Hard talk, 22nd September 2014

S:   = Stephen Sackur; G = Susan Greenfield


S:   My guest today, Baroness Susan Greenfield, carved out a reputation as a leader in the study of degenerative brain diseases such as Alzheimer’s. Of late, though she’s focussed her attention on the impact of 21st century digital technologies on brain development. She believes our screen habits could be doing us damage. But is her warning based on sound science?

Welcome to Hard Talk

You spent most of your professional life studying the brain,

G:  My entire professional life

S:   You’re a neuroscientist

It is an odd first question

How much do you think we do not know about our brain?

G:  Okay, well when I was at school and I did Greek, and I’m sure you’ve learned about the Hydra in Greek mythology, the monster that as soon as you cut off one head, there’s seven appear. It’s a little bit like that. The more you know, the more you know you don’t know.

So, the more you learn about the brain, the more you realise how exciting and puzzling and frustrating it is.

S:   You think about other elements of scientific discovery be it at work on the human body, you think about the knowledge we now have of other organs. Of the heart, for example, the brain is completely different, isn’t it?

G:  Well, it’s not different in that it is still made of cells, it’s made of the same stuff, but that is the exciting thing. Because this same stuff somehow gives you a subjectivity. It gives you an inner world that no-one else can hack into. However much you love someone, however articulate you are, you’re never going to be able to see the world as they see it or vice versa. And it’s this subjectivity, this seeing the world –

S:   it’s consciousness, emotion of the mind

G:  Indeed, well, we can unpack those two terms, cos they’re-, I think they are different. And although one influences the other they can be differentiated. But suffice it to say, it’s this subjectivity that makes the brain so tantalising and so hard.

For example, let’s have a very straightforward example. We all know, scientists know, how Prozac works, a very well-known antidepressant drug. We know it increases the availability of a certain chemical messenger, as it happens, serotonin. But if you say to me then, well, why is it that increasing the availability of this chemical messenger translates into a feeling of well-being? So, whilst the heart and the lungs are mechanical and very complex they may be, they’re just objective physically tangible things, and you just work out all the machinations of them. The brain’s not like that, because you can get it under your fingernail and look at it, but you still don’t quite understand how to frame that complete gap between the objective and the subjective

S:   And because you’ve spent a lot of your scientific life looking at the degenerative effects that can harm the brain, would you say that you now see the brain as a fundamentally very fragile, very vulnerable organ

G:  Well, it’s certainly vulnerable, but at the same time it has huge potential. So it’s both at once. It’s strength is its weakness, in that because it is adaptable to the environment, so it’s changing all the time, it means that on the one hand it can really flourish, it can develop unique connections between brain cells that make the unique person you are, even if you’re a clone, an identical twin, your heart, your lungs , your liver’s all going to be the same, your brain is not the same. And that’s what makes it so exciting, but I think before we go further we should differentiate the loss of mind, as in dementia, and what a mind is, from consciousness, because people often confuse the two, and if you say I’m going to blow my mind, or lose my mind, you’re not going to lose your consciousness. And similarly, when you do lose your consciousness, when you go to sleep, you don’t say, I’m going to bed tonight, I’m going to lose my mind. Of course you don’t.

S:   So can you try, if you can, to explain to me as simply as possible, given that there’s so much work has been connected to Alzheimers and dementia-related disease in the brain, explain to me, what is going on in the brain when somebody gets Alzheimers?

G:  OK. So this is the fastest ever neuroscience course in the world.

S:   You need to be very quick. We’ve got so much to talk about

G:  OK. So . When you’re born, your’re born with a full complement of brain cells. But what distinguishes the human from, say, a goldfish, who don’t have great personalities, let’s be brutal here, is that as you are born, or when you’re born, it’s the connections between the brain cells that distinguish and characterise the growth of the brain after birth. Now why is that interesting or important? It’s interesting or important because as you are having experiences, what will happen is different connections will strengthen or weaken or flourish or atrophy, according to your particular experience. So an example I like to give is say your mother, who initially when you are born, in the words of the great William James into a booming, buzzing confusion, you evaluate the world in sensory terms: how sweet , how fast, how bright. But gradually, as these connections are forming round the pattern of your mum’s face, slowly it will become a face, not a load of abstract blobs. And gradually, it will be differentiated from other faces, so this face, mum’s face, means something that other mums, other ladies, do not mean. So you start to personalise your brain’s connections. And we say that you go from a purely sensory take on the world, to what we call cognitive, from the Latin, cogito, I think, where you have a unique perspective. So if you saw my mum, you would have a different take on her than if I saw my mum. Another example, a wedding ring. A gold shiny simple thing, which as you grow you learn goes on fingers, and you learn it means something that other rings don’t, and you might have one of your own. And that might bring either great happiness or perhaps bitterness, and it’s the most important thing.

