Thomas Insel: Toward a new understanding of mental illness

So let's start with some good news, and the good news has to do with what do we know based on biomedical research that actually has changed the outcomes for many very serious diseases? Let's start with leukemia, acute lymphoblastic leukemia, ALL, the most common cancer of children. When was a student, the mortality rate was about !" percent. #oday, some $", %& years later, we're talking about a mortality rate that's reduced by '" percent. Si( thousand children each year who would have previously died of this disease are cured. f you want the really big numbers, look at these numbers for heart disease. )eart disease used to be the biggest killer, particularly for men in their *&s. #oday, we've seen a +%, percent reduction in mortality from heart disease ,, remarkably, -.- million deaths averted every year. A .S, incredibly, has /ust been named, in the past month, a chronic disease, meaning that a $&,year,old who becomes infected with ) 0 is e(pected not to live weeks, months, or a couple of years, as we said only a decade ago, but is thought to live decades, probably to die in his '+&s or '1&s from other causes altogether. #hese are /ust remarkable, remarkable changes in the outlook for some of the biggest killers. And one in particular that you probably wouldn't know about, stroke, which has been, along with heart disease, one of the biggest killers in this country, is a disease in which now we know that if you can get people into the emergency room within three hours of the onset, some %& percent of them will be able to leave the hospital without any disability whatsoever. 2emarkable stories, good,news stories, all of which boil down to understanding something about the diseases that has allowed us to detect early and intervene early. 3arly detection, early intervention, that's the story for these successes. 4nfortunately, the news is not all good. Let's talk about one other story which has to do with suicide. 5ow this is, of course, not a disease, per se. t's a condition, or it's a situation that leads to mortality. What you may not reali6e is /ust how prevalent it is. #here are %',&&& suicides each year in the 4nited States. #hat means one about every -" minutes. #hird most common cause of death amongst people between the ages of -" and $". t's kind of an e(traordinary story when you reali6e that this is twice as common as homicide and actually more common as a source of death than traffic fatalities in this country. 5ow, when we talk about suicide, there is also a medical contribution here, because !& percent of suicides are related to a mental illness7 depression, bipolar disorder, schi6ophrenia, anore(ia, borderline personality. #here's a long list of disorders that contribute, and as mentioned before, often early in life. 8ut it's not /ust the mortality from these disorders. t's also morbidity. f you look at disability, as measured by the World )ealth 9rgani6ation with something they call the .isability Ad/usted Life :ears, it's kind of a metric that nobody would think of e(cept an

economist, e(cept it's one way of trying to capture what is lost in terms of disability from medical causes, and as you can see, virtually %& percent of all disability from all medical causes can be attributed to mental disorders, neuropsychiatric syndromes. :ou're probably thinking that doesn't make any sense. mean, cancer seems far more serious. )eart disease seems far more serious. 8ut you can see actually they are further down this list, and that's because we're talking here about disability. What drives the disability for these disorders like schi6ophrenia and bipolar and depression? Why are they number one here? Well, there are probably three reasons. 9ne is that they're highly prevalent. About one in five people will suffer from one of these disorders in the course of their lifetime. A second, of course, is that, for some people, these become truly disabling, and it's about four to five percent, perhaps one in $&. 8ut what really drives these numbers, this high morbidity, and to some e(tent the high mortality, is the fact that these start very early in life. ;ifty percent will have onset by age -*, 1" percent by age $*, a picture that is very different than what one would see if you're talking about cancer or heart disease, diabetes, hypertension ,, most of the ma/or illnesses that we think about as being sources of morbidity and mortality. #hese are, indeed, the chronic disorders of young people. 5ow, started by telling you that there were some good,news stories. #his is obviously not one of them. #his is the part of it that is perhaps most difficult, and in a sense this is a kind of confession for me. <y /ob is to actually make sure that we make progress on all of these disorders. work for the federal government. Actually, work for you. :ou pay my salary. And maybe at this point, when you know what do, or maybe what 've failed to do, you'll think that probably ought to be fired, and could certainly understand that. 8ut what want to suggest, and the reason 'm here is to tell you that think we're about to be in a very different world as we think about these illnesses. What 've been talking to you about so far is mental disorders, diseases of the mind. #hat's actually becoming a rather unpopular term these days, and people feel that, for whatever reason, it's politically better to use the term behavioral disorders and to talk about these as disorders of behavior. ;air enough. #hey are disorders of behavior, and they are disorders of the mind. 8ut what want to suggest to you is that both of those terms, which have been in play for a century or more, are actually now impediments to progress, that what we need conceptually to make progress here is to rethink these disorders as brain disorders. 5ow, for some of you, you're going to say, =9h my goodness, here we go again. We're going to hear about a biochemical imbalance or we're going to hear about drugs or we're going to hear about some very simplistic notion that will take our sub/ective e(perience and turn it into molecules, or maybe into some sort of very flat, unidimensional understanding of what it is to have depression or schi6ophrenia. When we talk about the brain, it is anything but unidimensional or simplistic or reductionistic. t depends, of course, on what scale or what scope you want to think

about, but this is an organ of surreal comple(ity, and we are /ust beginning to understand how to even study it, whether you're thinking about the -&& billion neurons that are in the corte( or the -&& trillion synapses that make up all the connections. We have /ust begun to try to figure out how do we take this very comple( machine that does e(traordinary kinds of information processing and use our own minds to understand this very comple( brain that supports our own minds. t's actually a kind of cruel trick of evolution that we simply don't have a brain that seems to be wired well enough to understand itself. n a sense, it actually makes you feel that when you're in the safe 6one of studying behavior or cognition, something you can observe, that in a way feels more simplistic and reductionistic than trying to engage this very comple(, mysterious organ that we're beginning to try to understand. 5ow, already in the case of the brain disorders that 've been talking to you about, depression, obsessive compulsive disorder, post,traumatic stress disorder, while we don't have an in,depth understanding of how they are abnormally processed or what the brain is doing in these illnesses, we have been able to already identify some of the connectional differences, or some of the ways in which the circuitry is different for people who have these disorders. We call this the human connectome, and you can think about the connectome sort of as the wiring diagram of the brain. :ou'll hear more about this in a few minutes. #he important piece here is that as you begin to look at people who have these disorders, the one in five of us who struggle in some way, you find that there's a lot of variation in the way that the brain is wired, but there are some predictable patterns, and those patterns are risk factors for developing one of these disorders. t's a little different than the way we think about brain disorders like )untington's or >arkinson's or Al6heimer's disease where you have a bombed,out part of your corte(. )ere we're talking about traffic /ams, or sometimes detours, or sometimes problems with /ust the way that things are connected and the way that the brain functions. :ou could, if you want, compare this to, on the one hand, a myocardial infarction, a heart attack, where you have dead tissue in the heart, versus an arrhythmia, where the organ simply isn't functioning because of the communication problems within it. 3ither one would kill you? in only one of them will you find a ma/or lesion. As we think about this, probably it's better to actually go a little deeper into one particular disorder, and that would be schi6ophrenia, because think that's a good case for helping to understand why thinking of this as a brain disorder matters. #hese are scans from @udy 2apoport and her colleagues at the 5ational nstitute of <ental )ealth in which they studied children with very early onset schi6ophrenia, and you can see already in the top there's areas that are red or orange, yellow, are places where there's less gray matter, and as they followed them over five years, comparing them to age match controls, you can see that, particularly in areas like the dorsolateral prefrontal corte( or the superior temporal gyrus, there's a profound loss of gray matter. And it's important, if you try to model this, you can think about normal development as a loss of cortical mass, loss of cortical gray matter, and what's happening in schi6ophrenia is that you overshoot that mark, and at some point, when you overshoot, you cross a threshold, and it's that threshold where we say, this is a person who has this disease, because they have the behavioral symptoms of hallucinations and delusions. #hat's something we can observe.

8ut look at this closely and you can see that actually they've crossed a different threshold. #hey've crossed a brain threshold much earlier, that perhaps not at age $$ or $&, but even by age -" or -+ you can begin to see the tra/ectory for development is Auite different at the level of the brain, not at the level of behavior. Why does this matter? Well first because, for brain disorders, behavior is the last thing to change. We know that for Al6heimer's, for >arkinson's, for )untington's. #here are changes in the brain a decade or more before you see the first signs of a behavioral change. #he tools that we have now allow us to detect these brain changes much earlier, long before the symptoms emerge. 8ut most important, go back to where we started. #he good,news stories in medicine are early detection, early intervention. f we waited until the heart attack, we would be sacrificing -.- million lives every year in this country to heart disease. #hat is precisely what we do today when we decide that everybody with one of these brain disorders, brain circuit disorders, has a behavioral disorder. We wait until the behavior becomes manifest. #hat's not early detection. #hat's not early intervention. 5ow to be clear, we're not Auite ready to do this. We don't have all the facts. We don't actually even know what the tools will be, nor what to precisely look for in every case to be able to get there before the behavior emerges as different. 8ut this tells us how we need to think about it, and where we need to go. Are we going to be there soon? think that this is something that will happen over the course of the ne(t few years, but 'd like to finish with a Auote about trying to predict how this will happen by somebody who's thought a lot about changes in concepts and changes in technology. =We always overestimate the change that will occur in the ne(t two years and underestimate the change that will occur in the ne(t -&.= ,, 8ill Bates. #hanks very much. CApplauseD

E35 298 5S95 F SG)99LS E LL G23A# 0 #: Bood morning. )ow are you? t's been great, hasn't it? 've been blown away by the whole thing. n fact, 'm leaving. CLaughterD #here have been three themes, haven't there, running through the conference, which are relevant to what want to talk about. 9ne is the e(traordinary evidence of human creativity in all of the presentations that we've had and in all of the people here. @ust the variety of it and the range of it. #he second is that it's put us in a place where we have no idea what's going to happen, in terms of the future. 5o idea how this may play out. have an interest in education ,, actually, what find is everybody has an interest in education. .on't you? find this very interesting. f you're at a dinner party, and you say

you work in education ,, actually, you're not often at dinner parties, frankly, if you work in education. CLaughterD :ou're not asked. And you're never asked back, curiously. #hat's strange to me. 8ut if you are, and you say to somebody, you know, they say, =What do you do?= and you say you work in education, you can see the blood run from their face. #hey're like, =9h my Bod,= you know, =Why me? <y one night out all week.= CLaughterD 8ut if you ask about their education, they pin you to the wall. 8ecause it's one of those things that goes deep with people, am right? Like religion, and money and other things. have a big interest in education, and think we all do. We have a huge vested interest in it, partly because it's education that's meant to take us into this future that we can't grasp. f you think of it, children starting school this year will be retiring in $&+". 5obody has a clue ,, despite all the e(pertise that's been on parade for the past four days ,, what the world will look like in five years' time. And yet we're meant to be educating them for it. So the unpredictability, think, is e(traordinary. And the third part of this is that we've all agreed, nonetheless, on the really e(traordinary capacities that children have ,, their capacities for innovation. mean, Sirena last night was a marvel, wasn't she? @ust seeing what she could do. And she's e(ceptional, but think she's not, so to speak, e(ceptional in the whole of childhood. What you have there is a person of e(traordinary dedication who found a talent. And my contention is, all kids have tremendous talents. And we sAuander them, pretty ruthlessly. So want to talk about education and want to talk about creativity. <y contention is that creativity now is as important in education as literacy, and we should treat it with the same status. CApplauseD #hank you. #hat was it, by the way. #hank you very much. CLaughterD So, -" minutes left. Well, was born ... no. CLaughterD heard a great story recently ,, love telling it ,, of a little girl who was in a drawing lesson. She was si( and she was at the back, drawing, and the teacher said this little girl hardly ever paid attention, and in this drawing lesson she did. #he teacher was fascinated and she went over to her and she said, =What are you drawing?= And the girl said, = 'm drawing a picture of Bod.= And the teacher said, =8ut nobody knows what Bod looks like.= And the girl said, =#hey will in a minute.= CLaughterD When my son was four in 3ngland ,, actually he was four everywhere, to be honest. CLaughterD f we're being strict about it, wherever he went, he was four that year. )e was in the 5ativity play. .o you remember the story? 5o, it was big. t was a big story. <el Bibson did the seAuel. :ou may have seen it7 =5ativity .= 8ut @ames got the part of @oseph, which we were thrilled about. We considered this to be one of the lead parts. We had the place crammed full of agents in #,shirts7 =@ames 2obinson S @osephH= CLaughterD )e didn't have to speak, but you know the bit where the three kings come in. #hey come in bearing gifts, and they bring gold, frankincense and myrhh. #his really happened. We were sitting there and think they /ust went out of seAuence, because we talked to the little boy afterward and we said, =:ou 9E with that?= And he said, =:eah, why? Was that wrong?= #hey /ust switched, that was it. Anyway, the three boys came in ,, four,year,olds with tea towels on their heads ,, and they put these bo(es down, and the first boy said, = bring you gold.= And the second boy said, = bring you myrhh.= And the third boy said, =;rank sent this.= CLaughterD

What these things have in common is that kids will take a chance. f they don't know, they'll have a go. Am right? #hey're not frightened of being wrong. 5ow, don't mean to say that being wrong is the same thing as being creative. What we do know is, if you're not prepared to be wrong, you'll never come up with anything original ,, if you're not prepared to be wrong. And by the time they get to be adults, most kids have lost that capacity. #hey have become frightened of being wrong. And we run our companies like this, by the way. We stigmati6e mistakes. And we're now running national education systems where mistakes are the worst thing you can make. And the result is that we are educating people out of their creative capacities. >icasso once said this ,, he said that all children are born artists. #he problem is to remain an artist as we grow up. believe this passionately, that we don't grow into creativity, we grow out of it. 9r rather, we get educated out if it. So why is this? lived in Stratford,on,Avon until about five years ago. n fact, we moved from Stratford to Los Angeles. So you can imagine what a seamless transition that was. CLaughterD Actually, we lived in a place called Snitterfield, /ust outside Stratford, which is where Shakespeare's father was born. Are you struck by a new thought? was. :ou don't think of Shakespeare having a father, do you? .o you? 8ecause you don't think of Shakespeare being a child, do you? Shakespeare being seven? never thought of it. mean, he was seven at some point. )e was in somebody's 3nglish class, wasn't he? )ow annoying would that be? CLaughterD =<ust try harder.= 8eing sent to bed by his dad, you know, to Shakespeare, =Bo to bed, now,= to William Shakespeare, =and put the pencil down. And stop speaking like that. t's confusing everybody.= CLaughterD Anyway, we moved from Stratford to Los Angeles, and /ust want to say a word about the transition, actually. <y son didn't want to come. 've got two kids. )e's $- now? my daughter's -+. )e didn't want to come to Los Angeles. )e loved it, but he had a girlfriend in 3ngland. #his was the love of his life, Sarah. )e'd known her for a month. <ind you, they'd had their fourth anniversary, because it's a long time when you're -+. Anyway, he was really upset on the plane, and he said, = 'll never find another girl like Sarah.= And we were rather pleased about that, frankly, because she was the main reason we were leaving the country. CLaughterD 8ut something strikes you when you move to America and when you travel around the world7 3very education system on earth has the same hierarchy of sub/ects. 3very one. .oesn't matter where you go. :ou'd think it would be otherwise, but it isn't. At the top are mathematics and languages, then the humanities, and the bottom are the arts. 3verywhere on 3arth. And in pretty much every system too, there's a hierarchy within the arts. Art and music are normally given a higher status in schools than drama and dance. #here isn't an education system on the planet that teaches dance everyday to children the way we teach them mathematics. Why? Why not? think this is rather important. think math is very important, but so is dance. Ghildren dance all the time if they're allowed to, we all do. We all have bodies, don't we? .id miss a meeting? CLaughterD #ruthfully, what happens is, as children grow up, we start to educate them progressively from the waist up. And then we focus on their heads. And slightly to one side.

