What Matters to Me and Why - Claudia Kawas, M.D.

[Music] good afternoon ladies and gentlemen and welcome back to another action-packed fun-filled exciting what matters to me and why this is actually our 41st Speaker I believe it's almost hard to believe that since the fall of 2012 when Jonathan and I went to talk to the Chancellor and see if he would even amuse us by letting us do this we've gone this long so I'm John stuper I teach in the School of Engineering and as a member of the organizing committee I'm just kicking off our event so this program was developed with the intention to encourage reflection on values beliefs motivations etc in the lives of those who shaped our university the series explores personal journeys experiences choices made difficulties faith encountered commitments form challenges joys revealed all with the hope that these stories will help us to understand diverse pathways in life work and leadership here at UCI such understandings are crucial we believe for fortifying tolerance sustaining bonds and supporting the virtues that make us who we are as we celebrate diversity here at UCI and we do so today's featured speaker is our very own Claudia chaos who will be introduced by perfect professor physics professor Claire you and before that though I'd like to invite you to join us next month our last one of this school year may 16th to here our Vice Chancellor dr. Parham tell about his unique journey and perspectives before he leaves our University he moves on to become president at Cal State so you may want to sign up early for that event because we expect a large crowd so now before Claire comes up to introduce our speaker I have some housekeeping announcements first I'd like to ask you to discard the remains of your box lunch and the receptacles outside after the program secondly these talks are always filmed so if you don't want to be seen in it you may want to move to the back of the room third you are given a feedback form when you came in and if you would like to I'd like to remind you to fill it out turn it in because your comments and suggestions actually help us decide who to invite here to speak so please participate in that and lastly we'd like to give you a the audience at least one minute before the speaker comes up to just meet and greet each other around you just one minute though and then we'll interrupt and get started with our program so meet and greet one of the things I like to do is watch 60 minutes the television show on Sunday nights and the speaker today I first saw in a couple of episodes on 60 minutes one of which featured her 90 Plus study where she studies the oldest of the old the people who are 90 and over in Laguna Beach the Laguna Woods and fascinating of how some of these folks are able to maintain a vital and active life well into their 90's some of the secrets behind that her specialty on another episode was featured because she's been studying Alzheimer's and dementia and has found some very interesting features of that I noticed from reading some of the background material that some of the people who should exhibit quite severe forms of dementia if you look at their brains they actually seem to be pretty much okay whereas other people who show symptoms that dimension if you look at the pathology of their brains they they you would think their brains are fine but they don't seem to be save that way so there's all kinds of mysteries in this and today's speaker is one of those uncovering those she's a graduate of Swarthmore College and completed her medical studies at the University of Louisville in Kentucky and then did residency and postdoc work at the Albert Einstein College of Medicine she then joined the faculty at Johns Hopkins for fifteen years before coming here in the year 2000 to UCI where she is currently the alan trish nichols chair and clinical neuroscience and a professor of Neurobiology and behavior and neurology her she's received a number of awards and her expertise has been sought by a number of organizations and in terms of her serving on committees for the nih and as well as other associations such as the National Alzheimer's Association the US Food and Drug Administration the National Institute of Aging National Academies of science engineering and medicine and she's also been a member of the President's Council of Advisors on science and technology and so today we have the privilege of hearing what matters to her and why Thank You Claire for that really really lovely introduction I am i normal II tell people to please introduce me really really short because I have a hard time sitting there and listening I don't know who they're talking about when they're introducing and this time I said to Claire you know maybe you should talk a long time because then I have less time to talk about my journey because I can't even imagine that people would want to listen to my journey for 30 minutes or so and I have to start this out by saying that I give a fair amount of talks at this point in my life I've done quite a bit of speaking and and most of them don't concern me very much anymore but this talk ranks with the first time I did Grand Rounds at Johns Hopkins School of Medicine when I wanted to basically throw up for two months before I I didn't and I've often told people that over the years it went from two months to two weeks and then it went to own I only felt like throwing up for two days if I got better and then only two hours and then now it's you often just two minutes until this talk and we just went all the way back to two months and I've been going in circles for two months about what it was that I would I would tell you and how can you distill this grand notion of what matters to me and why into a 30 minute talk and not use PowerPoint to boost I mean you know I'm really driven by what's on my my slides and and then I was told that I really was supposed to make this more personal and and more about my journey so I'm hoping