S:   And over time these connections expand, and the brain becomes ever more sophisticated.

G:  Ever more personalised, yes.

S:   But my question was, and remains, what happens to a brain when Alzheimer’s kicks in?

G:  Well, I think you’ve now probably answered it yourself, because if we say it’s the connections in the brain that personalise it and give it a meaning, that liberate you from raw senses, so that you now have a highly individual view of the world and take on the world where things mean something beyond their physical properties. Imagine now if those connections are slowly dismantled. You’ll recapitulate childhood, you’ll go back to infancy, you’ll go back to a world of a booming, buzzing confusion. You’ll be conscious, you’ll enjoy icecream, you’ll enjoy the sun in your face, you’ll enjoy people smiling at you, like small children do

S:   And that’s where Alzheimer’sis taking those who suffer from it.

G:  Sadly, yes. That is why you’ll take the world literally at face value, and that’s what an infant will do. Because you now have far fewer connections that give you the checks and balances. If I came in now, dressed up as let’s say a ghost, let’s just say, you would probably work out it was some stupid brain scientist dressed up as a ghost. Whereas a small child would be very frightened by that, as would a dementing patient be very frightened. Because they don’t have the conceptual framework. They don’t have the connections any more that liberate you from the press of the moment. And I’m very interested in how we live our lives dominated by senses sometimes, when we choose to lose our mind or blow our mind, and other times when we put the senses on hold and actually have a very strongly cognitive take on the world.

S:   Now, a lot of people around the world who will be watching this will be aware that the numbers of people suffering from dementia and Alzheimer’s and related diseases of the brain is expanding massively, partly because of the ageing demographic.

G:  And it is the cruellest, because with heart disease or cancer, you’re still the person you were

S:   So what people will want to know, I think, including the 2 million in the UK who are expected to suffer from this by 2050, huge numbers, where’s the hope of a cure?

G:  But it’s worse than that. Because for every one person say, how many people love you? Say ten people love you in the world? Or care about you?

S:   A complicated question, but let’s -

G:  I’m sure we could multiply it by 10 easily. So, for those 2 milliion people, that would mean 20 milliion people whose lives – they’re giving up their jobs, their lives are devastated, having psychiatric problems, they’re distraught, well, they’re having personal tragedies. It’s not just the patients, it’s the carers.

S:   Very important point. So what they want to know is, after all of the work, and the time and effort you’ve invested in this study of the brain, how close are we to a cure? Do you have anything? To treatment and then a cure.

G:  OK. What I have to say first, is I’m sure you’re aware of this, other people have said it, any drug, even when there’s been proof of concept, it’s like ten to fifteen years before it comes on – We probably have this with the Ebola vaccine. You know, it has to go through rigorous clinical trials. So leaving that to one side, the mandatory ten years, let’s say, before, however brilliant the concept or effective the drug in a monkey, it will still take ten years. So leave that to one side. My own view is that it’s within a reasonable time, but not tomorrow. And the reason I say that is that for the last fifteen years there’s been no new drug for Alzheimers at all. Why? Given all the muscle of the pharmaceutical industry, you would expect that if there was a clearly defined target and an agreed mechanism, then people would have solved something by now. And that hasn’t happened.

S:   Well is that because they are actually not targeting Alzheimers with the money, with the resources and the expertise that they are applying to things like cancer?

G:  Well, obviously, because people are still embarrassed by mental disorders, and embarrassed by dementia it may be that until very recently, the wonderful work of people like Terry Pratchett, who actually come out and talk about it,

S:   Well, we’ve had him on this programme. He made the point that figures for 2010, the latest I could find showed that money in the UK, put into Alzheimers research, dementia, etc, 50 million, and into cancer and related subjects, 590 million.

