..........ANSWER " yES"

I Have had a rare autoimmune disorder called Lambert Eaton for 33
years. This disorder is related very closely to Myasthinia Gravis, a disease in which the thymus gland is often surgically removed

I also mentioned this to a doc and he didn't know what I was talking about.

Nov. 12 2012 01:49 PM
Tom from Chicago

If the scan was 85% effective in diagnosing depression, it is still inferior to the diagnostic modality it was compared to in the study. In clinical research this is called the "gold standard test." In this case the gold standard is a psychiatric interview. The fMRI is wrong 15% of the time. Based on this it is not at all reasonable to suggest that it would improve diagnosis or therapeutic monitoring in depression.

Oct. 14 2012 10:53 PM
Ruthanne Greenwood from Newport Beach, CA

Just heard your show today, October 12, 2012. Rerun?

Indeed, radiation was the top of the line treatment for children born with an enlarged thymus. Make us wonder about all the 'new' therapies researched today: botox treatments, cancer radiation, etc. 'FIRST, do no harm' still applies to research AND treatment; results are not known for may years after an innovative treatment.

I was irradiated for an enlarged thymus as an infant in the early 1940s.

In 2000, my thyroid was removed for a small speck of papillary carcinoma as my thyroid was had numerous nodules. It was determined that it was safer to remove the thyroid rather than biopsy several of many nodules maybe missing the few that had already become cancerous.

Without a thyroid, it's a constant testing to make sure the levels are correct or I could slip into a coma. But how grateful I am to be alive!

Oct. 13 2012 08:04 PM
Jeanne Lawson Mills from Portland

Sorry. I meant thymus, not thyroid.

Apr. 29 2012 01:57 AM
Jeanne Lawson Mills from Portland

Oh, my God. Do you know how many times I've mentioned to doctors this history of radiating the thyroids of babies only to have the doctor look at me blankly?! How confirming to hear this story and to understand how medicine of that era made the error. In 1954, my parents were instructed to have my thyroid reduced after I had a persistent cough as a 1 year old. They sought out the most respected specialist in the L.A. area. I, like many other of these babies, was diagnosed less than a year later with leukemia and hospitalized in a life and death battle that turned out to be, instead of leukemia, a super severe case of infectious mononucleosis. Knowing of all the babies that died of the resulting leukemia, my parents were always grateful to the doctor that had somehow given me a treatment that didn't kill me. I am disheartened to read about all the related cases of thyroid cancer, and yet glad to be warned of the possibility. Wow. THANK YOU for this story.

Apr. 28 2012 04:32 PM
Larry from Seattle

This comment is about the brain scans segment.

Jad is right.

The belief that "mental illness" is CAUSED by brain malfunction is one of the most dangerous ideas in this universe. And any psychologist or psychiatrist worth their salt knows it's not true.

We know that a body with a damaged brain doesn't work right. But we also know that trying to "fix" brains does not cure mental disorders. And a few brave researchers have even demonstrated that non-medical therapies can cure mental disorders.

Thus it is clear that most mental disorders are not medical disorders. And this tends to support the accusation that the "brain equals mind" idea is only promoted to give higher powers in society another way to harm people.

Dec. 17 2011 05:15 PM

There are a number of studies that have been done on infant thymus irradiation. They are from the University of Rochester in New York and span many years of follow up. I had the radiation when I was 6 weeks old. Have severed with Inflammatory Bowel Disease, Hashimoto's Thyroid Disease, and recently breast cancer. Would love to try and organize others who have been through this. If anyone is interested please email me anytime at Becky7213@aol.com.

Carol Foe

Oct. 01 2011 10:52 PM
Joyce

I was recently diagnosed with breast cancer. In 1953 I had my thymus gland irradiated, as far as my mother can remember when I was 2 days old and at 2 weeks. I am interested in finding other people who had this treatment and sharing information and support.

Sep. 27 2011 10:06 AM
Anita from SF CA

1953 @ 5 months of age I received 300R to my thymus. Now I have thyroid nodules and get the nodules biopsied every year. In 2008 I had a radical Mastectomy because of the thymus radiation. Yes, I am so angry I cry when I look up information on this abuse.

Any support groups? Any class action suits against the manufactures of the machines?