f you were to visit education, as an alien, and say =What's it for, public education?= think you'd have to conclude ,, if you look at the output, who really succeeds by this, who does everything that they should, who gets all the brownie points, who are the winners ,, think you'd have to conclude the whole purpose of public education throughout the world is to produce university professors. sn't it? #hey're the people who come out the top. And used to be one, so there. CLaughterD And like university professors, but you know, we shouldn't hold them up as the high,water mark of all human achievement. #hey're /ust a form of life, another form of life. 8ut they're rather curious, and say this out of affection for them. #here's something curious about professors in my e(perience ,, not all of them, but typically ,, they live in their heads. #hey live up there, and slightly to one side. #hey're disembodied, you know, in a kind of literal way. #hey look upon their body as a form of transport for their heads, don't they? CLaughterD t's a way of getting their head to meetings. f you want real evidence of out,of,body e(periences, by the way, get yourself along to a residential conference of senior academics, and pop into the discotheAue on the final night. CLaughterD And there you will see it ,, grown men and women writhing uncontrollably, off the beat, waiting until it ends so they can go home and write a paper about it. 5ow our education system is predicated on the idea of academic ability. And there's a reason. #he whole system was invented ,, around the world, there were no public systems of education, really, before the -!th century. #hey all came into being to meet the needs of industrialism. So the hierarchy is rooted on two ideas. 5umber one, that the most useful sub/ects for work are at the top. So you were probably steered benignly away from things at school when you were a kid, things you liked, on the grounds that you would never get a /ob doing that. s that right? .on't do music, you're not going to be a musician? don't do art, you won't be an artist. 8enign advice ,, now, profoundly mistaken. #he whole world is engulfed in a revolution. And the second is academic ability, which has really come to dominate our view of intelligence, because the universities designed the system in their image. f you think of it, the whole system of public education around the world is a protracted process of university entrance. And the conseAuence is that many highly talented, brilliant, creative people think they're not, because the thing they were good at at school wasn't valued, or was actually stigmati6ed. And think we can't afford to go on that way. n the ne(t %& years, according to 453SG9, more people worldwide will be graduating through education than since the beginning of history. <ore people, and it's the combination of all the things we've talked about ,, technology and its transformation effect on work, and demography and the huge e(plosion in population. Suddenly, degrees aren't worth anything. sn't that true? When was a student, if you had a degree, you had a /ob. f you didn't have a /ob it's because you didn't want one. And didn't want one, frankly. CLaughterD 8ut now kids with degrees are often heading home to carry on playing video games, because you need an <A where the previous /ob reAuired a 8A, and now you need a >h. for the other. t's a process of academic inflation. And it indicates the whole structure of education is shifting beneath our feet. We need to radically rethink our view of intelligence.

We know three things about intelligence. 9ne, it's diverse. We think about the world in all the ways that we e(perience it. We think visually, we think in sound, we think kinesthetically. We think in abstract terms, we think in movement. Secondly, intelligence is dynamic. f you look at the interactions of a human brain, as we heard yesterday from a number of presentations, intelligence is wonderfully interactive. #he brain isn't divided into compartments. n fact, creativity ,, which define as the process of having original ideas that have value ,, more often than not comes about through the interaction of different disciplinary ways of seeing things. #he brain is intentionally ,, by the way, there's a shaft of nerves that /oins the two halves of the brain called the corpus callosum. t's thicker in women. ;ollowing off from )elen yesterday, think this is probably why women are better at multi,tasking. 8ecause you are, aren't you? #here's a raft of research, but know it from my personal life. f my wife is cooking a meal at home ,, which is not often, thankfully. CLaughterD 8ut you know, she's doing ,, no, she's good at some things ,, but if she's cooking, you know, she's dealing with people on the phone, she's talking to the kids, she's painting the ceiling, she's doing open,heart surgery over here. f 'm cooking, the door is shut, the kids are out, the phone's on the hook, if she comes in get annoyed. say, =#erry, please, 'm trying to fry an egg in here. Bive me a break.= CLaughterD Actually, you know that old philosophical thing, if a tree falls in a forest and nobody hears it, did it happen? 2emember that old chestnut? saw a great t,shirt really recently which said, = f a man speaks his mind in a forest, and no woman hears him, is he still wrong?= CLaughterD And the third thing about intelligence is, it's distinct. 'm doing a new book at the moment called =3piphany,= which is based on a series of interviews with people about how they discovered their talent. 'm fascinated by how people got to be there. t's really prompted by a conversation had with a wonderful woman who maybe most people have never heard of? she's called Billian Lynne ,, have you heard of her? Some have. She's a choreographer and everybody knows her work. She did =Gats= and =>hantom of the 9pera.= She's wonderful. used to be on the board of the 2oyal 8allet in 3ngland, as you can see. Anyway, Billian and had lunch one day and said, =Billian, how'd you get to be a dancer?= And she said it was interesting? when she was at school, she was really hopeless. And the school, in the '%&s, wrote to her parents and said, =We think Billian has a learning disorder.= She couldn't concentrate? she was fidgeting. think now they'd say she had A.).. Wouldn't you? 8ut this was the -!%&s, and A.). hadn't been invented at this point. t wasn't an available condition. CLaughterD >eople weren't aware they could have that. Anyway, she went to see this specialist. So, this oak,paneled room, and she was there with her mother, and she was led and sat on this chair at the end, and she sat on her hands for $& minutes while this man talked to her mother about all the problems Billian was having at school. And at the end of it ,, because she was disturbing people? her homework was always late? and so on, little kid of eight ,, in the end, the doctor went and sat ne(t to Billian and said, =Billian, 've listened to all these things that your mother's told me, and need to speak to her privately.= )e said, =Wait here. We'll be back? we won't be very long,= and they went and left her. 8ut as they went out the room, he turned

on the radio that was sitting on his desk. And when they got out the room, he said to her mother, =@ust stand and watch her.= And the minute they left the room, she said, she was on her feet, moving to the music. And they watched for a few minutes and he turned to her mother and said, =<rs. Lynne, Billian isn't sick? she's a dancer. #ake her to a dance school.= said, =What happened?= She said, =She did. can't tell you how wonderful it was. We walked in this room and it was full of people like me. >eople who couldn't sit still. >eople who had to move to think.= Who had to move to think. #hey did ballet? they did tap? they did /a66? they did modern? they did contemporary. She was eventually auditioned for the 2oyal 8allet School? she became a soloist? she had a wonderful career at the 2oyal 8allet. She eventually graduated from the 2oyal 8allet School and founded her own company ,, the Billian Lynne .ance Gompany ,, met Andrew Lloyd Weber. She's been responsible for some of the most successful musical theater productions in history? she's given pleasure to millions? and she's a multi,millionaire. Somebody else might have put her on medication and told her to calm down. 5ow, think ... CApplauseD What think it comes to is this7 Al Bore spoke the other night about ecology and the revolution that was triggered by 2achel Garson. believe our only hope for the future is to adopt a new conception of human ecology, one in which we start to reconstitute our conception of the richness of human capacity. 9ur education system has mined our minds in the way that we strip,mine the earth7 for a particular commodity. And for the future, it won't serve us. We have to rethink the fundamental principles on which we're educating our children. #here was a wonderful Auote by @onas Salk, who said, = f all the insects were to disappear from the earth, within "& years all life on 3arth would end. f all human beings disappeared from the earth, within "& years all forms of life would flourish.= And he's right. What #3. celebrates is the gift of the human imagination. We have to be careful now that we use this gift wisely and that we avert some of the scenarios that we've talked about. And the only way we'll do it is by seeing our creative capacities for the richness they are and seeing our children for the hope that they are. And our task is to educate their whole being, so they can face this future. 8y the way ,, we may not see this future, but they will. And our /ob is to help them make something of it. #hank you very much.

82353 829W5

So, 'll start with this7 a couple years ago, an event planner called me because was going to do a speaking event. And she called, and she said, = 'm really struggling with how to write about you on the little flier.= And thought, =Well, what's the struggle?= And she said, =Well, saw you speak, and 'm going to call you a researcher, think, but 'm afraid if call you a researcher, no one will come, because they'll think you're boring and

irrelevant.= CLaughterD And was like, =9kay.= And she said, =8ut the thing liked about your talk is you're a storyteller. So think what 'll do is /ust call you a storyteller.= And of course, the academic, insecure part of me was like, =:ou're going to call me a what?= And she said, = 'm going to call you a storyteller.= And was like, =Why not magic pi(ie?= CLaughterD was like, =Let me think about this for a second.= tried to call deep on my courage. And thought, you know, am a storyteller. 'm a Aualitative researcher. collect stories? that's what do. And maybe stories are /ust data with a soul. And maybe 'm /ust a storyteller. And so said, =:ou know what? Why don't you /ust say 'm a researcher,storyteller.= And she went, =)aha. #here's no such thing.= CLaughterD So 'm a researcher,storyteller, and 'm going to talk to you today ,, we're talking about e(panding perception ,, and so want to talk to you and tell some stories about a piece of my research that fundamentally e(panded my perception and really actually changed the way that live and love and work and parent. And this is where my story starts. When was a young researcher, doctoral student, my first year had a research professor who said to us, =)ere's the thing, if you cannot measure it, it does not e(ist.= And thought he was /ust sweet,talking me. was like, =2eally?= and he was like, =Absolutely.= And so you have to understand that have a bachelor's in social work, a master's in social work, and was getting my >h... in social work, so my entire academic career was surrounded by people who kind of believed in the =life's messy, love it.= And 'm more of the, =life's messy, clean it up, organi6e it and put it into a bento bo(.= CLaughterD And so to think that had found my way, to found a career that takes me ,, really, one of the big sayings in social work is, =Lean into the discomfort of the work.= And 'm like, knock discomfort upside the head and move it over and get all A's. #hat was my mantra. So was very e(cited about this. And so thought, you know what, this is the career for me, because am interested in some messy topics. 8ut want to be able to make them not messy. want to understand them. want to hack into these things know are important and lay the code out for everyone to see. So where started was with connection. 8ecause, by the time you're a social worker for -& years, what you reali6e is that connection is why we're here. t's what gives purpose and meaning to our lives. #his is what it's all about. t doesn't matter whether you talk to people who work in social /ustice and mental health and abuse and neglect, what we know is that connection, the ability to feel connected, is ,, neurobiologically that's how we're wired ,, it's why we're here. So thought, you know what, 'm going to start with connection. Well, you know that situation where you get an evaluation from your boss, and she tells you %1 things you do really awesome, and one thing ,, an =opportunity for growth?= CLaughterD And all you can think about is that opportunity for growth, right? Well, apparently this is the way my work went as well, because, when you ask people about love, they tell you about heartbreak. When you ask people about belonging, they'll tell you their most e(cruciating e(periences of being e(cluded. And when you ask people about connection, the stories they told me were about disconnection. So very Auickly ,, really about si( weeks into this research ,, ran into this unnamed thing that absolutely unraveled connection in a way that didn't understand or had never seen. And so pulled back out of the research and thought, need to figure out what this

is. And it turned out to be shame. And shame is really easily understood as the fear of disconnection7 s there something about me that, if other people know it or see it, that won't be worthy of connection? #he things can tell you about it7 it's universal? we all have it. #he only people who don't e(perience shame have no capacity for human empathy or connection. 5o one wants to talk about it, and the less you talk about it the more you have it. What underpinned this shame, this = 'm not good enough,= ,, which we all know that feeling7 = 'm not blank enough. 'm not thin enough, rich enough, beautiful enough, smart enough, promoted enough.= #he thing that underpinned this was e(cruciating vulnerability, this idea of, in order for connection to happen, we have to allow ourselves to be seen, really seen. And you know how feel about vulnerability. hate vulnerability. And so thought, this is my chance to beat it back with my measuring stick. 'm going in, 'm going to figure this stuff out, 'm going to spend a year, 'm going to totally deconstruct shame, 'm going to understand how vulnerability works, and 'm going to outsmart it. So was ready, and was really e(cited. As you know, it's not going to turn out well. CLaughterD :ou know this. So, could tell you a lot about shame, but 'd have to borrow everyone else's time. 8ut here's what can tell you that it boils down to ,, and this may be one of the most important things that 've ever learned in the decade of doing this research. <y one year turned into si( years7 thousands of stories, hundreds of long interviews, focus groups. At one point, people were sending me /ournal pages and sending me their stories ,, thousands of pieces of data in si( years. And kind of got a handle on it. kind of understood, this is what shame is, this is how it works. wrote a book, published a theory, but something was not okay ,, and what it was is that, if roughly took the people interviewed and divided them into people who really have a sense of worthiness ,, that's what this comes down to, a sense of worthiness ,, they have a strong sense of love and belonging ,, and folks who struggle for it, and folks who are always wondering if they're good enough. #here was only one variable that separated the people who have a strong sense of love and belonging and the people who really struggle for it. And that was, the people who have a strong sense of love and belonging believe they're worthy of love and belonging. #hat's it. #hey believe they're worthy. And to me, the hard part of the one thing that keeps us out of connection is our fear that we're not worthy of connection, was something that, personally and professionally, felt like needed to understand better. So what did is took all of the interviews where saw worthiness, where saw people living that way, and /ust looked at those. What do these people have in common? have a slight office supply addiction, but that's another talk. So had a manila folder, and had a Sharpie, and was like, what am going to call this research? And the first words that came to my mind were whole, hearted. #hese are whole,hearted people, living from this deep sense of worthiness. So wrote at the top of the manila folder, and started looking at the data. n fact, did it first in a four,day very intensive data analysis, where went back, pulled these interviews, pulled the stories, pulled the incidents. What's the theme? What's the pattern? <y husband left town with the kids because always go into this @ackson >ollock cra6y thing, where 'm /ust like writing and in my researcher mode. And so here's what found.

