[CASW New Horizons: Sean Mackey, Pain Management]

I was telling another writing as I walked into this session, “I must be in the wrong business.” All the psychology talks are much more interesting than the other ones on stem cells and bioterrorism. This morning is Sean Mackey talking about pain perception. This is fascinating stuff. His website is at paincenter.stanford.edu.

Also, if you want to follow other science writers’ Twitters, you can see all Twitters on the conference.

Sean believes that we can’t understand pain by breaking it down into the individual pieces of the experience. It doesn’t lend itself to biological reduction. It’s a complex adaptive system. None of the brain systems that are related to pain are dedicated to pain only – they’re related to emotion, expectation, etc. Plus, pain is subjective. Different people experience pain in different amounts, for the same amount of bodily injury. He particularly uses fMRI to study brain activity in response to pain, which lets us look at brain activity without actually cutting into somebody’s head.

One thing that affects pain perception is attention. When people are distracted by reading a book or listening to music they experience less pain, though this works only to a certain point. High levels of pain don’t respond well to distraction. If we’re anxious, depressed, or afraid, that also affects our perception of pain. There is a really nice episode of WNYC Radio Lab (Placebo) on this – they talk about soldiers in the battlefield experience less pain with hugely traumatic injuries than do middle class business men with the same injuries. After all, think about it, you’re on your way to work and you get hit by a car and get a compound fracture. You’re thinking, “this sucks” If you’re a soldier in the battlefield and you get thrown by a mortar blast and get a compound fracture, you’ve seen your buddies go through much worse. You’re thiking, “I’m alive!”

One of the most interesting things he talked about was our empathy with others’ pain. He told us about a time his son tripped and fell and whacked is head against the wall. He and all the other parents in the room cringed and gasped, but the kid bounced up, just fine. He wondered, did that hurt me more than it hurt my son? It turns out that indeed, our empathy of pain is real. He forgot to warn the squeamish to turn away as he played some video of some terrible sports injuries – feet turned the wrong way, and a leg broken mid-calf. The whole audience cringed and gasped. He asked us, “How many of you FELT that pain?” It turns out that those who don’t just cringe, but actually feel a certain amount of pain in response, tend to be those who have had an injury to that part of the body before. We asked a lot of questions about desensitization to these sorts of images, and he believes that this is an important factor. For instance, surgeons and EMTs, or even children playing violent video games, are in a way trained not to react negatively to these images. In fact, in his own studies, he found one particular volunteer whose brain didn’t light up in the expected way when shown these videos of people in pain. They questioned him further, and found that he was an ex-convict. Interesting!

He also told us about some of his research on the effect of love on the experience of pain. This work is being published, so he couldn’t tell us much at all, but the teaser is that both the experience of pain and the experience of early, intense love, are both connected to our systems of reward (the dopamine systems). They’ve found some interesting connections between these two brain systems. But you’ll just have to wait until he’s published it!

In the Q&A we talked about the role of the anterior cingulate in pain perception. It turns out that people with Obsessive Compulsive Disorder may be treated by cutting the connections to the anterior singulate. People with chronic pain can also be treated this way. When queried, they’ll tell you that they still feel the pain, but they don’t care about it so much. So, the emotional connection to the pain has been cut. This just highlights the fact that pain perception is related to many different brain processes, its a systemic response, and so is very difficult to target. Some of his research has focused on the results of controlling patients’ anterior cingulate response and what that does to pain perception. But again, that’s still in the process of being published. Another interesting tidbit is that people with fibromyalgia (a chronic pain condition) don’t get runner’s high, which is created by our dopamine reward system in the anterior cingulate. Those people have some damage to that reward system. Acupuncture also seems to have some effect on the areas of the brain related to pain perception, which is only partially related to the expectation of reduced pain.

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[What’s science got to do with it? Thinking outside the Lab. KC Cole, Jennifer Ouellette, Paul Preuss, Adam Frank, Diandra Leslie-Pelecky]

Jennifer Ouellette posted a nice post about this session over at Cocktail Party Physics, so I won’t go into a lot of detail about it here, but just add a few thoughts.

Part of the reason that I got out of science writing as a full-time science career was that it seemed synonymous with science journalism and writing about science news.  I must admit, I’m deadly bored by a lot of the stuff in science news — dark matter, the LHC, stem cells.  I’m much more interested in the curious childlike questions.  Back in college when I was deciding whether to study more physics or not, I remember looking at the grass and thinking — If I could just understand everything there is to know about that blade of grass — the botany and how that grass interacts with the ecology, the cultural anthropology leading to its cultivation, the chemical processes that let it convert sunlight to energy, the physics and mathematics leading to its particular shape and curve — then that could be my life’s work.

I doubt I’ll ever be able to understand that blade of grass completely.