I'm gonna tell you about my journey is the ways I remember it and and hopefully somewhere out of that we'll both figure out what matters to me and why so there is a certain beginning it's not the real beginning but I was born in New York City I was always glad that I could say I was born in Manhattan because I thought that Manhattan sounded a lot cooler than saying you were born in Brooklyn which was actually where we were living and I were I'm a first-generation American my parents in fact at the time were both immigrants who had come over expressly to go to school and get an education my parents are Palestinian and as far as I know very Thoroughbred Palestinian for as far back as as I know my mother's maiden name was also Calif and so I thought for most of my childhood that you hey you had to have the name K was to be related to me because otherwise you know both sides of the family you know where K was and I don't think I was particularly I came along at a great time my my father had come over from the Middle East he was raised in Bethlehem and that's the not the one in Pennsylvania and he had come to get an education and had met my mother at the University of Texas where she was in pharmacy getting her college degree and after college they got married and my father was admitted to NYU Medical School so my dad was a medical student and my mother was doing her best to support us by working in the basement of Macy's at Herald Square because Macy's doesn't have a pharmacy in it now but it used to have a pharmacy in the in the basement and one of my main memories was riding the escalators up and down in Macy's you know because that and the subway which was very cheap in those days and hope not as dangerous as we sometimes seems to be now where my main two forms of entertainment that I remember from from those years so my my dad had been in this country long enough to be drafted it turns out although not long enough to be a citizen and when he finished medical school and an internship in Bellevue he was drafted called up by Uncle Sam and one thing led to another and I spent the next six grades in seven different schools courtesy of the US Army no place really all that interesting though we were in Fort Sam Houston three times for six months each time we were at Fort Knox and Fort Campbell in Kentucky and I to this day very much consider Kentucky my home I lived in Kentucky from the third grade on I went to high school there I went to medical school there and it's it's very much where I think I'm from and when people always said to me that I didn't seem like I was from Kentucky I often like to remind them that yeah I know I wear shoes it's it's very easy to you know be provincial about wherever it is you live but I think that one of the things that happened to me by moving around as much as I did was was the realization that that every place has wonderful things about it when I'm asked if I like California better than I like where I live before any of the places before it's never like that for me it's every place had wonderful and interesting things about the people about the scenery about the food about the the whole way of doing business and Kentucky in the south is my home and I may not sound like I'm from there but that is really where I think I'm from as well as from middle east so we're now in Washington my brother and sister are born at Walter Reed Army Hospital and we start traveling around to all these army bases and when I was about 11 my dad was sent on a TDY a tvy and the military means that he goes and the rest of the family stays behind somewhere so we tried staying behind a couple of different places but ultimately my mother and brother and sister went and stayed in the Middle East with my paternal grandfather and mother there and I went with my maternal grandmother I might spend a lot of time with off and on because um it's not easy to raise the baby and be a medical student and try to put your husband through Medical School and work in Macy's and do all these things so I'd spend my maternal grandmother had actually sent me back to my mother on my first birthday I'm told I was toilet trained and since I was the oldest one my mother honestly thought that all children effortlessly became toilet trained by age one year which of course was my brother and sister showed it was definitely not the case so Madisonville was a town of about eleven thousand people and we were probably one of the steps towards diversity for that particular town because when we arrived diversity was was the word diversity even sometimes in some places still means mostly the color of your skin and the integration was new at that time but it wasn't new to me because the US Army has always been integrated and so I didn't quite understand what all the hoopla was about but it started becoming apparent that people were I mean one boy asked me if I was black or if I was white and I believe it or not went home and asked my mother who told me to go tell him that I was brown and and the town like thought that we were so unusual that they ran this big article in the newspaper about us and it had a picture and and everything in the title was a little town of Bethlehem means special meaning for the chaos family and they told you know about our heritage so I want to go back a little bit to the real dreamers in my family I consider myself from a family of a lot of dreamers on both sides and and in both directions so my grandfather my paternal grandfather was 13 when he by himself got on a boat with literally pennies in his pocket and went across the ocean from the Middle East Bethlem where he was was living too Honduras and it turns out that if you look at a heat map of where Palestinians outside of the Middle East have settled it's the two hottest places on the planet by far are Mexico and Honduras and my family took part in that big wave of immigration that happened around there so he came when he was about 13 in Honduras he marries