What they had in common was a sense of courage. And want to separate courage and bravery for you for a minute. Gourage, the original definition of courage, when it first came into the 3nglish language ,, it's from the Latin word cor, meaning heart ,, and the original definition was to tell the story of who you are with your whole heart. And so these folks had, very simply, the courage to be imperfect. #hey had the compassion to be kind to themselves first and then to others, because, as it turns out, we can't practice compassion with other people if we can't treat ourselves kindly. And the last was they had connection, and ,, this was the hard part ,, as a result of authenticity, they were willing to let go of who they thought they should be in order to be who they were, which you have to absolutely do that for connection. #he other thing that they had in common was this7 #hey fully embraced vulnerability. #hey believed that what made them vulnerable made them beautiful. #hey didn't talk about vulnerability being comfortable, nor did they really talk about it being e(cruciating ,, as had heard it earlier in the shame interviewing. #hey /ust talked about it being necessary. #hey talked about the willingness to say, = love you= first, the willingness to do something where there are no guarantees, the willingness to breathe through waiting for the doctor to call after your mammogram. #hey're willing to invest in a relationship that may or may not work out. #hey thought this was fundamental. personally thought it was betrayal. could not believe had pledged allegiance to research, where our /ob ,, you know, the definition of research is to control and predict, to study phenomena, for the e(plicit reason to control and predict. And now my mission to control and predict had turned up the answer that the way to live is with vulnerability and to stop controlling and predicting. #his led to a little breakdown ,, CLaughterD ,, which actually looked more like this. CLaughterD And it did. call it a breakdown? my therapist calls it a spiritual awakening. A spiritual awakening sounds better than breakdown, but assure you it was a breakdown. And had to put my data away and go find a therapist. Let me tell you something7 you know who you are when you call your friends and say, = think need to see somebody. .o you have any recommendations?= 8ecause about five of my friends were like, =Wooo. wouldn't want to be your therapist.= CLaughterD was like, =What does that mean?= And they're like, = 'm /ust saying, you know. .on't bring your measuring stick.= was like, =9kay.= So found a therapist. <y first meeting with her, .iana ,, brought in my list of the way the whole,hearted live, and sat down. And she said, =)ow are you?= And said, = 'm great. 'm okay.= She said, =What's going on?= And this is a therapist who sees therapists, because we have to go to those, because their 8.S. meters are good. CLaughterD And so said, =)ere's the thing, 'm struggling.= And she said, =What's the struggle?= And said, =Well, have a vulnerability issue. And know that vulnerability is the core of shame and fear and our struggle for worthiness, but it appears that it's also the birthplace of /oy, of creativity, of belonging, of love. And think have a problem, and need some help.= And said, =8ut here's the thing7 no family stuff, no childhood shit.= CLaughterD = /ust need some strategies.= CLaughterD CApplauseD #hank you. So she goes like this. CLaughterD And then said, = t's bad, right?= And she said, = t's neither good nor bad.= CLaughterD = t /ust is what it is.= And said, =9h my Bod, this is going to suck.=

CLaughterD And it did, and it didn't. And it took about a year. And you know how there are people that, when they reali6e that vulnerability and tenderness are important, that they surrender and walk into it. A7 that's not me, and 87 don't even hang out with people like that. CLaughterD ;or me, it was a yearlong street fight. t was a slugfest. 0ulnerability pushed, pushed back. lost the fight, but probably won my life back. And so then went back into the research and spent the ne(t couple of years really trying to understand what they, the whole,hearted, what choices they were making, and what are we doing with vulnerability. Why do we struggle with it so much? Am alone in struggling with vulnerability? 5o. So this is what learned. We numb vulnerability ,, when we're waiting for the call. t was funny, sent something out on #witter and on ;acebook that says, =)ow would you define vulnerability? What makes you feel vulnerable?= And within an hour and a half, had -"& responses. 8ecause wanted to know what's out there. )aving to ask my husband for help because 'm sick, and we're newly married? initiating se( with my husband? initiating se( with my wife? being turned down? asking someone out? waiting for the doctor to call back? getting laid off? laying off people ,, this is the world we live in. We live in a vulnerable world. And one of the ways we deal with it is we numb vulnerability. And think there's evidence ,, and it's not the only reason this evidence e(ists, but think it's a huge cause ,, we are the most in,debt, obese, addicted and medicated adult cohort in 4.S. history. #he problem is ,, and learned this from the research ,, that you cannot selectively numb emotion. :ou can't say, here's the bad stuff. )ere's vulnerability, here's grief, here's shame, here's fear, here's disappointment. don't want to feel these. 'm going to have a couple of beers and a banana nut muffin. CLaughterD don't want to feel these. And know that's knowing laughter. hack into your lives for a living. Bod. CLaughterD :ou can't numb those hard feelings without numbing the other affects, our emotions. :ou cannot selectively numb. So when we numb those, we numb /oy, we numb gratitude, we numb happiness. And then we are miserable, and we are looking for purpose and meaning, and then we feel vulnerable, so then we have a couple of beers and a banana nut muffin. And it becomes this dangerous cycle. 9ne of the things that think we need to think about is why and how we numb. And it doesn't /ust have to be addiction. #he other thing we do is we make everything that's uncertain certain. 2eligion has gone from a belief in faith and mystery to certainty. 'm right, you're wrong. Shut up. #hat's it. @ust certain. #he more afraid we are, the more vulnerable we are, the more afraid we are. #his is what politics looks like today. #here's no discourse anymore. #here's no conversation. #here's /ust blame. :ou know how blame is described in the research? A way to discharge pain and discomfort. We perfect. f there's anyone who wants their life to look like this, it would be me, but it doesn't work. 8ecause what we do is we take fat from our butts and put it in our cheeks. CLaughterD Which /ust, hope in -&& years, people will look back and go, =Wow.= CLaughterD

And we perfect, most dangerously, our children. Let me tell you what we think about children. #hey're hardwired for struggle when they get here. And when you hold those perfect little babies in your hand, our /ob is not to say, =Look at her, she's perfect. <y /ob is /ust to keep her perfect ,, make sure she makes the tennis team by fifth grade and :ale by seventh grade.= #hat's not our /ob. 9ur /ob is to look and say, =:ou know what? :ou're imperfect, and you're wired for struggle, but you are worthy of love and belonging.= #hat's our /ob. Show me a generation of kids raised like that, and we'll end the problems think that we see today. We pretend that what we do doesn't have an effect on people. We do that in our personal lives. We do that corporate ,, whether it's a bailout, an oil spill, a recall ,, we pretend like what we're doing doesn't have a huge impact on other people. would say to companies, this is not our first rodeo, people. We /ust need you to be authentic and real and say, =We're sorry. We'll fi( it.= 8ut there's another way, and 'll leave you with this. #his is what have found7 to let ourselves be seen, deeply seen, vulnerably seen? to love with our whole hearts, even though there's no guarantee ,, and that's really hard, and can tell you as a parent, that's e(cruciatingly difficult ,, to practice gratitude and /oy in those moments of terror, when we're wondering, =Gan love you this much? Gan believe in this this passionately? Gan be this fierce about this?= /ust to be able to stop and, instead of catastrophi6ing what might happen, to say, = 'm /ust so grateful, because to feel this vulnerable means 'm alive.= And the last, which think is probably the most important, is to believe that we're enough. 8ecause when we work from a place, believe, that says, = 'm enough,= then we stop screaming and start listening, we're kinder and gentler to the people around us, and we're kinder and gentler to ourselves. #hat's all have. #hank you. CApplauseD

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)ow do you e(plain when things don't go as we assume? 9r better, how do you e(plain when others are able to achieve things that seem to defy all of the assumptions? ;or e(ample7 Why is Apple so innovative? :ear after year, after year, after year, they're more innovative than all their competition. And yet, they're /ust a computer company. #hey're /ust like everyone else. #hey have the same access to the same talent, the same agencies, the same consultants, the same media. #hen why is it that they seem to have something different? Why is it that <artin Luther Eing led the Givil 2ights <ovement? )e wasn't the only man who suffered in a pre,civil rights America, and he certainly wasn't the only great orator of the day. Why him? And why is it that the Wright brothers were able to figure out controlled, powered man flight when there were certainly other teams who

were better Aualified, better funded ... and they didn't achieve powered man flight, and the Wright brothers beat them to it. #here's something else at play here. About three and a half years ago made a discovery. And this discovery profoundly changed my view on how thought the world worked, and it even profoundly changed the way in which operate in it. As it turns out, there's a pattern. As it turns out, all the great and inspiring leaders and organi6ations in the world ,, whether it's Apple or <artin Luther Eing or the Wright brothers ,, they all think, act and communicate the e(act same way. And it's the complete opposite to everyone else. All did was codify it, and it's probably the world's simplest idea. call it the golden circle. Why? )ow? What? #his little idea e(plains why some organi6ations and some leaders are able to inspire where others aren't. Let me define the terms really Auickly. 3very single person, every single organi6ation on the planet knows what they do, -&& percent. Some know how they do it, whether you call it your differentiated value proposition or your proprietary process or your 4S>. 8ut very, very few people or organi6ations know why they do what they do. And by =why= don't mean =to make a profit.= #hat's a result. t's always a result. 8y =why,= mean7 What's your purpose? What's your cause? What's your belief? Why does your organi6ation e(ist? Why do you get out of bed in the morning? And why should anyone care? Well, as a result, the way we think, the way we act, the way we communicate is from the outside in. t's obvious. We go from the clearest thing to the fu66iest thing. 8ut the inspired leaders and the inspired organi6ations ,, regardless of their si6e, regardless of their industry ,, all think, act and communicate from the inside out. Let me give you an e(ample. use Apple because they're easy to understand and everybody gets it. f Apple were like everyone else, a marketing message from them might sound like this7 =We make great computers. #hey're beautifully designed, simple to use and user friendly. Want to buy one?= =<eh.= And that's how most of us communicate. #hat's how most marketing is done, that's how most sales is done and that's how most of us communicate interpersonally. We say what we do, we say how we're different or how we're better and we e(pect some sort of a behavior, a purchase, a vote, something like that. )ere's our new law firm7 We have the best lawyers with the biggest clients, we always perform for our clients who do business with us. )ere's our new car7 t gets great gas mileage, it has leather seats, buy our car. 8ut it's uninspiring. )ere's how Apple actually communicates. =3verything we do, we believe in challenging the status Auo. We believe in thinking differently. #he way we challenge the status Auo is by making our products beautifully designed, simple to use and user friendly. We /ust happen to make great computers. Want to buy one?= #otally different right? :ou're ready to buy a computer from me. All did was reverse the order of the information. What it proves to us is that people don't buy what you do? people buy why you do it. >eople don't buy what you do? they buy why you do it. #his e(plains why every single person in this room is perfectly comfortable buying a computer from Apple. 8ut we're also perfectly comfortable buying an <>% player from

Apple, or a phone from Apple, or a .02 from Apple. 8ut, as said before, Apple's /ust a computer company. #here's nothing that distinguishes them structurally from any of their competitors. #heir competitors are all eAually Aualified to make all of these products. n fact, they tried. A few years ago, Bateway came out with flat screen #0s. #hey're eminently Aualified to make flat screen #0s. #hey've been making flat screen monitors for years. 5obody bought one. .ell came out with <>% players and >.As, and they make great Auality products, and they can make perfectly well,designed products ,, and nobody bought one. n fact, talking about it now, we can't even imagine buying an <>% player from .ell. Why would you buy an <>% player from a computer company? 8ut we do it every day. >eople don't buy what you do? they buy why you do it. #he goal is not to do business with everybody who needs what you have. #he goal is to do business with people who believe what you believe. )ere's the best part7 5one of what 'm telling you is my opinion. t's all grounded in the tenets of biology. 5ot psychology, biology. f you look at a cross,section of the human brain, looking from the top down, what you see is the human brain is actually broken into three ma/or components that correlate perfectly with the golden circle. 9ur newest brain, our )omo sapien brain, our neocorte(, corresponds with the =what= level. #he neocorte( is responsible for all of our rational and analytical thought and language. #he middle two sections make up our limbic brains, and our limbic brains are responsible for all of our feelings, like trust and loyalty. t's also responsible for all human behavior, all decision, making, and it has no capacity for language. n other words, when we communicate from the outside in, yes, people can understand vast amounts of complicated information like features and benefits and facts and figures. t /ust doesn't drive behavior. When we can communicate from the inside out, we're talking directly to the part of the brain that controls behavior, and then we allow people to rationali6e it with the tangible things we say and do. #his is where gut decisions come from. :ou know, sometimes you can give somebody all the facts and figures, and they say, = know what all the facts and details say, but it /ust doesn't feel right.= Why would we use that verb, it doesn't =feel= right? 8ecause the part of the brain that controls decision,making doesn't control language. And the best we can muster up is, = don't know. t /ust doesn't feel right.= 9r sometimes you say you're leading with your heart, or you're leading with your soul. Well, hate to break it to you, those aren't other body parts controlling your behavior. t's all happening here in your limbic brain, the part of the brain that controls decision,making and not language. 8ut if you don't know why you do what you do, and people respond to why you do what you do, then how will you ever get people to vote for you, or buy something from you, or, more importantly, be loyal and want to be a part of what it is that you do. Again, the goal is not /ust to sell to people who need what you have? the goal is to sell to people who believe what you believe. #he goal is not /ust to hire people who need a /ob? it's to hire people who believe what you believe. always say that, you know, if you hire people /ust because they can do a /ob, they'll work for your money, but if you hire people who believe what you believe, they'll work for you with blood and sweat and tears. And nowhere else is there a better e(ample of this than with the Wright brothers.