Apr. 06 2010 02:29 PM
Bruce Burns from Sydney, Australia

The claim that pediatric thymus size was under-estimated due to early dissections being only of poor babies is a great illustration of the perils of poor sampling. So I tried looking up sources for this. However the reason for the size under-estimation given in articles such as Jacobs (1999, Radiology, 210:11-16) is that disease quickly shrinks the thymus. Most dissected babies die of disease, and thus have a small thymus, whereas SIDS victims by definition are healthy. So the sampling problem may be disease/sudden rather than poor/rich. Of course both factors may play a role (and poor babies die more often from diseases), but I can't find a reference arguing that rich babies who died after an illiness do not also have small thymus glands.

Apr. 03 2010 08:00 AM
Gabriel Ramos-Fernandez from Mexico

I enjoy your shows very much, they are a really good tool for teaching science to a general audience. However, in this one you have oversimplified matters to the absurd. From your presentation of Cynthia Fu's results, it follows that the fMRI scans allow a correct diagnosis of depression only if we know which patients are depressed to begin with. But then, how were those patients diagnosed in the first place? Isn't that what the scans were supposed to improve?

Keep up the good work!

Mar. 24 2010 07:04 PM
CATHERINE FREW from VANCOUVER CANADA

I AM INTERESTED IN FINDING OUT MORE ABOUT THESE 20,000 TO 30,000 DEATHS FROM THYROID CANCER FROM INFANT IRRADIATION FOR ENLARGED THYMUS GLAND.
I RECEIVED THIS TREATMENT IN 1952 AND AM NOW SUFFERING FROM MILD HYPERPARATHYROIDISM AS WELL AS BENIGN NODULES ON MY THYROID. MY SPECIALIST THINKS THIS COULD BE RELATED TO THE RADIATION I RECEIVED.

Jul. 29 2009 12:14 AM
Ian from Portland

What is the title of the piano piece at the ending? I would love to know.

Jul. 26 2009 11:11 PM
Rusty Whitney from Portland, Oregon

I liked this segment very much but you said fMRI can show blood flow because blood contains iron. That's a good one-sentence summary; however, fMRI imaging depends on the difference in magnetic properties depending on whether the blood's iron-bearing hemoglobin is oxygenated. When brain cells are more active, they absorb more oxygen from the blood resulting in the Blood-Oxygen-Level Dependent (BOLD) response observed with MRI equipment. For more, see http://en.wikipedia.org/wiki/Fmri.

Jul. 25 2009 06:43 PM
Graham from Ann Arbor

As a faithful listener of radiolab for some time now, I must admit I am very disappointed in the treatment of fMRI in the episode "Diagnosis." My respect for Dr. Kandel notwithstanding, the current literature regarding fMRI is not so conclusive as this program would lead the listener to believe. The brain is a complex system of networks, and increased metabolism in one area reflects more than input to or output from that area. Serious questions have been raised about the means by which data are analyzed in fMRI studies - particularly the group analysis described in this episode - as well as the way in which these results are interpreted. Rather than contribute to the popular infatuation with a technique whose worth is far from established, I encourage someone - anyone - at radiolab to be more responsible in their presentation of science.

For a better explanation of these problems to which I refer, please see the articles below.

What we can and cannot do with fMRI
http://www.nature.com/nature/journal/v453/n7197/full/nature06976.html

Puzzlingly high correlations in fMRI studies of emotion, personality, and social cognition
http://www.edvul.com/voodoocorr.php

May. 01 2009 01:31 AM
John from Boston

At least twice during the thymus segment Dr. Sapolsky says that "20,000 to 30,000" people died of thyroid cancer as a result of thymus radiation therapy. Could you please list the studies that support this conclusion?

Mar. 22 2009 09:15 PM
Jason from baltimore, md

Normally I'm very pleased with Radiolab's exploration of different subjects on science. It's never in great depth, but that's the point; it's meant to get you thinking and curious enough to investigate further on your own. But this show, particularly this last segment concerns me for the same reasons others have stated.

I have absolutely no qualms with using brain imaging for research purposes. I think the discussion of these findings contributes greatly to our understanding of the human mind. I also agree that psychological disturbances have physiological correlates.