he meets and marries another Palestinian my grandmother who was very young and together they had seven children and ultimately he decided that he wanted to go back to the Middle East to help his country and so they moved back to the Middle East my father les was born in Honduras but in fact his native language is Arabic and he tried to convince us his whole life that he spoke Spanish but believe me nobody would believe and nobody who heard him could believe that so he grew up in Bethlehem and when he was about 13 in fact he started going to a day school and in the neighboring town of Jerusalem how far apart do you guys think it is between Bethlehem and Jerusalem some guesses so I heard a range from five to thirty anyone want to go outside that fifty it's it's between three to five it is you can walk between there at least you could before all these walls were were unfortunately changed the character of the whole thing so he went as a as a day student and when he was about thirteen this Proclamation like I found this just quite accidentally recently in the New York Times archive and that can work there anyway I can well unless somebody knows had a oh look at that it's a touchscreen I'm technologically challenged so this Proclamation is from the from the New York Times actually Christmas Eve December twenty fourth nineteen thirty nine and in it the mayor of Bethlehem does what has been a tradition for for many many years wishing for peace on earth and goodwill towards men which is a phrase I always associated with Bethlehem growing up it says at the bottom that Palestine prepared today for its first peaceful Christmas in three years because the previous year twenty thousand British troops at an uneasy peace in a land torn by Arab Jewish strife this year the war in Europe has submerged at least temporarily Palin Stein's differences so this was when my dad was thirteen the proclamation though you might notice in the top line was was put out by my grandfather Hanukkah was who was the mayor of Bethlehem for the last ten years of the British Mandate and my father then became a dreamer who then got on a boat and came to the United States to get his own education and meet my mother on the other side of the family my maternal grandfather also went from the middle at about the same time he went first to Mexico which was where my mother was born in her native language and she really can't speak Spanish and then they didn't really like it there and they moved ultimately to Honduras because there's a lot of Palestinians down there and we do tend to try to stick together like like all of us and then eventually they one by one immigrated back to Mexico in order to cross the border into the United States almost exclusively so that all of the kids in turn could go to college and become engineers special ed school teachers pharmacists and the like so all this leads though to me now and on good days I speak English I can't and I'm embarrassed to say I'm useless in Arabic and Spanish and most sometimes I'm even pretty useless in English way it feels today but I grew up in this little town in Madisonville and I knew that you know we kind of had a lot of fun things I mean foods that other people didn't have and I knew my parents could speak languages that other people sometimes didn't understand and but through all this it was very clear that education was one of the central tenets of what has always moved people and always taken the world and individuals you know to a better place and so my parents I'm the first child they tell me I can go to school more or less wherever I can get in and I memorized Barron's College guide I absolutely probably could tell you everything about every every school and I ultimately decided I wanted to go to a small liberal arts school so I applied to source more probably because the first line in Behrens College guide was that it was one of the most exclusive schools in the country and I somehow didn't feel like that was going to be a problem and I I've told people I don't know what my family has done or how they did it but in those days I felt anything was possible there I wanted to be President what fool would want to be president right but if I wanted to be president I could and didn't matter to me at all it didn't seem to get in my way that a woman had never or to this day a half a century later still has never been President of the United States I felt like people could do whatever they were willing to put in the effort and energy to do and and everything and I don't know maybe it was a result of that brashness but I did get into Swarthmore and Oberlin and Vanderbilt which was where my parents wanted to go because it was me to go because it was close to home and I'll and it's worth more and I it's a very small school it's only 300 people per class and oh my god I have never seen 300 more amazing people in one one place up until that time and I had told them I wanted to be a sociology major don't ask me why I didn't even know what sociology was but it seemed important you know how people behave and and what they decide to do and and all this so my I was gonna be a sociology major and so the first quarter I take intro to Sosh and for me it was it could have also been called conclusion to such and in between so the very first grade I ever get it's worth more is I have to write a paper for this class and the class is does man have a biological propensity to commit aggression so first I have to look up all the words I don't even know what half of this means I've never written a paper in my life because that's just what happened at the school that I went to and a rural you know part of Kentucky and I had even walked out of my SAT test and I had asked my my college prep math teacher what was that flattened F sign that was in the test because I'd never even seen an integral sign so I was pretty unprepared when I arrived it's worth more to say the lease and I write this paper and I think it's pretty