G:  Yeah, and there’s another figure that I was reading just recently, about ongoing research projects or clinical trials, and it’s puny compared to what’s going on for cancer. I think the problem, it’s not just money. And people often, often hear politicians, dare I say it, well, we’re going to put more money in. Well, of course, you need money, but just chucking money at something, as the pharmaceutical industry have done for 10 or 15 years isn’t all there is. And my own view, and this is where I am quite heretical, and I will stick my neck out, because I’m very left of field, and I do a different approach to other people, is that the scientific community is a very conservative community, actually, with a little c. That is to say, most public sector grants are done with peer reviews. They’re done by committees. And the tendency of the committee is sometimes to be risk averse. That is to say, you want to show how sound you are to your colleagues, and you want to screen out the frankly loony or crazy things, that might waste taxpayers’ money. The price you pay for that is, there might be some new idea, something novel and exciting, that also is getting that treatment.

S:   We’re going to make  a turn in a minute, in your career, and talk about other environmental impacts on the brain which you are very worried about, but you’ve just raised an important point, which is you’ve suggested to me that the very foundation of scientific research, that is peer review, the notion that you go out, you do some research, you gather evidence, you draw conclusions, and then you present that to your peers, who can criticise it, and dig away at it as much as they want, are you suggesting that’s not the best way of looking at the brain?

G:  No, because immediately you’ll say, well what’s the alternative, then? And clearly you need some kind of expert appraisal of what you’re doing. I think the issue of money does constrain things, and people’s careers, and certainly in the public sector it is a problem that people can be overly cautious. What I would like to see is more diversity. To let a thousand flowers bloom. I’m not saying that I have the right approach, but just say I did or someone else has, it would be very sad if that was throttled at birth simply because it didn’t adhere to the current dogma.

Are you familiar with Thomas Kuhn? Politics of Science Revolutions. He wrote it is in the sixties. He introduced the notion of a paradigm shift. That is to say, he said, in science what happens is people have a certain paradigm or fashion, and then so many things accumulate that don’t quite make sense, he called them anomalies, and it’s only after a while, when you have too many anomalies to shove under the carpet, that there is a revolution, a paradigm shift, and I think that that’s what we need for neurodegeneration.

S:   I now want to turn to something that has preoccupied you of late, which isn’t much necessarily about the degeneration that we think of in Alzheimers, but a different form of damage done to the brain. You say, damage done potentially to the brain by, if I can put it that way, by a digital lifestyle. By the fact that more and more of particularly young people live so much of their lives through two-dimensional screens, using social networks on their computers or their mobile phones or gaming, using video games, you say that there is evidence that this is having a damaging effect on the brain.

G:  Can we just unpack that slightly. The word damaging is a very strong one, and it’s a value judgement. Because clearly, although there can be damage, and there is evidence for physical damage to the brain, I don’t want to give the impression that this is like smoking and cancer was.

S:   But one of the most high-profile articles you wrote on this, and it’s notable you’ve done a lot of this through the press, you used the word ‘threat’ in the Daily Mail, back in 2008, you called it, you called this sort of screen-based internet, computer-based lifestyle, a threat.

G:  Yes, On the whole it is a threat, but there is a difference between threat and damage. There’s a difference. And on the whole, I try to be cautious, although people do take me to task for using the subjunctive rather than the indicative and being careful. So I can’t really win. But nonetheless, yes. But in terms of this evidence, anyone is welcome to look at my website, and it’s been up there for the last year, there’s 500 peer reviewed papers in support of the possible problematic effects.

S:   But how much of that research has been done by you?

G:  It’s irrelevant. Why should it be done-  If it’s in a peer-reviewed journal it’s irrelevant who’s done it. It doesn’t make it any less valid if I haven’t done it.

S:   Why were you not motivated by the feeling that this was important to actually do some research yourself?

G:  Well, I have. But the whole range, because this is such a big subject, it spans through from molecular biology through to psychiatry, through to epidemiology, and I’m a neuroscientist, so I do what I do. But it’s rather silly, and this has been said to me before, so I’m quite used to it as a comeback-

S:   By lots of scientists -

G:  Who are they?