This session was perfect for me, as someone who’s not so interested in science news, but rather the more fundamental questions about how the world works.  The basic thrust of this session was to find new, fresh angles on science topics that tap into the readers’ interests. For example, Diandra Leslie-Pelecky wrote a book about the physics of NASCAR, and found that NASCAR fans would struggle through computational fluid dynamics in order to understand something they really wanted to know about — namely, why their guy didn’t win. At a similar talk a few years ago, one writer (was it Margaret Wertheim) suggested writing for women’s magazines with the same goal. For example, the chemistry of permanent waves or hair dyes talk about the science of something that someone is interested in already. People aren’t necessarily interested in the stuff that we think is fascinating, like string theory or the LHC. Why push our own agenda on them? Instead, bring our science to their lives.

I’m a big proponent on this, in particular on the science of everyday life. I’m fascinated by things like why coffee leaves rings, or why helium makes our voice sound high. If I had the time, this is all I would write on my blog. Jennifer related a story when she was walking along the street and saw concrete pouring, and thought “Ooh, self-organized criticality!” Similarly, I look at candles, and grass, and the cooling of coffee, and am curious. But I often find I don’t know the right questions to ask to make an interesting story about these things. I love hearing explanations, but perhaps my question-machine isn’t well honed.
“Be a child,” the panel suggested. “Take a walk. Ask the stupid obvious questions.”

Sounds like a laudable goal for me! If I only had more time….

For anyone who is also drawn by these questions of how the world works, and wants to be drawn into science stories by these wonderfully naive investigations, listen to WNYC’s Radio Lab.  In fact, one of their recent podcasts Making the Hippo Dance talks about some of the production elements they use to create Radio Lab in order to emphasize this sense of wonder and casual questioning.

[Pitch Slam:  Meet the editors.  Ivan Oransky (Scientific American), David Corcoran (NY TImes), Adam Rogers (Wired), Bob Sipchin (Sierra)].

Every year at NASW, they have this wonderful event where  we get to meet the editors from major science publications and try pitching a story to them and seeing whether they like them.  It’s really interesting to see what kinds of stories the diferent publications are looking for and what angle they require.  The same story can be interesting to one publication for one reason, but interesting to another publication for a different angle.

For those of you not in the know, a “pitch” is a 200-300 word blurb on the article you’d like to write — a well-written catchy synopsis with some journalistic research backing it up.  Some common themes that came up about writing a good pitch were:

  • Make the news angle clear (what’s new?)
  • Make sure to research whether that publication has done a similar story before
  • Pitching a question, “What will the tourist reaction to the death of pine trees in Colorado be?” is not very effective because the answer might not be surprising (“they won’t come”), or the answer might be “nothing much.”  If, on the other hand the answer is something surprising, like “A rising industry in disaster tourism,” then that is an interseting story.
  • Back up the claims in your pitch with some research, and be ready to answer questions from editor

Scientific American, for example, features articles primarily written by scientists so there are not many places for freelance writing  But in the front of the magazine and on the web there are some sections where writers can break in; they really like top 10 lists, for example.  In general any ideas that come straight from the science news wire services (like Eurekalert) aren’t going to fly; their staff writers are covering those stories.

That was also true of the New York Times, which is a very difficult venue to break into.  They primarily use writers that they’ve been working with for a long time, except for the “Cases” section in the science section where someone writes about their personal experience with the health care system.

Wired of course has a very different market — they want articles on what is cool and hot, technogeek kinds of stories.  Many science stories can be Wired stories, but you have to find the Wired angle in them.

Sierra Magazine, of course, requires the environmental angle in a story, such as green living, light technology, and sustainable living.

To give you some ideas of the kinds of pitches that we heard, and editors’ reactions:

What we can learn from polar bears.  There are some very interesting aspects to polar bears health that could have implications for human health.  For example, though they are inactive during hibernation, they don’t develop osteoporosis.  They also develop insulin resistance during hibernation, but don’t develop diabetes.  These are good reasons to promote bear conservation.  Great story, right?  Well, said the Sierra Magazine, we’re kind of sick of hearing about polar bears!  Maybe this could be done instead as an infoporn graphic page, with a sillhouette of a polar bear and diagramming what we can learn from different parts of polar bears.  Readers are jaded about polar bears, so you have to find a new angle.

Another story was about the hospital of the future. Much research suggests that having noise privacy, views of trees, and other simple modifications in hospitals, can promote healing.  How will this research affect hospital design?  Scientific American didn’t like this story, they’ve done a lot of green and sustainable building articles in the magazine.  What is surprising in this story?  It seems obvious that a view of a tree is a good thing, but who will pay for this, what is the incentive for a hospital to implement these changes?  Is there a hospital that is doing this? The Sierra Magazine liked that pitch better, because sustainable design is a hot thing now. If that story about the benefit for the patient could be combined with the benefits for the planet, then that would be an interesting story.   Wired wasn’t too enthusiastic, since they’ve done similar stories.  A new story would have to have a specific focus or angle.  Plus, much of this research is based on small studies, and they would want to know the research had been well-developed.