good not great maybe but pretty good and I get it back and it is a d-plus so now I've got a choice I mean do I pack my bags tonight or tomorrow and go home but I think that that one of the things I've noticed a lot of times in my whole life I seem to arrive in spots I want to be in but I'm really not prepared for them because after majoring in ultimately I decided to major in linguistics and then I go to medical school and I wasn't prepared for that either but I really really through all this have realized the value and the loveliness of liberal arts education and learning a lot of things besides the skills that we want to do to practice a specific job because I think we bring so much to the table that influences us if we broaden our thinking so when I'm trying to figure out a major I'm the most under undecided students you've ever seen I mean from my entire life I've never quite known what I wanted to do and the students that come to my office now they scare me with their direct I mean their focus I think it's good in many ways that we try to focus our students and I say to them that you know all the time one of my favorite sayings is focus focus did I say focus but I'm usually talking about focusing on a scientific question and the way to tease apart the answer but here now I'm not gonna do sociology I'm not sure what I'm gonna do and while I was I'm trying to figure out I asked my linguistics professor because I became very interested in how children learn language and that ended up being the basis for my major it's worth more I am I did like a dissertation thesis an undergraduate thesis on a child's acquisition of negation how a two-year-old learns what no means right but it was amazing to me that a two-year-old could learn a language which I my entire life couldn't absorb and they did it at a time when their brain was soem if I put a blanket over their rattle they wouldn't realize that the rattle was still underneath the blanket but they could learn a complex language and learn it in a way that I mean and be what we call a native speaker and how did the brain do that incredible thing I mean so what really have guided me through through college had been interested in how the brain works and all the classes and things that I took had to do with that and I'm now applying to graduate school and I think I want to maybe go to graduate school in linguistics or or I wasn't sure at all but I was sure of though at that point was that the educational environment was such an incredibly wondrous place that I wanted to spend the rest of my life in it and then the question was if I'm gonna be a teacher the only question was what was I going to teach and it could be linguistics or it could be psychology or it could be any number of things but I had to figure it out kind of quickly and nobody starting with my family expected me to apply to medical school but my linguistics cycle and psychology I had a couple of psychology professors who were going all the way down to Baltimore to see aphasia patients patients who had had strokes and because of those strokes they couldn't talk and I often wondered why are we going all the way from Philadelphia to Baltimore I mean there's stroke patients that can't talk all over the world and every city block pretty much but I realized ultimately we weren't going down really because of the patients we were going down because of a neurologist named Oscar Marin who was one of the few neurologists who made behavior his interest most neurologists especially in a place like Hopkins you know it's it's the neuromuscular Junction or the peripheral nerve or the you know I mean the spinal cord or the myelin sheath or whatever that they become you know very interested in and do research and are famous for and almost I mean I used to joke at Hopkins that if it was above the tentorium the tentorium is is the thick membrane in your skull upon which the brain sits all of it except for the cerebellum which has to do with with balance and I used to say that if it was above the tentorium at Hopkins they didn't think it was in the nervous system you know almost the whole faculty there was really looking at the nervous system from here on down to the toes but behavior is a really complex thing and we're using the brain to try to study the brains be which is even more complex but but to me it was the essence of why the nervous system was was most interesting and seeing it in these children was was incredible and then he said to me one of the times we were down there well you know maybe you should be a neurologist and that was a completely new idea it never even occurred to me to apply to medical school I had two majors both in the non sciences and one thing led to another and I went to medical school and I got there and I was so unprepared that it took me three weeks to find a fine focus on my microscope and I really did not feel that education was so wonderful while they're cramming the names of two hundred and some-odd bones and five thousand muscles and and other things down me and I've got a memory like a sieve I mean one of the things that strikes me as amazing is how wide the ranges of people's memories you know the people who can be taken in a helicopter ride over a city and then draw it you know it's quite different for me who you can tell me your phone number ten times and I won't be able to remember it long enough to walk across the room and dial it so but memory memory is an important part of what we're about language was an important part and I thought I wanted to maybe try to study it that way so I ended up doing internal medicine in Massachusetts and then I went on and did neurology in New York and when I'm finishing my neurology residency you know it dawns on me finally that you kind of need to specialize if you want to be a teacher and in a field and so what am I going to specialize in and I looked at so many things and I really didn't know the chair of the department there was a man