<ost people don't know about Samuel >ierpont Langley. And back in the early $&th century, the pursuit of powered man flight was like the dot com of the day. 3verybody was trying it. And Samuel >ierpont Langley had, what we assume, to be the recipe for success. mean, even now, you ask people, =Why did your product or why did your company fail?= and people always give you the same permutation of the same three things7 under,capitali6ed, the wrong people, bad market conditions. t's always the same three things, so let's e(plore that. Samuel >ierpont Langley was given "&,&&& dollars by the War .epartment to figure out this flying machine. <oney was no problem. )e held a seat at )arvard and worked at the Smithsonian and was e(tremely well,connected? he knew all the big minds of the day. )e hired the best minds money could find and the market conditions were fantastic. #he 5ew :ork #imes followed him around everywhere, and everyone was rooting for Langley. #hen how come we've never heard of Samuel >ierpont Langley? A few hundred miles away in .ayton 9hio, 9rville and Wilbur Wright, they had none of what we consider to be the recipe for success. #hey had no money? they paid for their dream with the proceeds from their bicycle shop? not a single person on the Wright brothers' team had a college education, not even 9rville or Wilbur? and #he 5ew :ork #imes followed them around nowhere. #he difference was, 9rville and Wilbur were driven by a cause, by a purpose, by a belief. #hey believed that if they could figure out this flying machine, it'll change the course of the world. Samuel >ierpont Langley was different. )e wanted to be rich, and he wanted to be famous. )e was in pursuit of the result. )e was in pursuit of the riches. And lo and behold, look what happened. #he people who believed in the Wright brothers' dream worked with them with blood and sweat and tears. #he others /ust worked for the paycheck. And they tell stories of how every time the Wright brothers went out, they would have to take five sets of parts, because that's how many times they would crash before they came in for supper. And, eventually, on .ecember -1th, -!&%, the Wright brothers took flight, and no one was there to even e(perience it. We found out about it a few days later. And further proof that Langley was motivated by the wrong thing7 #he day the Wright brothers took flight, he Auit. )e could have said, =#hat's an ama6ing discovery, guys, and will improve upon your technology,= but he didn't. )e wasn't first, he didn't get rich, he didn't get famous so he Auit. >eople don't buy what you do? they buy why you do it. And if you talk about what you believe, you will attract those who believe what you believe. 8ut why is it important to attract those who believe what you believe? Something called the law of diffusion of innovation, and if you don't know the law, you definitely know the terminology. #he first two and a half percent of our population are our innovators. #he ne(t -% and a half percent of our population are our early adopters. #he ne(t %* percent are your early ma/ority, your late ma/ority and your laggards. #he only reason these people buy touch tone phones is because you can't buy rotary phones anymore. CLaughterD

We all sit at various places at various times on this scale, but what the law of diffusion of innovation tells us is that if you want mass,market success or mass,market acceptance of an idea, you cannot have it until you achieve this tipping point between -" and -' percent market penetration, and then the system tips. And love asking businesses, =What's your conversion on new business?= And they love to tell you, =9h, it's about -& percent,= proudly. Well, you can trip over -& percent of the customers. We all have about -& percent who /ust =get it.= #hat's how we describe them, right? #hat's like that gut feeling, =9h, they /ust get it.= #he problem is7 )ow do you find the ones that get it before you're doing business with them versus the ones who don't get it? So it's this here, this little gap that you have to close, as @effrey <oore calls it, =Grossing the Ghasm= ,, because, you see, the early ma/ority will not try something until someone else has tried it first. And these guys, the innovators and the early adopters, they're comfortable making those gut decisions. #hey're more comfortable making those intuitive decisions that are driven by what they believe about the world and not /ust what product is available. #hese are the people who stood in line for si( hours to buy an i>hone when they first came out, when you could have /ust walked into the store the ne(t week and bought one off the shelf. #hese are the people who spent *&,&&& dollars on flat screen #0s when they first came out, even though the technology was substandard. And, by the way, they didn't do it because the technology was so great? they did it for themselves. t's because they wanted to be first. >eople don't buy what you do? they buy why you do it and what you do simply proves what you believe. n fact, people will do the things that prove what they believe. #he reason that person bought the i>hone in the first si( hours, stood in line for si( hours, was because of what they believed about the world, and how they wanted everybody to see them7 #hey were first. >eople don't buy what you do? they buy why you do it. So let me give you a famous e(ample, a famous failure and a famous success of the law of diffusion of innovation. ;irst, the famous failure. t's a commercial e(ample. As we said before, a second ago, the recipe for success is money and the right people and the right market conditions, right? :ou should have success then. Look at #i0o. ;rom the time #i0o came out about eight or nine years ago to this current day, they are the single highest,Auality product on the market, hands down, there is no dispute. #hey were e(tremely well,funded. <arket conditions were fantastic. mean, we use #i0o as verb. #i0o stuff on my piece of /unk #ime Warner .02 all the time. 8ut #i0o's a commercial failure. #hey've never made money. And when they went >9, their stock was at about %& or *& dollars and then plummeted, and it's never traded above -&. n fact, don't think it's even traded above si(, e(cept for a couple of little spikes. 8ecause you see, when #i0o launched their product they told us all what they had. #hey said, =We have a product that pauses live #0, skips commercials, rewinds live #0 and memori6es your viewing habits without you even asking.= And the cynical ma/ority said, =We don't believe you. We don't need it. We don't like it. :ou're scaring us.= What if they had said, = f you're the kind of person who likes to have total control over every aspect of your life, boy, do we have a product for you. t pauses live #0, skips commercials,

memori6es your viewing habits, etc., etc.= >eople don't buy what you do? they buy why you do it, and what you do simply serves as the proof of what you believe. 5ow let me give you a successful e(ample of the law of diffusion of innovation. n the summer of -!+%, $"&,&&& people showed up on the mall in Washington to hear .r. Eing speak. #hey sent out no invitations, and there was no website to check the date. )ow do you do that? Well, .r. Eing wasn't the only man in America who was a great orator. )e wasn't the only man in America who suffered in a pre,civil rights America. n fact, some of his ideas were bad. 8ut he had a gift. )e didn't go around telling people what needed to change in America. )e went around and told people what he believed. = believe, believe, believe,= he told people. And people who believed what he believed took his cause, and they made it their own, and they told people. And some of those people created structures to get the word out to even more people. And lo and behold, $"&,&&& people showed up on the right day at the right time to hear him speak. )ow many of them showed up for him? Iero. #hey showed up for themselves. t's what they believed about America that got them to travel in a bus for eight hours to stand in the sun in Washington in the middle of August. t's what they believed, and it wasn't about black versus white7 $" percent of the audience was white. .r. Eing believed that there are two types of laws in this world7 those that are made by a higher authority and those that are made by man. And not until all the laws that are made by man are consistent with the laws that are made by the higher authority will we live in a /ust world. t /ust so happened that the Givil 2ights <ovement was the perfect thing to help him bring his cause to life. We followed, not for him, but for ourselves. And, by the way, he gave the = have a dream= speech, not the = have a plan= speech. CLaughterD Listen to politicians now, with their comprehensive -$,point plans. #hey're not inspiring anybody. 8ecause there are leaders and there are those who lead. Leaders hold a position of power or authority, but those who lead inspire us. Whether they're individuals or organi6ations, we follow those who lead, not because we have to, but because we want to. We follow those who lead, not for them, but for ourselves. And it's those who start with =why= that have the ability to inspire those around them or find others who inspire them. #hank you very much. CApplauseD

82 A5 B9L.<A5, .9G#92S <AE3 < S#AE3S. GA5 W3 #ALE A894# #)A#?

think we have to do something about a piece of the culture of medicine that has to change. And think it starts with one physician, and that's me. And maybe 've been around long enough that can afford to give away some of my false prestige to be able to do that. 8efore actually begin the meat of my talk, let's begin with a bit of baseball. )ey, why not? We're near the end, we're getting close to the World Series. We all love baseball, don't we? CLaughterD 8aseball is filled with some ama6ing statistics. And there's hundreds of them. =<oneyball= is about to come out, and it's all about statistics and using statistics to build a great baseball team. 'm going to focus on one stat that hope a lot of you have heard of. t's called batting average. So we talk about a %&&, a batter who bats %&&. #hat means that ballplayer batted safely, hit safely three times out of -& at bats. #hat means hit the ball into the outfield, it dropped, it didn't get caught, and whoever tried to throw it to first base didn't get there in time and the runner was safe. #hree times out of -&. .o you know what they call a %&& hitter in <a/or League 8aseball? Bood, really good, maybe an all,star. .o you know what they call a *&& baseball hitter? #hat's somebody who hit, by the way, four times safely out of every -&. Legendary ,, as in #ed Williams legendary ,, the last <a/or League 8aseball player to hit over *&& during a regular season. 5ow let's take this back into my world of medicine where 'm a lot more comfortable, or perhaps a bit less comfortable after what 'm going to talk to you about. Suppose you have appendicitis and you're referred to a surgeon who's batting *&& on appendectomies. CLaughterD Somehow this isn't working out, is it? 5ow suppose you live in a certain part of a certain remote place and you have a loved one who has blockages in two coronary arteries and your family doctor refers that loved one to a cardiologist who's batting $&& on angioplasties. 8ut, but, you know what? She's doing a lot better this year. She's on the comeback trail. And she's hitting a $"1. Somehow this isn't working. 8ut 'm going to ask you a Auestion. What do you think a batting average for a cardiac surgeon or a nurse practitioner or an orthopedic surgeon, an 98B:5, a paramedic is supposed to be? -,&&&, very good. 5ow truth of the matter is, nobody knows in all of medicine what a good surgeon or physician or paramedic is supposed to bat. What we do though is we send each one of them, including myself, out into the world with the admonition, be perfect. 5ever ever, ever make a mistake, but you worry about the details, about how that's going to happen. And that was the message that absorbed when was in med school. was an obsessive compulsive student. n high school, a classmate once said that 8rian Boldman would study for a blood test. CLaughterD And so did. And studied in my little garret at the nurses' residence at #oronto Beneral )ospital, not far from here. And memori6ed everything. memori6ed in my anatomy class the origins and e(ertions of every muscle, every branch of every artery that came off the aorta, differential diagnoses obscure and common. even knew the differential diagnosis in how to classify renal tubular acidosis. And all the while, was amassing more and more knowledge.

And did well, graduated with honors, cum laude. And came out of medical school with the impression that if memori6ed everything and knew everything, or as much as possible, as close to everything as possible, that it would immuni6e me against making mistakes. And it worked for a while, until met <rs. .rucker. was a resident at a teaching hospital here in #oronto when <rs. .rucker was brought to the emergency department of the hospital where was working. At the time was assigned to the cardiology service on a cardiology rotation. And it was my /ob, when the emergency staff called for a cardiology consult, to see that patient in emerg. and to report back to my attending. And saw <rs. .rucker, and she was breathless. And when listened to her, she was making a whee6y sound. And when listened to her chest with a stethoscope, could hear crackly sounds on both sides that told me that she was in congestive heart failure. #his is a condition in which the heart fails, and instead of being able to pump all the blood forward, some of the blood backs up into the lung, the lungs fill up with blood, and that's why you have shortness of breath. And that wasn't a difficult diagnosis to make. made it and set to work treating her. gave her aspirin. gave her medications to relieve the strain on her heart. gave her medications that we call diuretics, water pills, to get her to pee out the access fluid. And over the course of the ne(t hour and a half or two, she started to feel better. And felt really good. And that's when made my first mistake? sent her home. Actually, made two more mistakes. sent her home without speaking to my attending. didn't pick up the phone and do what was supposed to do, which was call my attending and run the story by him so he would have a chance to see her for himself. And he knew her, he would have been able to furnish additional information about her. <aybe did it for a good reason. <aybe didn't want to be a high,maintenance resident. <aybe wanted to be so successful and so able to take responsibility that would do so and would be able to take care of my attending's patients without even having to contact him. #he second mistake that made was worse. n sending her home, disregarded a little voice deep down inside that was trying to tell me, =Boldman, not a good idea. .on't do this.= n fact, so lacking in confidence was that actually asked the nurse who was looking after <rs. .rucker, =.o you think it's okay if she goes home?= And the nurse thought about it and said very matter,of,factly, =:eah, think she'll do okay.= can remember that like it was yesterday. So signed the discharge papers, and an ambulance came, paramedics came to take her home. And went back to my work on the wards. All the rest of that day, that afternoon, had this kind of gnawing feeling inside my stomach. 8ut carried on with my work. And at the end of the day, packed up to leave the hospital and walked to the parking lot to take my car and drive home when did something that don't usually do. walked through the emergency department on my way home. And it was there that another nurse, not the nurse who was looking after <rs. .rucker before, but another nurse, said three words to me that are the three words that most

emergency physicians know dread. 9thers in medicine dread them as well, but there's something particular about emergency medicine because we see patients so fleetingly. #he three words are7 .o you remember? =.o you remember that patient you sent home?= the other nurse asked matter,of,factly. =Well she's back,= in /ust that tone of voice. Well she was back all right. She was back and near death. About an hour after she had arrived home, after 'd sent her home, she collapsed and her family called !-- and the paramedics brought her back to the emergency department where she had a blood pressure of "&, which is in severe shock. And she was barely breathing and she was blue. And the emerg. staff pulled out all the stops. #hey gave her medications to raise her blood pressure. #hey put her on a ventilator. And was shocked and shaken to the core. And went through this roller coaster, because after they stabili6ed her, she went to the intensive care unit, and hoped against hope that she would recover. And over the ne(t two or three days, it was clear that she was never going to wake up. She had irreversible brain damage. And the family gathered. And over the course of the ne(t eight or nine days, they resigned themselves to what was happening. And at about the nine day mark, they let her go ,, <rs. .rucker, a wife, a mother and a grandmother. #hey say you never forget the names of those who die. And that was my first time to be acAuainted with that. 9ver the ne(t few weeks, beat myself up and e(perienced for the first time the unhealthy shame that e(ists in our culture of medicine ,, where felt alone, isolated, not feeling the healthy kind of shame that you feel, because you can't talk about it with your colleagues. :ou know that healthy kind, when you betray a secret that a best friend made you promise never to reveal and then you get busted and then your best friend confronts you and you have terrible discussions, but at the end of it all that sick feeling guides you and you say, 'll never make that mistake again. And you make amends and you never make that mistake again. #hat's the kind of shame that is a teacher. #he unhealthy shame 'm talking about is the one that makes you so sick inside. t's the one that says, not that what you did was bad, but that you are bad. And it was what was feeling. And it wasn't because of my attending? he was a doll. )e talked to the family, and 'm Auite sure that he smoothed things over and made sure that didn't get sued. And kept asking myself these Auestions. Why didn't ask my attending? Why did send her home? And then at my worst moments7 Why did make such a stupid mistake? Why did go into medicine? Slowly but surely, it lifted. began to feel a bit better. And on a cloudy day, there was a crack in the clouds and the sun started to come out and wondered, maybe could feel better again. And made myself a bargain that if only redouble my efforts to be perfect and never make another mistake again, please make the voices stop. And they did. And went back to work. And then it happened again. #wo years later was an attending in the emergency department at a community hospital /ust north of #oronto, and saw a $" year,old man with a sore throat. t was busy, was