My problem is also a charge of reductionism in that you cannot EQUATE objective data with subjective experience, or vice versa. Seeing the brain at work in terms of data and quantities is not the same as knowing how that person thinks and feels, the qualities of his or her experience.

Besides brain scanning every mental illness patient being a ludicrously expensive way to diagnose, it is also a fundamentally alienating act against the patient. The sense that there is something broken that needs fixing becomes reinforced. No one has ever found going into an fMRI comforting or consoling. The patient is further disempowered by not being an active partner in his own diagnosis, in the understanding of his or her symptoms.

I think the previous segment of this show should be mentioned. When Emanuel's father decided nothing was wrong with him, decided not to let the doctors and the teachers call him retarded, he let his son become himself. I think it's great he got help later with his autism, but his father did spare him a life inside a box. Making boxes and putting people into them is what reductionist medicine does.

We cannot take our minds to a mechanic and get it back "good as new." This has been an extremely destructive metaphor and we need to move beyond it.

Feb. 19 2009 04:01 PM
ginny fredricks from austin texas

The show on SIDS and thymus just aired here today- I only caught the last part ,but heard enough to know it was about me!! The baby born 2 years before me died of SIDS- so they radiated my thymus to reduce the chances for another SIDS death!! Two years ago I had my thyroid out after several years of biopsies and ultrasounds to be sure all the nodules on my thyroid were benign. They were, but once they started growing, we decided to take it out- I kinda knew there was a link, but this show definitely confirmed it. My mom was also given DES to prevent miscarriages- though she'd never even had one!!! The wonderful world of medicine-

Feb. 12 2009 05:37 PM
MJG

Hi RadioLab -

I recently read the beginning of Bill Bryson's "Mother Tongue," a history of the English language. Bryson makes a quick connection between the part of our throat that allows us to talk, breathe and eat simultaneously (epiglottis? I no longer have the book with me to confirm) and SIDS. I believe he stated the development occurs at the same time that children can fall victim to SIDS. Hearing your show and reading his book was a strange overlap.
Your work is excellent. It is compelling to those of us who are interested in learning but who hadn't considered ourselves science-focused.
Keep making the hippo dance.

Feb. 06 2009 09:19 PM
MJG

Hi RadioLab -

I recently read the beginning of Bill Bryson's "Mother Tongue," a history of the English language. Bryson makes a quick connection between the part of our throat that allows us to talk, breathe and eat simultaneously (epiglottis? I no longer have the book with me to confirm) and SIDS. I believe he stated the development occurs at the same time that children can fall victim to SIDS. Hearing your show and reading his book was a strange overlap.
Your work is excellent. It is compelling to those of us who are interested in learning but who hadn't considered ourselves science-focused.
Keep making the hippo dance.

Feb. 06 2009 09:19 PM
John Maples PhD from miami florida

Love your work so the following is not critical as much as pointing out a bubble in the glue. This show of Dec. 05 2008 "..Cure what ails you" had some interesting subtle aspects. The "pattern" matching of the brain scans was done with AI software (that the researchers called computer modeling). This type of software is similar to what caused the financial crisis (www.sciam.com/article.cfm?id=after-the-crash
and points out a very human dependence on computer output as being right regardless of real world logic. AI programs can match most things using a defined data base with and repeat this with great success. The same programs frequently (most of the time) don't work with real world data. When they do work it is difficult to understand what the computer algorithm is doing. Your story on the thymus fit right into this picture... probably without you realizing it but maybe not. Assumptions made from data that was in "error" or "opps" [I have to mention Colbert's 'truthiness' here. Truth is what we vote it to be?] You covered your concerns and doubts. Reinventing the wheel and repeating the mistakes of the past are increasing at an alarming rate. Learning comes from making mistakes, but there are few publications on "what did not work" or "how I failed". Please do more of these types of 'thymus' programs. The financial crisis modeling is a great example. NPR covered it somewhat but not in this light. Other examples are assumptions in DNA genetics that were way wrong. The so called noble gases is another example. Thalidomide is another example. Einstein didn't even know that other galaxies existed because there was great resistance that ours was not special (earth centric, solar system centric, universe centric, the human ego vs science). Mix human financial, political, fame ego into science and the need to check "assumptions" is enormous.
Thank you for what you do. Keep it up.
John

Jan. 26 2009 10:48 AM
pam from london

Great show, as always. And that MUSIC at the very end (I think it was used somewhere towards the beginning as well) – please tell us what it was! I almost sprung tears just listening to the music alone.