named Bob Katzman who at one point had the most cited article on Alzheimer's disease for many years it was a two-page editorial entitled the prevalence and malignancy of Alzheimer's disease and then it he had warned us and this is back in 1978 he had warned us that the problem of dementia and aging was a really important problem that we needed to give attention to and that it occurred at all ages because when I went to medical school merits textbook of neurology the standard textbook at the time had one paragraph on Alzheimer's disease and it said in there that it was so rare that I would probably never see a case in my career and in those days we really didn't understand what we were talking about it just comes back to I feel I'm first and foremost a teacher and I say all the time half of what I'm teaching you is wrong and I know that nobody really believes that but it's true and the only question is figuring out which half it is and making more knowledge in place those things that we believe are true and turn out not to be so he had just gotten a couple of grants actually to do these aging studies and he says to me well I need somebody basically to examine a thousand people a year for this research and would you like the job and I said to him I'm not interested in aging when you're you know 20 30 s and everything I mean there was a medical school classmate who had said she was interested in geriatrics and I always felt sorry for her I you know so I don't think so and he says well what are you interested in and I am I said I didn't know and he said well why don't you do this while you decide and I tell people I guess I'm still deciding but the truth is after three months after starting I really realized that I found a great niche for myself with all the things that I loved and taking care of patients that I really enjoyed and wanting to also add to knowledge so now I have to figure out how to do research because three months after I decided this was where I wanted to be and what I wanted to do this department share for 20 years announced that he was leaving to become chair of neurosciences at UCSD so shortly afterwards you know he moved to now I'm really trying to figure out okay how am I gonna do this and I had a couple of choices and one was to go to UCSD but basically to continue being a postdoc fellow which another was a job offer from Pittsburgh and another one was a job offer from Hopkins and I decided ultimately to stay on the East Coast because now I've done Massachusetts Pennsylvania Baltimore Washington area you know born in New York and one residency there so I moved to Baltimore and I ended up staying there actually for 15 years and Baltimore was not what I expected but I think that's true of every place I've moved to and I had a lot of ways in which Hopkins and Baltimore were really a wonderful place to spend a lot of years before I found just this wonderful place to spend the last half of my career which is here at UCI so now I'm thinking at the point in my life actually where I'm thinking more about retiring and the end of my career and I I think the thing that makes me saddest when I thought about this is that I never expected that in the last third of a century that we wouldn't have made more progress than we have made in treating preventing or in other ways ameliorating dementing illnesses which has been the main focus of my research I never thought that we we wouldn't have so much more progress to offer and that makes me very sad but when I look back on my career I never imagined I would have had so much fun doing so many things most of which I could never have even imagined when I was in medical school trying to not quit because I hated it it is it's been a real wild ride and it's a wild ride of different sorts in different places I mean you know and and in the Baltimore Washington area when I had VIP patients they were you know the parents of Supreme Court justices or when I was asked to give a talk it was you know on Capitol Hill or for a president's committee here I seem to be well for starters I promised my mother and Edinson ville i would never go on 60 minutes because and we used to watch it as a family that's how old the show is and there was always somebody jumping out of a window like to get on a plane to go to South America because usually 60 minutes wasn't asking them about something good and when they first called me you know I I literally said to the producer I promised my mother I would not go on 60 minutes I never imagined that I would talk to the the writers of house and ER and I know and and the SAG community about how to portray also my patients on TV and everything I mean it's a whole different culture out here and it's it's been a fun and good a great thing to see and be part of I'm still holding out though that somewhere along the line and somewhere soon we're going to have some some ways of combating what I think is probably the scariest disability and illness of all and that is also Murray's disease so what matters to me and why well first and foremost I need to start with my family's tradition of always wanting peace on earth goodwill towards men and I definitely want it for the Middle East but I also want it for Afghanistan and I want it for Korea and I want it for all over the world because unfortunately now that I do know what the words mean I think I've almost sadly come to the conclusion that I don't know if we have a biological propensity to commit aggression but boy we sure do it an awful lot and it's not good for for any of us or our world to not have peace and good goodwill um the second thing I'd say on the list that would have to come up and you can tell how the way I've chosen to spend my life and that is education I think education is the raises all boats we don't even know why education is so strongly tied to things like health and forms of cancer and things like that we do a lot of hand waving about how higher educated people have different hell