in a bit of a hurry. )e kept pointing here. looked at his throat, it was a little bit pink. And gave him a prescription for penicillin and sent him on his way. And even as he was walking out the door, he was still sort of pointing to his throat. And two days later came to do my ne(t emergency shift, and that's when my chief asked to speak to me Auietly in her office. And she said the three words7 .o you remember? =.o you remember that patient you saw with the sore throat?= Well it turns out, he didn't have a strep throat. )e had a potentially life,threatening condition called epiglottitis. :ou can Boogle it, but it's an infection, not of the throat, but of the upper airway, and it can actually cause the airway to close. And fortunately he didn't die. )e was placed on intravenous antibiotics and he recovered after a few days. And went through the same period of shame and recriminations and felt cleansed and went back to work, until it happened again and again and again. #wice in one emergency shift, missed appendicitis. 5ow that takes some doing, especially when you work in a hospital that at the time saw but -* people a night. 5ow in both cases, didn't send them home and don't think there was any gap in their care. 9ne thought had a kidney stone. ordered a kidney J,ray. When it turned out to be normal, my colleague who was doing a reassessment of the patient noticed some tenderness in the right lower Auadrant and called the surgeons. #he other one had a lot of diarrhea. ordered some fluids to rehydrate him and asked my colleague to reassess him. And he did and when he noticed some tenderness in the right lower Auadrant, called the surgeons. n both cases, they had their operations and they did okay. 8ut each time, they were gnawing at me, eating at me. And 'd like to be able to say to you that my worst mistakes only happened in the first five years of practice as many of my colleagues say, which is total 8.S. CLaughterD Some of my doo6ies have been in the last five years. Alone, ashamed and unsupported. )ere's the problem7 f can't come clean and talk about my mistakes, if can't find the still, small voice that tells me what really happened, how can share it with my colleagues? )ow can teach them about what did so that they don't do the same thing? f were to walk into a room ,, like right now, have no idea what you think of me. When was the last time you heard somebody talk about failure after failure after failure? 9h yeah, you go to a cocktail party and you might hear about some other doctor, but you're not going to hear somebody talking about their own mistakes. f were to walk into a room filled with my colleages and ask for their support right now and start to tell what 've /ust told you right now, probably wouldn't get through two of those stories before they would start to get really uncomfortable, somebody would crack a /oke, they'd change the sub/ect and we would move on. And in fact, if knew and my colleagues knew that one of my orthopedic colleagues took off the wrong leg in my hospital, believe me, 'd have trouble making eye contact with that person. #hat's the system that we have. t's a complete denial of mistakes. t's a system in which there are two kinds of positions ,, those who make mistakes and those who don't, those who can't handle sleep deprivation and those who can, those who have lousy outcomes

and those who have great outcomes. And it's almost like an ideological reaction, like the antibodies begin to attack that person. And we have this idea that if we drive the people who make mistakes out of medicine, what will we be left with, but a safe system. 8ut there are two problems with that. n my $& years or so of medical broadcasting and /ournalism, 've made a personal study of medical malpractice and medical errors to learn everything can, from one of the first articles wrote for the #oronto Star to my show =White Goat, 8lack Art.= And what 've learned is that errors are absolutely ubiAuitous. We work in a system where errors happen every day, where one in -& medications are either the wrong medication given in hospital or at the wrong dosage, where hospital, acAuired infections are getting more and more numerous, causing havoc and death. n this country, as many as $*,&&& Ganadians die of preventable medical errors. n the 4nited States, the nstitute of <edicine pegged it at -&&,&&&. n both cases, these are gross underestimates, because we really aren't ferreting out the problem as we should. And here's the thing. n a hospital system where medical knowledge is doubling every two or three years, we can't keep up with it. Sleep deprivation is absolutely pervasive. We can't get rid of it. We have our cognitive biases, so that can take a perfect history on a patient with chest pain. 5ow take the same patient with chest pain, make them moist and garrulous and put a little bit of alcohol on their breath, and suddenly my history is laced with contempt. don't take the same history. 'm not a robot? don't do things the same way each time. And my patients aren't cars? they don't tell me their symptoms in the same way each time. Biven all of that, mistakes are inevitable. So if you take the system, as was taught, and weed out all the error,prone health professionals, well there won't be anybody left. And you know that business about people not wanting to talk about their worst cases? 9n my show, on =White Goat, 8lack Art,= made it a habit of saying, =)ere's my worst mistake,= would say to everybody from paramedics to the chief of cardiac surgery, =)ere's my worst mistake,= blah, blah, blah, blah, blah, =What about yours?= and would point the microphone towards them. And their pupils would dilate, they would recoil, then they would look down and swallow hard and start to tell me their stories. #hey want to tell their stories. #hey want to share their stories. #hey want to be able to say, =Look, don't make the same mistake did.= What they need is an environment to be able to do that. What they need is a redefined medical culture. And it starts with one physician at a time. #he redefined physician is human, knows she's human, accepts it, isn't proud of making mistakes, but strives to learn one thing from what happened that she can teach to somebody else. She shares her e(perience with others. She's supportive when other people talk about their mistakes. And she points out other people's mistakes, not in a gotcha way, but in a loving, supportive way so that everybody can benefit. And she works in a culture of medicine that acknowledges that human beings run the system, and when human beings run the system, they will make mistakes from time to time. So the system is evolving to create backups that make it easier to detect those mistakes that humans inevitably make and also fosters in a loving, supportive way places where

everybody who is observing in the health care system can actually point out things that could be potential mistakes and is rewarded for doing so, and especially people like me, when we do make mistakes, we're rewarded for coming clean. <y name is 8rian Boldman. am a redefined physician. 'm human. make mistakes. 'm sorry about that, but strive to learn one thing that can pass on to other people. still don't know what you think of me, but can live with that. And let me close with three words of my own7 do remember. CApplauseD @ LL 89L#3 #A:L92KS S#29E3 9; 5S B)# grew up to study the brain because have a brother who has been diagnosed with a brain disorder7 schi6ophrenia. And as a sister and later, as a scientist, wanted to understand, why is it that can take my dreams, can connect them to my reality, and can make my dreams come true? What is it about my brother's brain and his schi6ophrenia that he cannot connect his dreams to a common and shared reality, so they instead become delusion? So dedicated my career to research into the severe mental illnesses. And moved from my home state of ndiana to 8oston, where was working in the lab of .r. ;rancine 8enes, in the )arvard .epartment of >sychiatry. And in the lab, we were asking the Auestion, =What are the biological differences between the brains of individuals who would be diagnosed as normal control, as compared with the brains of individuals diagnosed with schi6ophrenia, schi6oaffective or bipolar disorder?= So we were essentially mapping the microcircuitry of the brain7 which cells are communicating with which cells, with which chemicals, and then in what Auantities of those chemicals? So there was a lot of meaning in my life because was performing this type of research during the day. 8ut then in the evenings and on the weekends, traveled as an advocate for 5A< , the 5ational Alliance on <ental llness. 8ut on the morning of .ecember -&, -!!+, woke up to discover that had a brain disorder of my own. A blood vessel e(ploded in the left half of my brain. And in the course of four hours, watched my brain completely deteriorate in its ability to process all information. 9n the morning of the hemorrhage, could not walk, talk, read, write or recall any of my life. essentially became an infant in a woman's body. f you've ever seen a human brain, it's obvious that the two hemispheres are completely separate from one another. And have brought for you a real human brain. So this is a real human brain. #his is the front of the brain, the back of brain with the spinal cord hanging down, and this is how it would be positioned inside of my head. And when you look at the brain, it's obvious that the two cerebral cortices are completely separate from one another. ;or

those of you who understand computers, our right hemisphere functions like a parallel processor, while our left hemisphere functions like a serial processor. #he two hemispheres do communicate with one another through the corpus collosum, which is made up of some %&& million a(onal fibers. 8ut other than that, the two hemispheres are completely separate. 8ecause they process information differently, each of our hemispheres think about different things, they care about different things, and, dare say, they have very different personalities. 3(cuse me. #hank you. t's been a /oy. Assistant7 t has been. 9ur right human hemisphere is all about this present moment. t's all about =right here, right now.= 9ur right hemisphere, it thinks in pictures and it learns kinesthetically through the movement of our bodies. nformation, in the form of energy, streams in simultaneously through all of our sensory systems and then it e(plodes into this enormous collage of what this present moment looks like, what this present moment smells like and tastes like, what it feels like and what it sounds like. am an energy,being connected to the energy all around me through the consciousness of my right hemisphere. We are energy,beings connected to one another through the consciousness of our right hemispheres as one human family. And right here, right now, we are brothers and sisters on this planet, here to make the world a better place. And in this moment we are perfect, we are whole and we are beautiful. <y left hemisphere ,, our left hemisphere ,, is a very different place. 9ur left hemisphere thinks linearly and methodically. 9ur left hemisphere is all about the past and it's all about the future. 9ur left hemisphere is designed to take that enormous collage of the present moment and start picking out details, details and more details about those details. t then categori6es and organi6es all that information, associates it with everything in the past we've ever learned, and pro/ects into the future all of our possibilities. And our left hemisphere thinks in language. t's that ongoing brain chatter that connects me and my internal world to my e(ternal world. t's that little voice that says to me, =)ey, you gotta remember to pick up bananas on your way home. need them in the morning.= t's that calculating intelligence that reminds me when have to do my laundry. 8ut perhaps most important, it's that little voice that says to me, = am. am.= And as soon as my left hemisphere says to me = am,= become separate. become a single solid individual, separate from the energy flow around me and separate from you. And this was the portion of my brain that lost on the morning of my stroke. 9n the morning of the stroke, woke up to a pounding pain behind my left eye. And it was the kind of pain ,, caustic pain ,, that you get when you bite into ice cream. And it /ust gripped me ,, and then it released me. And then it /ust gripped me ,, and then it released me. And it was very unusual for me to ever e(perience any kind of pain, so thought, =9E, 'll /ust start my normal routine.= So got up and /umped onto my cardio glider, which is a full,body, full,e(ercise machine. And 'm /amming away on this thing, and 'm reali6ing that my hands look like

primitive claws grasping onto the bar. And thought, =#hat's very peculiar.= And looked down at my body and thought, =Whoa, 'm a weird,looking thing.= And it was as though my consciousness had shifted away from my normal perception of reality, where 'm the person on the machine having the e(perience, to some esoteric space where 'm witnessing myself having this e(perience. And it was all very peculiar, and my headache was /ust getting worse. So get off the machine, and 'm walking across my living room floor, and reali6e that everything inside of my body has slowed way down. And every step is very rigid and very deliberate. #here's no fluidity to my pace, and there's this constriction in my area of perceptions, so 'm /ust focused on internal systems. And 'm standing in my bathroom getting ready to step into the shower, and could actually hear the dialogue inside of my body. heard a little voice saying, =9E. :ou muscles, you gotta contract. :ou muscles, you rela(.= And then lost my balance, and 'm propped up against the wall. And look down at my arm and reali6e that can no longer define the boundaries of my body. can't define where begin and where end, because the atoms and the molecules of my arm blended with the atoms and molecules of the wall. And all could detect was this energy ,, energy. And 'm asking myself, =What is wrong with me? What is going on?= And in that moment, my brain chatter ,, my left hemisphere brain chatter ,, went totally silent. @ust like someone took a remote control and pushed the mute button. #otal silence. And at first was shocked to find myself inside of a silent mind. 8ut then was immediately captivated by the magnificence of the energy around me. And because could no longer identify the boundaries of my body, felt enormous and e(pansive. felt at one with all the energy that was, and it was beautiful there. #hen all of a sudden my left hemisphere comes back online, and it says to me, =)eyH We got a problemH We got a problemH We gotta get some help.= And 'm going, =AhhH got a problem. got a problem.= So it's like, =9E. 9E. got a problem.= 8ut then immediately drifted right back out into the consciousness ,, and affectionately refer to this space as La La Land. 8ut it was beautiful there. magine what it would be like to be totally disconnected from your brain chatter that connects you to the e(ternal world. So here am in this space, and my /ob ,, and any stress related to my /ob ,, it was gone. And felt lighter in my body. And imagine all of the relationships in the e(ternal world and any stressors related to any of those ,, they were gone. And felt this sense of peacefulness. And imagine what it would feel like to lose %1 years of emotional baggageH CLaughterD 9hH felt euphoria ,, euphoria. t was beautiful. And then, again, my left hemisphere comes online and it says, =)eyH :ou've got to pay attention. We've got to get help.= And 'm thinking, = got to get help. gotta focus.= So

get out of the shower and mechanically dress and 'm walking around my apartment, and 'm thinking, = gotta get to work. gotta get to work. Gan drive? Gan drive?= And in that moment my right arm went totally paraly6ed by my side. #hen reali6ed, =9h my goshH 'm having a strokeH 'm having a strokeH= And the ne(t thing my brain says to me is, =WowH #his is so cool.= CLaughterD =#his is so coolH )ow many brain scientists have the opportunity to study their own brain from the inside out?= CLaughterD And then it crosses my mind, =8ut 'm a very busy womanH= CLaughterD = don't have time for a strokeH= So 'm like, =9E, can't stop the stroke from happening, so 'll do this for a week or two, and then 'll get back to my routine. 9E. So gotta call help. gotta call work.= couldn't remember the number at work, so remembered, in my office had a business card with my number on it. So go into my business room, pull out a three,inch stack of business cards. And 'm looking at the card on top and even though could see clearly in my mind's eye what my business card looked like, couldn't tell if this was my card or not, because all could see were pi(els. And the pi(els of the words blended with the pi(els of the background and the pi(els of the symbols, and /ust couldn't tell. And then would wait for what call a wave of clarity. And in that moment, would be able to reattach to normal reality and could tell that's not the card ... that's not the card ... that's not the card. t took me *" minutes to get one inch down inside of that stack of cards. n the meantime, for *" minutes, the hemorrhage is getting bigger in my left hemisphere. do not understand numbers, do not understand the telephone, but it's the only plan have. So take the phone pad and put it right here. take the business card, put it right here, and 'm matching the shape of the sAuiggles on the card to the shape of the sAuiggles on the phone pad. 8ut then would drift back out into La La Land, and not remember when came back if 'd already dialed those numbers. So had to wield my paraly6ed arm like a stump and cover the numbers as went along and pushed them, so that as would come back to normal reality, 'd be able to tell, =:es, 've already dialed that number.= 3ventually, the whole number gets dialed and 'm listening to the phone, and my colleague picks up the phone and he says to me, =Woo woo woo woo.= CLaughterD And think to myself, =9h my gosh, he sounds like a Bolden 2etrieverH= And so say to him ,, clear in my mind, say to him7 =#his is @illH need helpH= And what comes out of my voice is, =Woo woo woo woo woo.= 'm thinking, =9h my gosh, sound like a Bolden 2etriever.= So couldn't know ,, didn't know that couldn't speak or understand language until tried. So he recogni6es that need help and he gets me help. And a little while later, am riding in an ambulance from one hospital across 8oston to L<assachusettsM Beneral )ospital. And curl up into a little fetal ball. And /ust like a

balloon with the last bit of air, /ust, /ust right out of the balloon, /ust felt my energy lift and /ust ,, felt my spirit surrender. And in that moment, knew that was no longer the choreographer of my life. And either the doctors rescue my body and give me a second chance at life, or this was perhaps my moment of transition. When woke later that afternoon, was shocked to discover that was still alive. When felt my spirit surrender, said goodbye to my life. And my mind was now suspended between two very opposite planes of reality. Stimulation coming in through my sensory systems felt like pure pain. Light burned my brain like wildfire, and sounds were so loud and chaotic that could not pick a voice out from the background noise, and /ust wanted to escape. 8ecause could not identify the position of my body in space, felt enormous and e(pansive, like a genie /ust liberated from her bottle. And my spirit soared free, like a great whale gliding through the sea of silent euphoria. 5irvana. found 5irvana. And remember thinking, there's no way would ever be able to sAuee6e the enormousness of myself back inside this tiny little body. 8ut then reali6ed, =8ut 'm still aliveH 'm still alive, and have found 5irvana. And if have found 5irvana and 'm still alive, then everyone who is alive can find 5irvana.= And pictured a world filled with beautiful, peaceful, compassionate, loving people who knew that they could come to this space at any time. And that they could purposely choose to step to the right of their left hemispheres and find this peace. And then reali6ed what a tremendous gift this e(perience could be, what a stroke of insight this could be to how we live our lives. And it motivated me to recover. #wo and a half weeks after the hemorrhage, the surgeons went in and they removed a blood clot the si6e of a golf ball that was pushing on my language centers. )ere am with my mama, who is a true angel in my life. t took me eight years to completely recover. So who are we? We are the life,force power of the universe, with manual de(terity and two cognitive minds. And we have the power to choose, moment by moment, who and how we want to be in the world. 2ight here, right now, can step into the consciousness of my right hemisphere, where we are. am the life,force power of the universe. am the life,force power of the "& trillion beautiful molecular geniuses that make up my form, at one with all that is. 9r, can choose to step into the consciousness of my left hemisphere, where become a single individual, a solid. Separate from the flow, separate from you. am .r. @ill 8olte #aylor7 intellectual, neuroanatomist. #hese are the =we= inside of me. Which would you choose? Which do you choose? And when? believe that the more time we spend choosing to run the deep inner,peace circuitry of our right hemispheres, the more peace we will pro/ect into the world, and the more peaceful our planet will be. And thought that was an idea worth spreading.