S:   Lots of scientists have said to you, where’s your evidence?

G:  Oh no, that’s different. You’re confusing two things, with respect. Between people saying, where’s your evidence,

S:   Your evidence, evidence you yourself have discovered

G:  Well, I don’t think a scientist would say that because, I’d like to know who they are, because,

S:   Well, we’ll go through a few. Ben Goldacre, for example.

G:  He’s not a scientist, he’s a journalist

S:   Well he is a scientist

G:  No, he’s not.

S:   He’s trained as a scientist but he’s also a journalist. He turned journalist and he blogs on science, but it doesn’t mean he’s not a scientist

G:  Well, it depends how you define scientist. How many peer-reviewed journals-

S:   He is a trained scientist. He says this, he say, why can’t she simply publish her claims in a peer-reviewed academic paper with the accompanying evidence that can then be properly assessed.

G:  Let’s unpack that. On the whole, a scientist would go by the paper. They wouldn’t give a stuff, frankly, who actually did it. It doesn’t make it more or less valid if I’ve done it or if someone else has done it. If I did it and it’s been through-

S:   Our audience won’t necessarily know so much about these names, but there’s Dean Burnett at Cardiff University, there’s Peter Etchells at Bath Spa. They both work in neuroscience. Peter Etchells works in biological psychology

G:  And what do they say?

S:   He says, why has-  forgive me, I don’t want to misquote him. He says she, that means you, has the influence and ability to set up a study into her theories on the impact of gaming and social media and then publish her findings. So why doesn’t she do it.

G:  Well I would challenge two things, yeah. First of all, within my area of expertise, I’ve published on the effects of environmental enrichment on the brain, I’ve published extensively on dopamine, which is the molecule that features in my book a lot and I have lots and lots of papers on that, and I’ve actually published on neuroscience in education, so within my expertise, given that I can’t go through from molecular biology through to psychiatry to epidemiology, within my area of expertise, for sure I’ve published. I’d also challenge him, and I’m in a way flattered that he thinks I’ve got the money and the resources and the influence to set up a study.

S:   You are pretty influential.

G:  I’m not

S:   You were director of the Royal Institution. You’re one of Britain’s leading scientists. And you’re saying something so profoundly important to so many people. Because you’ve taken it in different directions. For example, it appears that many people, as you have pointed out, for example, that there is a rise in rate of diagnosis of autism, alongside the widespread use of the internet and social media. You appear, to many people, to have drawn a correlation and a causal link between the two.

G:  Oh no.

S:   And that upsets many scientists, who say there’s absolutely no causation at all.

G:  I think we’re conflating, conflating things. About how much I have done, and the validity of the claim irrespective of whether I’ve done it or not. So let me just clear the first thing up. I cannot do molecular biology through to psychiatry. I don’t have infinite resources to set up a study. If someone watching this now wants to give me a lot of money, then, yeah fine.

S:   You’re being honest about where your expertise lies, but you also make very big claims.

G:  Of course.

S:   Going back to the Daily Mail. Because again, people say, she’s a scientist, she communicates her ideas through the press rather than through journals and peer review

G:  Can I just say I have published 200 peer-reviewed papers.

S:   I understand that, but much of it on the degenerative effects of Alzheimer’s and things like that-

G:  Also on dopamine, also on environmental enrichment-

S:   But here’s the thing, the claims are so sweeping. Back to the Daily Mail. You said “A growing number of adults choose to inhabit a world that is producing changes in their behaviour. Attention spans are shorter, personal communication skills reduced. There’s a marked reduction in the ability to think abstractly. In short, digital immersive technology is rewiring our brains”. I mean, these are huge claims you are making.

G:  Yeah. Fine, well look at my website, or buy the book, and you’ll see it’s based on five or six hundred papers. And whilst nothing in science is definitive, there’s no smoking gun experiment, yes, I stand by those claims. And if they are sweeping, well shouldn’t we be thinking about that, rather than trying to chop me off at the knees , and say oh it’s not right because she hasn’t published it. Shouldn’t we be looking at those things? Don’t you owe it to the kids? The next generation?

S:   We have to be careful to be absolutely responsible in the ideas we spread. For example, not so long ago, we saw one scientist absolutely convinced and publishing papers to suggest that there was a direct link between autism and certain vaccinations. It’s been completely debunked. And now the National Autism Society and others are accusing you of scaremongering.