Abbot trust me it's more complicated than that but education is one of the major ways in which prosperity and societies and improvements and everything happens to everybody what we need right now is the best educated population to make the best possible society and world that we we live in and I obviously think health care and I think that health care and fortunately I've sort of in my head is a right unfortunately sometimes we act like it's not only not a right but not even a privilege and and I'm kind of sad that we haven't worked harder in this country in particular to make sure there's universal health care for for all we spend a lot of money on health care but not on the right things I don't think in all cases and then third on the list obviously has to be family and friends I can't imagine where any I have to make my main acknowledgments at the end of this talk obviously to my parents and my grandparents and aunts and uncles all of whom without him I wouldn't be here and I certainly wouldn't be Who I am but I believe in sort of the family of man and I feel like I've got family all over UCI and family all over a lot of places in the world and I even claim some non blood-related grandchildren that literally are living in three different countries right now so I think there's some of the things that matter to me and and why and I'd like to hear what matters to some of you and why thank you I don't know how to advance this yeah this is some of the players in my family clan so on this side is my my paternal my grandfather who was mayor and his wife and some family outside of their house and on that side my maternal and my parents at their engagement party and wedding and when my dad was in the military and me and my brother and sister thank you so you said that you found your niche basically during your postdoc years and it also a little bit sounds like you kind of went in the direction of whatever opportunities opened up and then that kind of define you as I didn't develop that well enough I mean I think it's good to be directed but I think if you don't watch out your blinders will keep you from seeing opportunities that are around you and diverse things I mean you know it's easy when you're little to say I want to be a brain surgeon or whatever it is you imagine you want to be but for starters you don't really know what doing brain surgery really means and whether you're gonna actually like it I mean a lot of people want to be a brain surgeon but they don't want to do a brain surgeons life and get up at 4:00 in the morning and be in the or at 6:30 and always be looking through you know little microscope and and and what all but but I think also most of the jobs in the world they don't have names that when you're young you can apply to them so so we tend to pick things that we can easily name that's part of what the psychology of language is and our different languages allow us to think in different ways even and an Eskimo knows a lot more words for snow than than we do because snow has a lot more variety well I think there's a lot of jobs out there and a lot of paths to take even within a particular job and you don't see that until you take the blinders off and kind of constantly be looking around you and seeing where things you know will work out and and so yeah I think that is my main advice I think to that a lot of people tell me oh I don't want to be a doctor because it'll take too long or something like that you have to feel that it's not just the goal I mean it's the journey so when my calculate however many years I was in school I mean at flabbergast a lot of people because I not only did medical school but I did two separate residences and then I did a fellowship and but I didn't you know I was just happy to be in school my whole life and sometimes maybe I was called the student and sometimes I've been called the teacher but every day I feel like I'm both and in particular I mean I feel that I learned more from from you guys than I ever have any kind of knowledge that I give to you so yeah I would say that's exactly the message thank you if it's not too personal how do you feel about euthanasia woohoo so first tell me what youth in Asia is and then I'll tell you exactly how I feel about it okay so um I mean I think we we generally don't call it euthanasia we call it assisted suicide I don't know it's another version of does language really change it and in some ways it doesn't and some it doesn't and I think it's been very interesting because you know we spend most people don't want to spend a large part of their life with certain kinds of disabilities and unfortunately that that often happens in one way or another but I think it's also interesting that even the states that have mechanisms where you can get pills and things like that only about a quarter of people who get go through the entire process actually complete it to me that means in part that first of all we like having the knowledge that we can do that not necessarily the the need to exercise it in all cases we make it really hard to to go through that process so unfortunately the majority of us who might want to do it are not competent to go through the process and I think that that's where most of us worry is that we might have particularly something like dementia in which case it's not legal pretty much anywhere I I do think that we have an expert actually at UCI who's very much into this discussion but I think that all physicians in a way are our experts at this and I've noticed over the course of my career how much more regulatory stuff there is it makes me crazy I tell you right now I'm going to retire early because I don't want to write another statement about my teaching philosophy or my use of technology or my and I don't want to take any more training modules on whatever but every every physician had during their career grapples with this with patients and their families and it used to be a little quieter of a discussion