3LL 9# E2A53, #)3 <:S#32: 9; G)295 G >A 5 'm a pediatrician and an anesthesiologist, so put children to sleep for a living. CLaughterD And 'm an academic, so put audiences to sleep for free. CLaughterD 8ut what actually mostly do is manage the pain management service at the >ackard Ghildren's )ospital up at Stanford in >alo Alto. And it's from the e(perience from about $& or $" years of doing that that want to bring to you the message this morning, that pain is a disease. 5ow most of the time, you think of pain as a symptom of a disease, and that's true most of the time. t's the symptom of a tumor or an infection or an inflammation or an operation. 8ut about -& percent of the time, after the patient has recovered from one of those events, pain persists. t persists for months and oftentimes for years, and when that happens, it is its own disease. And before tell you about how it is that we think that happens and what we can do about it, want to show you how it feels for my patients. So imagine, if you will, that 'm stroking your arm with this feather, as 'm stroking my arm right now. 5ow, want you to imagine that 'm stroking it with this. >lease keep your seat. CLaughterD A very different feeling. 5ow what does it have to do with chronic pain? magine, if you will, these two ideas together. magine what your life would be like if were to stroke it with this feather, but your brain was telling you that this is what you are feeling ,, and that is the e(perience of my patients with chronic pain. n fact, imagine something even worse. magine were to stroke your child's arm with this feather, and their brain LwasM telling them that they were feeling this hot torch. #hat was the e(perience of my patient, Ghandler, whom you see in the photograph. As you can see, she's a beautiful, young woman. She was -+ years old last year when met her, and she aspired to be a professional dancer. And during the course of one of her dance rehearsals, she fell on her outstretched arm and sprained her wrist. 5ow you would probably imagine, as she did, that a wrist sprain is a trivial event in a person's life. Wrap it in an AG3 bandage, take some ibuprofen for a week or two, and that's the end of the story. 8ut in Ghandler's case, that was the beginning of the story. #his is what her arm looked like when she came to my clinic about three months after her sprain. :ou can see that the arm is discolored, purplish in color. t was cadaverically cold to the touch. #he muscles were fro6en, paraly6ed ,, dystonic is how we refer to that. #he pain had spread from her wrist to her hands, to her fingertips, from her wrist up to her elbow, almost all the way to her shoulder. 8ut the worst part was, not the spontaneous pain that was there $* hours a day. #he worst part was that she had allodynia, the medical term for the phenomenon that /ust illustrated with the feather and with the torch. #he lightest touch of her arm ,, the touch of a hand, the touch even of a sleeve, of a garment, as she put it on ,, caused e(cruciating, burning pain. )ow can the nervous system get this so wrong? )ow can the nervous system misinterpret an innocent sensation like the touch of a hand and turn it into the malevolent sensation of the touch of the flame? Well you probably imagine that the nervous system in the body is

hardwired like your house. n your house, wires run in the wall, from the light switch to a /unction bo( in the ceiling and from the /unction bo( to the light bulb. And when you turn the switch on, the light goes on. And when you turn the switch off, the light goes off. So people imagine the nervous system is /ust like that. f you hit your thumb with a hammer, these wires in your arm ,, that, of course, we call nerves ,, transmit the information into the /unction bo( in the spinal cord where new wires, new nerves, take the information up to the brain where you become consciously aware that your thumb is now hurt. 8ut the situation, of course, in the human body is far more complicated than that. nstead of it being the case that that /unction bo( in the spinal cord is /ust simple where one nerve connects with the ne(t nerve by releasing these little brown packets of chemical information called neurotransmitters in a linear one,on,one fashion, in fact, what happens is the neurotransmitters spill out in three dimensions ,, laterally, vertically, up and down in the spinal cord ,, and they start interacting with other ad/acent cells. #hese cells, called glial cells, were once thought to be unimportant structural elements of the spinal cord that did nothing more than hold all the important things together, like the nerves. 8ut it turns out the glial cells have a vital role in the modulation, amplification and, in the case of pain, the distortion of sensory e(periences. #hese glial cells become activated. #heir .5A starts to synthesi6e new proteins, which spill out and interact with ad/acent nerves, and they start releasing their neurotransmitters, and those neurotransmitters spill out and activate ad/acent glial cells, and so on and so forth, until what we have is a positive feedback loop. t's almost as if somebody came into your home and rewired your walls so that the ne(t time you turned on the light switch, the toilet flushed three doors down, or your dishwasher went on, or your computer monitor turned off. #hat's cra6y, but that's, in fact, what happens with chronic pain. And that's why pain becomes its own disease. #he nervous system has plasticity. t changes, and it morphs in response to stimuli. Well, what do we do about that? What can we do in a case like Ghandler's? We treat these patients in a rather crude fashion at this point in time. We treat them with symptom, modifying drugs ,, painkillers ,, which are, frankly, not very effective for this kind of pain. We take nerves that are noisy and active that should be Auiet, and we put them to sleep with local anesthetics. And most importantly, what we do is we use a rigorous, and often uncomfortable, process of physical therapy and occupational therapy to retrain the nerves in the nervous system to respond normally to the activities and sensory e(periences that are part of everyday life. And we support all of that with an intensive psychotherapy program to address the despondency, despair and depression that always accompanies severe, chronic pain. t's successful, as you can see from this video of Ghandler, who, two months after we first met her, is now doings a back flip. And had lunch with her yesterday because she's a college student studying dance at Long 8each here, and she's doing absolutely fantastic. 8ut the future is actually even brighter. #he future holds the promise that new drugs will be developed that are not symptom,modifying drugs that simply mask the problem, as we

have now, but that will be disease,modifying drugs that will actually go right to the root of the problem and attack those glial cells, or those pernicious proteins that the glial cells elaborate, that spill over and cause this central nervous system wind,up, or plasticity, that so is capable of distorting and amplifying the sensory e(perience that we call pain. So have hope that in the future, the prophetic words of Beorge Garlin will be reali6ed, who said, =<y philosophy7 5o pain, no pain.= #hank you very much. CApplauseD

SA2A) @A:53 8LAE3<923 F #)3 <:S#32 94S W92E 5BS 9; #)3 A.9L3SG35# 82A 5

;ifteen years ago, it was widely assumed that the vast ma/ority of brain development takes place in the first few years of life. 8ack then, -" years ago, we didn't have the ability to look inside the living human brain and track development across the lifespan. n the past decade or so, mainly due to advances in brain imaging technology such as magnetic resonance imaging, or <2 , neuroscientists have started to look inside the living human brain of all ages, and to track changes in brain structure and brain function, so we use structural <2 if you'd like to take a snapshot, a photograph, at really high resolution of the inside of the living human brain, and we can ask Auestions like, how much gray matter does the brain contain, and how does that change with age? And we also use functional <2 , called f<2 , to take a video, a movie, of brain activity when participants are taking part in some kind of task like thinking or feeling or perceiving something. So many labs around the world are involved in this kind of research, and we now have a really rich and detailed picture of how the living human brain develops, and this picture has radically changed the way we think about human brain development by revealing that it's not all over in early childhood, and instead, the brain continues to develop right throughout adolescence and into the '$&s and '%&s. So adolescence is defined as the period of life that starts with the biological, hormonal, physical changes of puberty and ends at the age at which an individual attains a stable, independent role in society. CLaughterD t can go on a long time. CLaughterD 9ne of the brain regions that changes most dramatically during adolescence is called prefrontal corte(. So this is a model of the human brain, and this is prefrontal corte(, right at the front. >refrontal corte( is an interesting brain area. t's proportionally much bigger in humans than in any other species, and it's involved in a whole range of high level

cognitive functions, things like decision,making, planning, planning what you're going to do tomorrow or ne(t week or ne(t year, inhibiting inappropriate behavior, so stopping yourself saying something really rude or doing something really stupid. t's also involved in social interaction, understanding other people, and self,awareness. So <2 studies looking at the development of this region have shown that it really undergoes dramatic development during the period of adolescence. So if you look at gray matter volume, for e(ample, gray matter volume across age from age four to $$ years increases during childhood, which is what you can see on this graph. t peaks in early adolescence. #he arrows indicate peak gray matter volume in prefrontal corte(. :ou can see that that peak happens a couple of years later in boys relative to girls, and that's probably because boys go through puberty a couple of years later than girls on average, and then during adolescence, there's a significant decline in gray matter volume in prefrontal corte(. 5ow that might sound bad, but actually this is a really important developmental process, because gray matter contains cell bodies and connections between cells, the synapses, and this decline in gray matter volume during prefrontal corte( is thought to correspond to synaptic pruning, the elimination of unwanted synapses. #his is a really important process. t's partly dependent on the environment that the animal or the human is in, and the synapses that are being used are strengthened, and synapses that aren't being used in that particular environment are pruned away. :ou can think of it a bit like pruning a rosebush. :ou prune away the weaker branches so that the remaining, important branches, can grow stronger, and this process, which effectively fine,tunes brain tissue according to the species,specific environment, is happening in prefrontal corte( and in other brain regions during the period of human adolescence. So a second line of inAuiry that we use to track changes in the adolescent brain is using functional <2 to look at changes in brain activity across age. So 'll /ust give you an e(ample from my lab. So in my lab, we're interested in the social brain, that is the network of brain regions that we use to understand other people and to interact with other people. So like to show a photograph of a soccer game to illustrate two aspects of how your social brains work. So this is a soccer game. CLaughterD <ichael 9wen has /ust missed a goal, and he's lying on the ground, and the first aspect of the social brain that this picture really nicely illustrates is how automatic and instinctive social emotional responses are, so within a split second of <ichael 9wen missing this goal, everyone is doing the same thing with their arms and the same thing with their face, even <ichael 9wen as he slides along the grass, is doing the same thing with his arms, and presumably has a similar facial e(pression, and the only people who don't are the guys in yellow at the back N CLaughsD N and think they're on the wrong end of the stadium, and they're doing another social emotional response that we all instantly recogni6e, and that's the second aspect of the social brain that this picture really nicely illustrates, how good we are at reading other people's behavior, their actions, their gestures, their facial e(pressions, in terms of their underlying emotions and mental states. So you don't have to ask any of these guys. :ou have a pretty good idea of what they're feeling and thinking at this precise moment in time.

So that's what we're interested in looking at in my lab. So in my lab, we bring adolescents and adults into the lab to have a brain scan, we give them some kind of task that involves thinking about other people, their minds, their mental states, their emotions, and one of the findings that we've found several times now, as have other labs around the world, is part of the prefrontal corte( called medial prefrontal corte(, which is shown in blue on the slide, and it's right in the middle of prefrontal corte( in the midline of your head. #his region is more active in adolescents when they make these social decisions and think about other people than it is in adults, and this is actually a meta,analysis of nine different studies in this area from labs around the world, and they all show the same thing, that activity in this medial prefrontal corte( area decreases during the period of adolescence. And we think that might be because adolescents and adults use a different mental approach, a different cognitive strategy, to make social decisions, and one way of looking at that is to do behavioral studies whereby we bring people into the lab and we give them some kind of behavioral task, and 'll /ust give you another e(ample of the kind of task that we use in my lab. So imagine that you're the participant in one of our e(periments. :ou come into the lab, you see this computeri6ed task. n this task, you see a set of shelves. 5ow, there are ob/ects on these shelves, on some of them, and you'll notice there's a guy standing behind the set of shelves, and there are some ob/ects that he can't see. #hey're occluded, from his point of view, with a kind of gray piece of wood. #his is the same set of shelves from his point of view. 5otice that there are only some ob/ects that he can see, whereas there are many more ob/ects that you can see. 5ow your task is to move ob/ects around. #he director, standing behind the set of shelves, is going to direct you to move ob/ects around, but remember, he's not going to ask you to move ob/ects that he can't see. #his introduces a really interesting condition whereby there's a kind of conflict between your perspective and the director's perspective. So imagine he tells you to move the top truck left. #here are three trucks there. :ou're going to instinctively go for the white truck, because that's the top truck from your perspective, but then you have to remember, =9h, he can't see that truck, so he must mean me to move the blue truck,= which is the top truck from his perspective. 5ow believe it or not, normal, healthy, intelligent adults like you make errors about "& percent of the time on that kind of trial. #hey move the white truck instead of the blue truck. So we give this kind of task to adolescents and adults, and we also have a control condition where there's no director and instead we give people a rule. We tell them, okay, we're going to do e(actly the same thing but this time there's no director. nstead you've got to ignore ob/ects with the dark gray background. :ou'll see that this is e(actly the same condition, only in the no,director condition they /ust have to remember to apply this somewhat arbitrary rule, whereas in the director condition, they have to remember to take into account the director's perspective in order to guide their ongoing behavior. 9kay, so if /ust show you the percentage errors in a large developmental study we did, this is in a study ranging from age seven to adulthood, and what you're going to see is the percentage errors in the adult group in both conditions, so the gray is the director condition, and you see that our intelligent adults are making errors about "& percent of the time, whereas they make far fewer errors when there's no director present, when they