Jan. 23 2009 12:46 PM
Lucia from New York

I love Radiolab for a lot of reasons, mainly because it makes me think about the world in a new way. It points out relationships among things I never would have connected. It's sort of a springboard, a jumping off point for me to go and do my own investigations. So I don't have the same criticisms of its scientific method that the above commenters have.

I do want to say something about the potential usefulness of brain scans to diagnose disease. As someone who is being treated for severe depression, I know about the stigma that still surrounds the disease. It is not a question of merely going to a doctor because you "feel sad." It is much deeper, and more devastating, than that. A depressed person constantly questions the reality of depression as a disease; I get angry with myself for not being able to "just get over it." If someone could look at my brain and say for sure that there is something different about it, that there is a concrete physical reason for this disease, and suggest a more effective treatment....how could that be a bad thing? I would see that as one more lifeline to pull me out of this darkness. Provided of course that there were enough controls and the studies were repeatable, and all of the other precautions were followed.

There is always danger when we look at current medical practice and say "This is THE truth." It is safer to say "This is the best we can do right now," and continue to support researchers who strive for better diagnostic tools and treatments. Thank you to Radiolab for providing a platform for the discussion!

Jan. 03 2009 05:48 PM
Burk from San Rafael, CA

I was puzzled by the ending of this piece. Has the concept of controls not occurred to the presenters? The thymus/SIDs story bears little relation to the current fMRI/depression story because the algorithm that discriminates depression from normal in the latter used controls. It was fed known normal (control) and depressed patients for learning and testing. The thymus/SIDs story made quite evident that no one looked at the population at large at the time to check on normal vs non-normal status in children of that age, matched for "age, and intelligence quotient ... and no history of ... neurological disorder or head injury", etc., as did Cynthia Fu's group. They did not do the proper controls, and this is one way that scientific critique has advanced over the years. The Nobel prize really does mean something!

Fu CHY, Mourao-Miranda J, Costafreda SG, Khanna A, Marquand A, Williams SCR, Brammer MJ. Pattern classification of sad facial processing: toward the development of neurobiological markers in depression. Biological Psychiatry 2008;63:656-662.

Jan. 02 2009 05:33 PM
Thomas L. Rodebaugh from Washington University

I love the show. Unfortunately, my scientific background leaves me quite disappointed in the first part of this segment.

Let me amplify Sara from CA’s comments by noting that it’s bizarre to suggest that brain scans are needed because otherwise we cannot determine if a therapy works. It's equally strange to suggest that until brain scans, the sole product of psychotherapy research was a series of therapists simply claiming that their treatments work.

I know there are pressures to keep the show brief and simplified without being too simplified, but this is too simplified.

Worse, the simplification makes the segment self-contradictory. If the algorithm was right 85% of the time (and this was considered a good outcome), then a reasonable listener could ask: Compared to what? Compared to usual assessments. This means that established clinical methods were right 100% of the time and were considered a good standard.

In other words, the algorithm was *aspiring* to the accuracy of methods that we already have available.

I look forward to the day when we have a method for assessing mental disorders via brain scans. In the meantime, we have treatments that work, reliable methods for assessing those disorders, and reliable and relatively objective means of assessing change. The previous sentence could specify "non-biological" at every step of the way, and to the extent that that term means anything, the statement would still be true.

If the folks at Radiolab aren't aware of the above, then they have a great opportunity: There's a whole range of scientific inquiry left for them to explore!

As I mentioned, I admire the show a great deal. I have encouraged friends and students to listen to it. I wouldn't be bothering to write this message at all if the segment had been a standard NPR show. But this is Radiolab. I expect a lot from y'all.

Best,

tom

Dec. 25 2008 11:14 PM
Ryan S. from Washington, DC

I'd like to echo the high praise for the last segment, fascinating and well-presented. Does anybody know the title of the piano music that was playing at the end of graverobbing/thymus story? It was perfect.