and more private of the discussion and I have to tell you I think you'd probably be surprised how often physicians and families help ease patients death in one way or another and III think that's important for all of us to think that that can happen in one way or another if the Devils in the details about how to execute it and it gets really complicated when you try to put it into legal statute though if it's um so it's made it a complex national discussion I think now I need to know how do you feel about it so for me one of the things I've always said is that I mean everyone always thinks my research sort of changed me and it probably should have but I don't think it did for starters I mean it's I published things that unfortunately I've gotten known for that I wish I hadn't gotten known for but they include things like you you live longer if you exercise but you also live longer if you have two to four hundred milligrams of caffeine a day drink moderate alcohol get out and engage I mean so so most of those things at least I know they're good and the ones that I don't know that I that I didn't do before I'm still having trouble doing now and exercise leads that list but I've also published that as you get older being overweight is not bad for mortality so I don't feel like it's changed you know me a lot but what what I what has what I have seen a lot of and especially when I was doing more Hospital based work than I do now is that people sometimes feel a need to prolong life longer than I would would want for myself for sure and although I understand when you're dealing with your family and I think the doctors unfortunately have sort of ridden along on that bandwagon and there have been a lot of times when I've argued with surgeons about whether or not to take a patient that I share with them to the operating room for example or something like that I mean I think the notion of healthcare that we should do everything we possibly can is just a blind notion and there needs to be a lot more consideration about all the other things that's going on for each individual person and that can't be regulated on this topic I would highly recommend the book being mortal it's really really good it talks a lot about the medicalization and and how patients used to die at home and because language matters my mom died from Lewy body dementia just kept saying Alzheimer's Alzheimer's Alzheimer's and finally when she was put on a psych hold because she was getting completely out of control and they were playing hot potato nobody wanted her the site the doctor the psych hospital said I don't think it's Alzheimer's I think it's Lewy body and making that distinction and changing her meds made all the difference in the world in terms of her care and because language matters does I know Alzheimer's is well known and that's good but I think it's a do you think it's as important to make sure people recognize that there are different dementia is that and that those distinctions matter that's been my main measure one of my main things for a while in fact they just flew back ten days ago from Turin in Italy where specifically what I was asked to speak on was essentially if we wipe Alzheimer's disease off the face of dementia off the face of the in the United States how much dementia would be left over and the bottom line is that most I mean if we got rid of every whiff of Alzheimer's disease every plaque every tangle at most we would get rid of half of the dementia that we need to worry about so they're alive and and I used to when I started teaching I would put up a slide and it had like it was completely illegible it had causes of except for the title which that causes of dementia because there were like something like 300 causes on there and I try to make the point with everybody that you know it's all not Alzheimer's the problem has been that up until now we don't have easy easy ways to diagnose it and we even have less motivation you know the day we get a cure there's going to be a lot more motivation to making sure that the person you know really has a disease the disease that responds to it and so and it's and and we've evolved a society where we pay for healthcare when someone does a procedure so if a neurologist does an EMG or a nerve conduction study which is pretty much our only procedure you know they'll get probably several thousand dollars from the insurance company if I spent two hours with a patient trying to figure out the right diagnosis I will get at most one hundred and fifty dollars and then we evolve a healthcare system where we make it sound like it's the fault of the physicians when they spent more than fifteen minutes with somebody so we put them on these schedules and then there's no incentive or time or ability and at the end of the day you can't blame the physicians for if it's not gonna make a huge difference or I can't cure them or whatever I think that's changing I think that is the one thing that by the time I finished my career we are going to have some advanced advances in much of that has been technologically driven at least on the level of now we can see plaques and tangles which are the main abnormal proteins of Alzheimer's disease in the brains of individuals using PET scans so that's cool the the problem I think is going to be that I now know from the research I've done that having plaques and tangles in your head it's not a bad thing necessarily my next five years I'm waiting for a funding statement now to study what we're calling resilience which is people who seem to have plaques and tangles in their head and it doesn't bother their thinking and often in elderly people we will find plaques and tangles and I'm not sure they're causing the trouble because we'll also find things like hippocampus fluorosis which nobody is that but affects one out of every three demented oldest old individuals and if you have that you don't walk around normal so I've often said when I'm giving talks if I had a