/ust have to remember that rule of ignoring the gray background. .evelopmentally, these two conditions develop in e(actly the same way. 8etween late childhood and mid, adolescence, there's an improvement, in other words a reduction of errors, in both of these trials, in both of these conditions. 8ut it's when you compare the last two groups, the mid,adolescent group and the adult group where things get really interesting, because there, there is no continued improvement in the no,director condition. n other words, everything you need to do in order to remember the rule and apply it seems to be fully developed by mid,adolescence, whereas in contrast, if you look at the last two gray bars, there's still a significant improvement in the director condition between mid,adolescence and adulthood, and what this means is that the ability to take into account someone else's perspective in order to guide ongoing behavior, which is something, by the way, that we do in everyday life all the time, is still developing in mid,to,late adolescence. So if you have a teenage son or a daughter and you sometimes think they have problems taking other people's perspectives, you're right. #hey do. And this is why. So we sometimes laugh about teenagers. #hey're parodied, sometimes even demoni6ed in the media for their kind of typical teenage behavior. #hey take risks, they're sometimes moody, they're very self,conscious. have a really nice anecdote from a friend of mine who said that the thing he noticed most about his teenage daughters before and after puberty was their level of embarrassment in front of him. So, he said, =8efore puberty, if my two daughters were messing around in a shop, 'd say, ')ey, stop messing around and 'll sing your favorite song,' and instantly they'd stop messing around and he'd sing their favorite song. After puberty, that became the threat. CLaughterD #he very notion of their dad singing in public was enough to make them behave. So people often ask, =Well, is adolescence a kind of recent phenomenon? s it something we've invented recently in the West?= And actually, the answer is probably not. #here are lots of descriptions of adolescence in history that sound very similar to the descriptions we use today. So there's a famous Auote by Shakespeare from =#he Winter's #ale= where he describes adolescence as follows7 = would there were no age between ten and three,and,twenty, or that youth would sleep out the rest? for there is nothing in the between but getting wenches with child, wronging the ancientry, stealing, fighting.= CLaughterD )e then goes on to say, =)aving said that, would any but these boiled brains of nineteen and two,and, twenty hunt in this weather?= CLaughterD So almost *&& years ago, Shakespeare was portraying adolescents in a very similar light to the light that we portray them in today, but today we try to understand their behavior in terms of the underlying changes that are going on in their brain. So for e(ample, take risk,taking. We know that adolescents have a tendency to take risks. #hey do. #hey take more risks than children or adults, and they are particularly prone to taking risks when they're with their friends. #here's an important drive to become independent from one's parents and to impress one's friends in adolescence. 8ut now we try to understand that in terms of the development of a part of their brain called the limbic system, so 'm going to show you the limbic system in red in the slide behind me, and

also on this brain. So the limbic system is right deep inside the brain, and it's involved in things like emotion processing and reward processing. t gives you the rewarding feeling out of doing fun things, including taking risks. t gives you the kick out of taking risks. And this region, the regions within the limbic system, have been found to be hypersensitive to the rewarding feeling of risk,taking in adolescents compared with adults, and at the very same time, the prefrontal corte(, which you can see in blue in the slide here, which stops us taking e(cessive risks, is still very much in development in adolescents. So brain research has shown that the adolescent brain undergoes really Auite profound development, and this has implications for education, for rehabilitation, and intervention. #he environment, including teaching, can and does shape the developing adolescent brain, and yet it's only relatively recently that we have been routinely educating teenagers in the West. All four of my grandparents, for e(ample, left school in their early adolescence. #hey had no choice. And that's still the case for many, many teenagers around the world today. ;orty percent of teenagers don't have access to secondary school education. And yet, this is a period of life where the brain is particularly adaptable and malleable. t's a fantastic opportunity for learning and creativity. So what's sometimes seen as the problem with adolescents N heightened risk,taking, poor impulse control, self,consciousness N shouldn't be stigmati6ed. t actually reflects changes in the brain that provide an e(cellent opportunity for education and social development. #hank you. CApplauseD CApplauseD

<4S#A;A AE:9L F 83L 3; 0S #2A. # 95 5 @324SAL3< A few weeks ago, had a chance to go to Saudi Arabia. And the first thing wanted to do as a <uslim was go to <ecca and visit the Eaaba, the holiest shrine of slam. And did that? put on my ritualistic dress? went to the holy mosAue? did my prayers? observed all the rituals. And meanwhile, besides all the spirituality, there was one mundane detail in the Eaaba that was pretty interesting for me. #here was no separation of se(es. n other words, men and women were worshiping all together. #hey were together while doing the tawaf, the circular walk around the Eaaba. #hey were together while praying. And if you wonder why this is interesting at all, you have to see the rest of Saudi Arabia because it's a country which is strictly divided between the se(es. n other words, as men, you are not simply supposed to be in the same physical space with women. And noticed this in a very funny way. left the Eaaba to eat something in downtown <ecca. headed to the nearest 8urger Eing restaurant. And went there ,, noticed that there was a male section, which was carefully separated from the female section. And had to pay, order and eat at the male section. = t's funny,= said to myself, =:ou can mingle with the opposite se( at the holy Eaaba, but not at the 8urger Eing.=

Ouite ironic. ronic, and it's also, think, Auite telling. 8ecause the Eaaba and the rituals around it are relics from the earliest phase of slam, that of prophet <uhammad. And if there was a big emphasis at the time to separate men from women, the rituals around the Eaaba could have been designed accordingly. 8ut apparently that was not an issue at the time. So the rituals came that way. #his is also, think, confirmed by the fact that the seclusion of women in creating a divided society is something that you also do not find in the Eoran, the very core of slam ,, the divine core of slam that all <uslims, and eAually myself, believe. And think it's not an accident that you don't find this idea in the very origin of slam. 8ecause many scholars who study the history of slamic thought ,, <uslim scholars or Westerners ,, think that actually the practice of dividing men and women physically came as a later development in slam, as <uslims adopted some pree(isting cultures and traditions of the <iddle 3ast. Seclusion of women was actually a 8y6antine and >ersian practice, and <uslims adopted that and made that a part of their religion. And actually this is /ust one e(ample of a much larger phenomenon. What we call today slamic Law, and especially slamic culture ,, and there are many slamic cultures actually? the one in Saudi Arabia is much different from where come from in stanbul or #urkey. 8ut still, if you're going to speak about a <uslim culture, this has a core, the divine message, which began the religion, but then many traditions, perceptions, many practices were added on top of it. And these were traditions of the <iddle 3ast ,, medieval traditions. And there are two important messages, or two lessons, to take from that reality. ;irst of all, <uslims ,, pious, conservative, believing <uslims who want to be loyal to their religion ,, should not cling onto everything in their culture, thinking that that's divinely mandated. <aybe some things are bad traditions and they need to be changed. 9n the other hand, the Westerners who look at slamic culture and see some troubling aspects should not readily conclude that this is what slam ordains. <aybe it's a <iddle 3astern culture that became confused with slam. #here is a practice called female circumcision. t's something terrible, horrible. t is basically an operation to deprive women of se(ual pleasure. And Westerners, 3uropeans or Americans, who didn't know about this before faced this practice within some of the <uslim communities who migrated from 5orth Africa. And they've thought, =9h, what a horrible religion that is which ordains something like that.= 8ut actually when you look at female circumcision, you see that it has nothing to do with slam, it's /ust a 5orth African practice, which predates slam. t was there for thousands of years. And Auite tellingly, some <uslims do practice that. #he <uslims in 5orth Africa, not in other places. 8ut also the non,<uslim communities of 5orth Africa ,, the Animists, even some Ghristians and even a @ewish tribe in 5orth Africa is known to practice female circumcision. So what might look like a problem within slamic faith might turn out to be a tradition that <uslims have subscribed to. #he same thing can be said for honor killings, which is a recurrent theme in the Western media ,, and which is, of course, a horrible tradition. And we see truly in some <uslim

communities that tradition. 8ut in the non,<uslim communities of the <iddle 3ast, such as some Ghristian communities, 3astern communities, you see the same practice. We had a tragic case of an honor killing within #urkey's Armenian community /ust a few months ago. 5ow these are things about general culture, but 'm also very much interested in political culture and whether liberty and democracy is appreciated, or whether there's an authoritarian political culture in which the state is supposed to impose things on the citi6ens. And it is no secret that many slamic movements in the <iddle 3ast tend to be authoritarian, and some of the so,called = slamic regimes= such as Saudi Arabia, ran and the worst case was the #aliban in Afghanistan ,, they are pretty authoritarian. 5o doubt about that. ;or e(ample, in Saudi Arabia there is a phenomenon called the religious police. And the religious police imposes the supposed slamic way of life on every citi6en, by force ,, like women are forced to cover their heads ,, wear the hi/ab, the slamic head cover. 5ow that is pretty authoritarian, and that's something 'm very much critical of. 8ut when reali6ed that the non,<uslim, or the non, slamic,minded actors in the same geography, sometimes behaved similarly, reali6ed that the problem maybe lies in the political culture of the whole region, not /ust slam. Let me give you an e(ample7 in #urkey where come from, which is a very hyper,secular republic, until very recently we used to have what call secularism police, which would guard the universities against veiled students. n other words, they would force students to uncover their heads, and think forcing people to uncover their head is as tyrannical as forcing them to cover it. t should be the citi6en's decision. 8ut when saw that, said, =<aybe the problem is /ust an authoritarian culture in the region, and some <uslims have been influenced by that. 8ut the secular,minded people can be influenced by that. <aybe it's a problem of the political culture, and we have to think about how to change that political culture.= 5ow these are some of the Auestions had in mind a few years ago when sat down to write a book. said, =Well will make a research about how slam actually came to be what it is today, and what roads were taken and what roads could have been taken.= #he name of the book is = slam Without 3(tremes7 A <uslim Gase for Liberty.= And as the subtitle suggests, looked at slamic tradition and the history of slamic thought from the perspective of individual liberty, and tried to find what are the strengths with regard to individual liberty. And there are strengths in slamic tradition. slam actually, as a monotheistic religion, which defined man as a responsible agent by itself, created the idea of the individual in the <iddle 3ast and saved it from the communitarianism, the collectivism of the tribe. :ou can derive many ideas from that. 8ut besides that, also saw problems within slamic tradition. 8ut one thing was curious7 most of those problems turn out to be problems that emerged later, not from the very divine core of slam, the Eoran, but from, again, traditions and mentalities, or the interpretations of the Eoran that <uslims made in the <iddle Ages. #he Eoran, for e(ample, doesn't condone stoning. #here is no punishment on apostasy. #here is no punishment on personal things like drinking. #hese

things which make slamic Law, the troubling aspects of slamic Law, were later developed into later interpretations of slam. Which means that <uslims can, today, look at those things and say, =Well, the core of our religion is here to stay with us. t's our faith, and we will be loyal to it. 8ut we can change how it was interpreted, because it was interpreted according to the time and milieu in the <iddle Ages. 5ow we are living in a different world with different values and different political systems.= #hat interpretation is Auite possible and feasible. 5ow if were the only person thinking that way, we would be in trouble. 8ut that's not the case at all. Actually, from the -!th century on, there's a whole revisionist, reformist ,, whatever you call it ,, tradition, a trend in slamic thinking. And these were intellectuals or statesmen of the -!th century, and later, $&th century, which looked at 3urope basically and saw that 3urope has many things to admire, like science and technology. 8ut not /ust that? also democracy, parliament, the idea of representation, the idea of eAual citi6enship. #hese <uslim thinkers and intellectuals and statesmen of the -!th century looked at 3urope, saw these things. #hey said, =Why don't we have these things?= And they looked back at slamic tradition, they saw that there are problematic aspects, but they're not the core of the religion, so maybe they can be re,understood, and the Eoran can be reread in the modern world. #hat trend is generally called slamic modernism, and it was advanced by intellectuals and statesmen, not /ust as an intellectual idea though, but also as a political program. And that's why actually in the -!th century the 9ttoman 3mpire, which then covered the whole <iddle 3ast, made very important reforms ,, reforms like giving Ghristians and @ews an eAual citi6enship status, accepting a constitution, accepting a representative parliament, advancing the idea of freedom of religion. And that's why the 9ttoman 3mpire in its last decades turned into a proto,democracy, a constitutional monarchy, and freedom was a very important political value at the time. Similarly, in the Arab world, there was what the great Arab historian Albert )ourani defines as the Liberal Age. )e has a book, =Arabic #hought in the Liberal Age,= and the Liberal Age, he defines as -!th century and early $&th century. Ouite notably, this was the dominant trend in the early $&th century among slamic thinkers and statesmen and theologians. 8ut there is a very curious pattern in the rest of the $&th century, because we see a sharp decline in this slamic modernist line. And in place of that, what happens is that slamism grows as an ideology which is authoritarian, which is Auite strident, which is Auite anti,Western, and which wants to shape society based on a utopian vision. So slamism is the problematic idea that really created a lot of problems in the $&th century slamic world. And even the very e(treme forms of slamism led to terrorism in the name of slam ,, which is actually a practice that think is against slam, but some, obviously, e(tremists did not think that way. 8ut there is a curious Auestion7 f slamic modernism was so popular in the -!th and early $&th centuries, why did slamism become so popular in the rest of the $&th century? And this is a Auestion, think, which needs to be discussed carefully. And in my book, went into that Auestion as well. And actually you don't need to be a rocket scientist to understand that. :ou /ust look at the

political history of the $&th century, and you see things have changed a lot. #he conte(t has changed. n the -!th century, when <uslims were looking at 3urope as an e(ample, they were independent? they were more self,confident. n the early $&th century, with the fall of the 9ttoman 3mpire, the whole <iddle 3ast was coloni6ed. And when you have coloni6ation what do you have? :ou have anti,coloni6ation. So 3urope is not /ust an e(ample now to emulate? it's an enemy to fight and to resist. So there's a very sharp decline in liberal ideas in the <uslim world, and what you see is more of a defensive, rigid, reactionary strain, which led to Arab socialism, Arab nationalism and ultimately to the slamist ideology. And when the colonial period ended, what you had in place of that was, generally, secular dictators, which say they're a country, but did not bring democracy to the country, and established their own dictatorship. And think the West, at least some powers in the West, particularly the 4nited States, made the mistake of supporting those secular dictators, thinking that they were more helpful for their interests. 8ut the fact that those dictators suppressed democracy in their country and suppressed slamic groups in their country actually made the slamists much more strident. So in the $&th century, you had this vicious cycle in the Arab world where you have a dictatorship suppressing its own people including the slamic,pious, and they're reacting in reactionary ways. #here was one country, though, which was able to escape or stay away from that vicious cycle. And that's the country where come from? that's #urkey. #urkey has never been coloni6ed, so it remained as an independent nation after the fall of the 9ttoman 3mpire. #hat's one thing to remember. #hey did not share the same anti, colonial hype that you can find in some other countries in the region. Secondly, and most importantly, #urkey became a democracy earlier than any of the countries we are talking about. n -!"&, #urkey had the first free and fair elections, which ended the more autocratic secular regime, which was the beginning of #urkey. And the pious <uslims in #urkey saw that they can change the political system by voting. And they reali6e that democracy is something that is compatible with slam, compatible with their values, and they've been supportive of democracy. #hat's an e(perience that not every other <uslim nation in the <iddle 3ast had until very recently. Secondly, in the past two decades, thanks to globali6ation, thanks to the market economy, thanks to the rise of a middle,class, we in #urkey see what define as a rebirth of slamic modernism. 5ow there's the more urban middle,class pious <uslims who, again, look at their tradition and see that there are some problems in the tradition, and they understand that they need to be changed and Auestioned and reformed. And they look at 3urope, and they see an e(ample, again, to follow. #hey see an e(ample, at least, to take some inspiration from. #hat's why the 3.4. process, #urkey's effort to /oin the 3.4., has been supported inside #urkey by the slamic,pious, while some secular nations were against that. Well that process has been a little bit blurred by the fact that not all 3uropeans are that welcoming ,, but that's another discussion. 8ut the pro,3.4. sentiment in #urkey in the past decade has become almost an slamic cause and supported by the slamic liberals and the secular liberals as well, of course.