Dec. 19 2008 04:31 PM
Laura B. from ypsilanti, MI

This amazing story about SIDS, the thymus, the poorhouse, and gravediggers simply astounded my husband and I. We were rapt. The ending left me open-mouthed with astonishment. The story spiraled out and out and out and then came home with a bang. One of the best stories I've heard on the radio, ever. RadioLab is eclipsing This American Life as my favorite program. The next time pledge drive rolls around, I will tell my local station that it is for RadioLab that I am pledging.

(applauds!)

Dec. 14 2008 10:20 PM
Natasha from Monterey, CA

As I listened to the segment about radiation of enlarged thymus glands in babies, my jaw dropped. I was one of those babies. And in July I had my thyroid removed: I had thyroid nodules with strange cells. Because of my history of radiation, the chances of thyroid cancer were high. I had a lot anger that the doctors had radiated my thymus, causing me to lose my thyroid decades later; and now, to learn that their reason for thinking my "enlarged" thymus was a danger was misguided, brings that anger back. Thank you for the show.

Dec. 14 2008 10:19 PM
Tom from New Jersey

Today, doctors try to prevent SIDS by not allowing babies get Slow Wave Sleep (Stage 3 and Stage 4 NREM sleep combined). Is this safe?

If a baby sleeps on their stomach they go through all 4 stages of NREM sleep and then through REM sleep in a typical 90 minute sleep cycle.

But, if you put a baby to sleep on it's back it goes through the first 2 stages of NREM sleep and then skips to REM sleep without going through Stage 3 and Stage 4 NREM sleep.

Before 1992 over 90% of U.S. babies slept on their stomach or side. Now, over 75% of U.S. babies sleep on their backs.

When humans are awake the memories they make are stored in their hippocampus. Then, during SWS, they are transferred to their Neocortex for permanent storage. This doesn't happen for babies anymore since they don't get SWS. Tummy Time is while they are Awake so SWS won't occur here either. Since 1992 we've had a huge increase in toddlers with neurodevelopmental issues specifically PDD-NOS.

What I'm trying to get at is that I think a possible unintended consequence of the SIDS "Back to Sleep" Campaign is that it has caused the Autism Epidemic.

http://tummysleepcentral.blogspot.com/2008_03_01_archive.html

Dec. 05 2008 05:22 PM
Patrice

Awesome, awesome show.

Dec. 05 2008 03:43 PM
sara from California

Abumrad was correct: biological reductionsim has been the siren song of psychiatric illness and has led to many destructive 'therapies.'
Unfortunately, the argument is not a fuzzy attachment to a couch and ambiguity. The fact that we can observe gross alterations in a brain thru imaging may have little specificity when it comes to effective treatment.
Modern models have established that experience shapes brain structures. Psychotherapeutic relational experience can modify what is seen on an fMRI. Baxter showed that OCD brains change after CBT as much as after medication.
Both Krulwich & Abumrad were surprisingly uninformed in the way they posed their 'argument.' Krulwich seemed gaga about the
reductionist fantasies of the MDs excited about their new tool; the SIDS history simply clarified that 'evidence-based' medicine can be woefully misguided.
I doubt anyone would really need to have imaging to assess the value of their psychotherapy; the proof is in
how fully human one feels - not how big the hippocampus !

Nov. 30 2008 02:18 AM
Ani from miami, fl

Awesome work. But wait...you never explained what caused the infants' sudden death?!

Nov. 29 2008 12:48 AM
C.L. Ball

Jad Abumrad's objections to the diagnostic brain scans for mental illness are bizarre are anti-scientific. Abumrad is essentially denying the bio-chemical basis of mental illness when he says he wants the problem solved on the therapist's couch. Furthermore, doubts over the therapist's ability to accurately diagnosis the illness is the very reason for pursuing clinical brain scan technology.

Linking this to SIDS is also strange. The doctors who developed the thymus gland theory on SIDS should have compared thymuses of SIDS-death babies w/ babies that did *not* die from SIDS. If they had modern imaging technology, they might have been able to.

Nov. 20 2008 04:04 PM
Julie from Minneapolis

The end of this segment actually caused me to gasp "oh my god" out loud at my desk. Really excellent work, as always.

Nov. 20 2008 04:04 PM

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