choice give me Alzheimer's disease because I don't want hippocampal sclerosis I don't want Lilly bodies I don't want any of those other things because they're even worse but half of the people that we will image amyloid in even though they'll have a positive amyloid scan they will also have some of those other things and those we still haven't figured out how to diagnose but I think that over time we're going to improve I hope and then it'll make things at least a little better thanks for being here thank you for having me I think I can't I can't imagine why would someone spend their lunch doing this you've talked about retirement but yeah you've talked about this amazing dynamic career and and very up-to-date when are you planning on retiring it and what the heck will you do I just don't quite see it such a good question because I mean the sad part is I don't I always thought people who had a lot of interests and everything would be much better at retiring than me and I don't have any interests and so that's not really good and a lot of our identities is is wrapped up I think and especially in academics you know and the other thing is I love what I do and I still want to do a lot I mean 65 used to be the retirement age because almost no one made it to 65 and now we've extended life 28 years in the last century and as you well know there are plenty of people around here who were 20 years older than 65 and still keep coming in but one of the things that bothers me a lot is I I really feel like we've done the young people a disservice I really feel that when you don't retire around that time then it sort of backed up the whole academic system so so I mean years ago you know the first chairs of departments here was like 32 years old and they were chairs and Dean's and Vice Chancellors now a 30 year old is usually a postdoc still trying to get their first faculty job and we have to take some responsibility I mean it's it's not that I'm trying to get rid of myself but I do think that I need to move over and let young and new ideas you know start start filling in so I guess the question for me I'm using this year to try to figure out exactly what at how and when last year I don't know what came over me it was probably my colleague Maria Kurata I've always like written a grant and then I do it and then I write a grant and I do it and it's a big one but I've only had a half dozen grants basically almost in my life and last year we wrote about a half a dozen and I guess five of them got funded so I got a lot of work to do and and I'm gonna figure out you know how how to do it but I'm also gonna try to figure out how to take myself out of the the other end one of the one of the five grants I'm really excited about Maria Kurata Mike OPI here and Rachael with more in who's about to be UC Davis and dragging me along with them we're gonna do a minority 90 plus study and Kaiser Oakland so it's going to be a third Hispanic a third Asian and a third african-american and a couple hundred whites to show we're not prejudiced and and so that's I'm really really excited about that we've been like you know flown up a time and getting ready to fly up again and every week we're doing you know a lot of phone calls to get that one launched another one is don't ask me how but we convinced NIH that japanese-american men which is the composition of the Honolulu Asian aging study and mostly white women which is a composition of the nun study and those two studies are actually not active anymore but we answered an RFA to combine the data from those two studies with our 90 plus data and somehow come up with hopefully some interesting things I think one thing that is exciting kind of about diversity is you know people always ask me why the stuff I'm learning and unfortunately our 90-plus study is all white and it reflects the comp I did a population-based sample so it reflects people living in one city in 1981 and that city was all white and so even though we went to 37 states to find those individuals you know they reflected the community at the time and so we don't have really any minority representation of note and so every time I publish something everyone wants to know well is it only white Orange County women who you know will benefit from drinking their martini at lunch and and so it's it's it's really nice when then you can say if you find something similar whether it be pathologic or epidemiologic or whatever in japanese-american men who were selected because they were in World War two as part of the US Army so if you find the same thing in a group of individuals that's actually completely different sexes and completely different then you kind of get the notion that maybe it does apply to humans since most things really do apply to humans what's different about us is is not nearly as much as what's the same about us but it's going to be to try to diversify some of the work I've done because I have to confess I've been embarrassed that before I came here I did Baltimore longitudinal study of Aging which was basically retired government scientists and for the first 40 years it was all male and then finally they decided that they would let women in and this is always amazing to me all the old aging studies that were started many years ago before my time usually they were all-male Baltimore longitudinal was all-male government scientists and Honolulu aging was all japanese-american men and yet for every species on the planet where there is a difference in longevity it is always the female that lives longer so when we want to study Aging we only study men yeah but I unfortunately like many scientists have done almost all my work in that arena so I my parting shot is gonna be to change that at least good things must come to an end we've hit our time thank you all very much [Applause]

Channel: UCI Media

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Id: dxLI6GT8fmY

Length: 57min 6sec (3426 seconds)

Published: Tue May 01 2018