G:  Well-

S:   In your linkage of autism and this use of digital technology.

G:  No. You have to be careful, because what I say is autistic spectrum disorder. That’s not the same as autism. I don’t <?> the book, I don’t have all the references at my fingertips now, but there are various authorities that say, yes. Well let me give you one paper that I just do happen to remember.  If someone with autistic spectrum disorder is shown a table and a face, their EEG will be similar to both presentations; someone without autistic spectrum disorder, if you show a table and a face, the response to the face will be much more exaggerated. Faces being more important than tables. People who are heavy internet users have the same EEG response, or a similar EEG response to someone with autistic spectrum disorder. That’s just one example. Now, -

S:   So hang on. That’s important. Are you saying that any of us, whether we’re diagnosed autistic or not, that any of us human beings with human brains, if we spend a lot of time on screens from videogaming to social networking, we run the risk of displaying autistic-like behaviours?

G:  Some people think that, yes. It’s not just me.

S:   Some people think that. Do you think that?

G:  Yes. And I’ll tell you why

S:   Do you really believe that?

G:  Yes, I’ll tell you why I think that. Is the problem – Well, when you talk to someone like we’re talking now. We look each other in the eye, we’re seeing forward. If you were averting your eyes and folding your arms, I wouldn’t feel so much of a rapport. I’d talk to you. Oh, you’re folding your arms now.

S:   So what does that say about me? But maybe that just means you are being far too sweeping and generalising way too much?

G:  No, no. Let me finish my point. We’re using interpersonal communication skills. We’re trying to process what we’re each saying. We’re judging from voice tone, from body language, what the person is feeling. On the screen, those cues are not available to you. So people with autistic spectrum disorder have a problem anyway with understanding how other people are feeling and thinking. So if you are constantly rehearsing a form of communication where you don’t practice eye contact, body language, voice tone interpretation it seems not unreasonable to say you’re not going to be so good at those things. And that is not a sweeping generalisation. You can always call – how is it that generalisations are always sweeping? Why can’t you have an ordinary generalisation? It just seems a reasonable suggestion.

S:   You turn it into some sort of sweeping idea. You call it mind change. You say the 21st century with all its digital technologies is introducing this concept of mind change, which you say is actually as important and far-reaching as climate change.

G:  I do

S:   It’s obviously happening in all our individual heads

G:  I do, I do, I do

S:   The thing about climate change is, once it happens, there are negative feedbacks which many people believe make it irreversible. Surely the difference is that this mind change is not irreversible because your whole theory is that the brain is incredibly plastic.

G:  Absolutely. Absolutely. Now. Like all analogies, they only go so far. The analogies, there’s four. Which I think are strong and important. First is, it’s global. Second, it’s unprecedented. Third, as you are displaying admirably, it’s controversial. And fourth, it’s multifaceted. It’s not such a thing as is climate change good or bad or one thing. And the same with mind change. Are computers good or bad? Of  course, you have to break it down into social interaction, and empathy and social networking or videogaming or attention or search engines and information versus knowledge. So it’s a multifaceted issue. Another reason why you can’t do the single smoking gun experiment. There’s lots of different questions to unpack. So because of those four parallels, I would strongly suggest that mind change is comparable to climate change. But the difference, and this is something I say in my book at the end, because I’m often demonised as some great Luddite, pessimist person, no, surely because the brain is so adaptable, this is fantastic because it gives us a chance. Unlike climate change, which is as far as I understand, it’s just putting the brakes on, doing damage limitation, this doesn’t have to be. Surely we could harness this technology to deliver the most marvellous environment.

S:   We’re almost out of time. What do you believe we have to do? How to change our relationship with the computer, the digital age, to make sure we don’t damage our brain?

G:  Very briefly. I think we have to ask the hardest question of all. Which is what we want out of life. What do you want your kids to be? What kind of society do you want to live in? Because until we know, this is the first time humans, in other parts of the world they still can’t do that. You’re hungry, you’re cold, you’re in pain. This country, we’re able to ask that question, and I think what we should say is, first of all what do we want out of our lives, and then how do we harness this very powerful technology to deliver that