And thanks to that, #urkey has been able to reasonably create a success story in which slam and the most pious understandings of slam have become part of the democratic game, and even contributes to the democratic and economic advance of the country. And this has been an inspiring e(ample right now for some of the slamic movements or some of the countries in the Arab world. :ou must have all seen the Arab Spring, which began in #unis and in 3gypt. And Arab masses /ust revolted against their dictators. #hey were asking for democracy? they were asking for freedom. And they did not turn out to be the slamist boogyman that the dictators were always using to /ustify their regime. #hey said that =we want freedom? we want democracy. We are <uslim believers, but we want to be living as free people in free societies.= 9f course, this is a long road. .emocracy is not an overnight achievement? it's a process. 8ut this is a promising era in the <uslim world. And believe that the slamic modernism which began in the -!th century, but which had a setback in the $&th century because of the political troubles of the <uslim world, is having a rebirth. And think the getaway message from that would be that slam, despite some of the skeptics in the West, has the potential in itself to create its own way to democracy, create its own way to liberalism, create its own way to freedom. #hey /ust should be allowed to work for that. #hanks so much. CApplauseD

Dan Buettner:
Something called the .anish #win Study established that only about -& percent of how long the average person lives, within certain biological limits, is dictated by our genes. #he other !& percent is dictated by our lifestyle. So the premise of 8lue Iones7 if we can find the optimal lifestyle of longevity we can come up with a de facto formula for longevity. 8ut if you ask the average American what the optimal formula of longevity is, they probably couldn't tell you. #hey've probably heard of the South 8each .iet, or the Atkins .iet. :ou have the 4S.A food pyramid. #here is what 9prah tells us. #here is what .octor 96 tells us. #he fact of the matter is there is a lot of confusion around what really helps us live longer better. Should you be running marathons or doing yoga? Should you eat organic meats or should you be eating tofu? When it comes to supplements, should you be taking them? )ow about these hormones or resveratrol? And does purpose play into it? Spirituality? And how about how we sociali6e?

Well, our approach to finding longevity was to team up with 5ational Beographic, and the 5ational nstitute on Aging, to find the four demographically confirmed areas that are geographically defined. And then bring a team of e(perts in there to methodically go through e(actly what these people do, to distill down the cross,cultural distillation. And at the end of this 'm going to tell you what that distillation is. 8ut first 'd like to debunk some common myths when it comes to longevity. And the first myth is if you try really hard you can live to be -&&. ;alse. #he problem is, only about one out of ",&&& people in America live to be -&&. :our chances are very low. 3ven though it's the fastest growing demographic in America, it's hard to reach -&&. #he problem is that we're not programmed for longevity. We are programmed for something called procreative success. love that word. t reminds me of my college days. 8iologists term procreative success to mean the age where you have children and then another generation, the age when your children have children. After that the effect of evolution completely dissipates. f you're a mammal, if you're a rat or an elephant, or a human, in between, it's the same story. So to make it to age -&&, you not only have to have had a very good lifestyle, you also have to have won the genetic lottery. #he second myth is, there are treatments that can help slow, reverse, or even stop aging. ;alse. When you think of it, there is !! things that can age us. .eprive your brain of o(ygen for /ust a few minutes, those brain cells die, they never come back. >lay tennis too hard, on your knees, ruin your cartilage, the cartilage never comes back. 9ur arteries can clog. 9ur brains can gunk up with plaAue, and we can get Al6heimer's. #here is /ust too many things to go wrong. 9ur bodies have %" trillion cells, trillion with a =#.= We're talking national debt numbers here. CLaughterD #hose cells turn themselves over once every eight years. And every time they turn themselves over there is some damage. And that damage builds up. And it builds up e(ponentially. t's a little bit like the days when we all had 8eatles albums or 3agles albums and we'd make a copy of that on a cassette tape, and let our friends copy that cassette tape, and pretty soon, with successive generations that tape sounds like garbage. Well, the same things happen to our cells. #hat's why a +",year,old person is aging at a rate of about -$" times faster than a -$,year,old person. So, if there is nothing you can do to slow your aging or stop your aging, what am doing here? Well, the fact of the matter is the best science tells us that the capacity of the human body, my body, your body, is about !& years, a little bit more for women. 8ut life e(pectancy in this country is only 1'. So somewhere along the line, we're leaving about -$ good years on the table. #hese are years that we could get. And research shows that they would be years largely free of chronic disease, heart disease, cancer and diabetes. We think the best way to get these missing years is to look at the cultures around the world that are actually e(periencing them, areas where people are living to age -&& at rates up to -& times greater than we are, areas where the life e(pectancy is an e(tra do6en years, the rate of middle age mortality is a fraction of what it is in this country.

We found our first 8lue Ione about -$" miles off the coast of taly, on the island of Sardinia. And not the entire island, the island is about -.* million people, but only up in the highlands, an area called the 5uoro province. And here we have this area where men live the longest, about -& times more centenarians than we have here in America. And this is a place where people not only reach age -&&, they do so with e(traordinary vigor. >laces where -&$ year olds still ride their bike to work, chop wood, and can beat a guy +& years younger than them. CLaughterD #heir history actually goes back to about the time of Ghrist. t's actually a 8ron6e Age culture that's been isolated. 8ecause the land is so infertile, they largely are shepherds, which occasions regular, low,intensity physical activity. #heir diet is mostly plant,based, accentuated with foods that they can carry into the fields. #hey came up with an unleavened whole wheat bread called carta musica made out of durum wheat, a type of cheese made from grass,fed animals so the cheese is high in 9mega,% fatty acids instead of 9mega,+ fatty acids from corn,fed animals, and a type of wine that has three times the level of polyphenols than any known wine in the world. t's called Gannonau. 8ut the real secret think lies more in the way that they organi6e their society. And one of the most salient elements of the Sardinian society is how they treat older people. :ou ever notice here in America, social eAuity seems to peak at about age $*? @ust look at the advertisements. )ere in Sardinia, the older you get the more eAuity you have, the more wisdom you're celebrated for. :ou go into the bars in Sardinia, instead of seeing the Sports llustrated swimsuit calendar, you see the centenarian of the month calendar. #his, as it turns out, is not only good for your aging parents to keep them close to the family ,, it imparts about four to si( years of e(tra life e(pectancy ,, research shows it's also good for the children of those families, who have lower rates of mortality and lower rates of disease. #hat's called the grandmother effect. We found our second 8lue Ione on the other side of the planet, about '&& miles south of #okyo, on the archipelago of 9kinawa. 9kinawa is actually -+- small islands. And in the northern part of the main island, this is ground 6ero for world longevity. #his is a place where the oldest living female population is found. t's a place where people have the longest disability,free life e(pectancy in the world. #hey have what we want. #hey live a long time, and tend to die in their sleep, very Auickly, and often, can tell you, after se(. #hey live about seven good years longer than the average American. ;ive times as many centenarians as we have in America. 9ne fifth the rate of colon and breast cancer, big killers here in America. And one si(th the rate of cardiovascular disease. And the fact that this culture has yielded these numbers suggests strongly they have something to teach us. What do they do? 9nce again, a plant,based diet, full of vegetables with lots of color in them. And they eat about eight times as much tofu as Americans do. <ore significant than what they eat is how they eat it. #hey have all kinds of little strategies to keep from overeating, which, as you know, is a big problem here in America. A few of the strategies we observed7 they eat off of smaller plates, so they tend

to eat fewer calories at every sitting. nstead of serving family style, where you can sort of mindlessly eat as you're talking, they serve at the counter, put the food away, and then bring it to the table. #hey also have a %,&&&,year,old adage, which think is the greatest sort of diet suggestion ever invented. t was invented by Gonfucius. And that diet is known as the )ara, )atchi, 8u diet. t's simply a little saying these people say before their meal to remind them to stop eating when their stomach is L'&M percent full. t takes about a half hour for that full feeling to travel from your belly to your brain. And by remembering to stop at '& percent it helps keep you from doing that very thing. 8ut, like Sardinia, 9kinawa has a few social constructs that we can associate with longevity. We know that isolation kills. ;ifteen years ago, the average American had three good friends. We're down to one and half right now. f you were lucky enough to be born in 9kinawa, you were born into a system where you automatically have a half a do6en friends with whom you travel through life. #hey call it a <oai. And if you're in a <oai you're e(pected to share the bounty if you encounter luck, and if things go bad, child gets sick, parent dies, you always have somebody who has your back. #his particular <oai, these five ladies have been together for !1 years. #heir average age is -&$. #ypically in America we've divided our adult life up into two sections. #here is our work life, where we're productive. And then one day, boom, we retire. And typically that has meant retiring to the easy chair, or going down to Ari6ona to play golf. n the 9kinawan language there is not even a word for retirement. nstead there is one word that imbues your entire life, and that word is =ikigai.= And, roughly translated, it means =the reason for which you wake up in the morning.= ;or this -&$,year,old karate master, his ikigai was carrying forth this martial art. ;or this hundred,year,old fisherman it was continuing to catch fish for his family three times a week. And this is a Auestion. #he 5ational nstitute on Aging actually gave us a Auestionnaire to give these centenarians. And one of the Auestions, they were very culturally astute, the people who put the Auestionnaire. 9ne of the Auestions was, =What is your ikigai?= #hey instantly knew why they woke up in the morning. ;or this -&$ year old woman, her ikigai was simply her great,great,great,granddaughter. #wo girls separated in age by -&- and a half years. And asked her what it felt like to hold a great, great,great,granddaughter. And she put her head back and she said, = t feels like leaping into heaven.= thought that was a wonderful thought. <y editor at Beographic wanted me to find America's 8lue Ione. And for a while we looked on the prairies of <innesota, where actually there is a very high proportion of centenarians. 8ut that's because all the young people left. CLaughterD So, we turned to the data again. And we found America's longest,lived population among the Seventh,.ay Adventists concentrated in and around Loma Linda, Galifornia. Adventists are conservative <ethodists. #hey celebrate their Sabbath from sunset on ;riday till sunset

on Saturday. A =$*,hour sanctuary in time,= they call it. And they follow five little habits that conveys to them e(traordinary longevity, comparatively speaking. n America here, life e(pectancy for the average woman is '&. 8ut for an Adventist woman, their life e(pectancy is '!. And the difference is even more pronounced among men, who are e(pected to live about -- years longer than their American counterparts. 5ow, this is a study that followed about 1&,&&& people for %& years. Sterling study. And think it supremely illustrates the premise of this 8lue Ione pro/ect. #his is a heterogeneous community. t's white, black, )ispanic, Asian. #he only thing that they have in common are a set of very small lifestyle habits that they follow ritualistically for most of their lives. #hey take their diet directly from the 8ible. Benesis7 Ghapter one, 0erse L$!M, where Bod talks about legumes and seeds, and on one more stan6a about green plants, ostensibly missing is meat. #hey take this sanctuary in time very serious. ;or $* hours every week, no matter how busy they are, how stressed out they are at work, where the kids need to be driven, they stop everything and they focus on their Bod, their social network, and then, hardwired right in the religion, are nature walks. And the power of this is not that it's done occasionally, the power is it's done every week for a lifetime. 5one of it's hard. 5one of it costs money. Adventists also tend to hang out with other Adventists. So, if you go to an Adventist's party you don't see people swilling @im 8eam or rolling a /oint. nstead they're talking about their ne(t nature walk, e(changing recipes, and yes, they pray. 8ut they influence each other in profound and measurable ways. #his is a culture that has yielded 3llsworth Whareham. 3llsworth Whareham is !1 years old. )e's a multimillionaire, yet when a contractor wanted +,&&& dollars to build a privacy fence, he said, =;or that kind of money 'll do it myself.= So for the ne(t three days he was out shoveling cement, and hauling poles around. And predictably, perhaps, on the fourth day he ended up in the operating room. 8ut not as the guy on the table? the guy doing open,heart surgery. At !1 he still does $& open,heart surgeries every month. 3d 2awlings, -&% years old now, an active cowboy, starts his morning with a swim. And on weekends he likes to put on the boards, throw up rooster tails. And then <arge .eton. <arge is -&*. )er grandson actually lives in the #win Gities here. She starts her day with lifting weights. She rides her bicycle. And then she gets in her root,beer colored -!!* Gadillac Seville, and tears down the San 8ernardino freeway, where she still volunteers for seven different organi6ations. 've been on -! hardcore e(peditions. 'm probably the only person you'll ever meet who rode his bicycle across the Sahara desert without sunscreen. 8ut 'll tell you, there is no adventure more harrowing than riding shotgun with <arge .eton. =A stranger is a friend haven't met yetH= she'd say to me. So, what are the common denominators in these three cultures? What are the things that they all do? And we managed to boil it down to nine. n fact we've done two more 8lue

Ione e(peditions since this and these common denominators hold true. And the first one, and 'm about to utter a heresy here, none of them e(ercise, at least the way we think of e(ercise. nstead, they set up their lives so that they are constantly nudged into physical activity. #hese -&&,year,old 9kinawan women are getting up and down off the ground, they sit on the floor, %& or *& times a day. Sardinians live in vertical houses, up and down the stairs. 3very trip to the store, or to church or to a friend's house occasions a walk. #hey don't have any conveniences. #here is not a button to push to do yard work or house work. f they want to mi( up a cake, they're doing it by hand. #hat's physical activity. #hat burns calories /ust as much as going on the treadmill does. When they do do intentional physical activity, it's the things they en/oy. #hey tend to walk, the only proven way to stave off cognitive decline, and they all tend to have a garden. #hey know how to set up their life in the right way so they have the right outlook. 3ach of these cultures take time to downshift. #he Sardinians pray. #he Seventh,.ay Adventists pray. #he 9kinawans have this ancestor veneration. 8ut when you're in a hurry or stressed out, that triggers something called the inflammatory response, which is associated with everything from Al6heimer's disease to cardiovascular disease. When you slow down for -" minutes a day you turn that inflammatory state into a more anti, inflammatory state. #hey have vocabulary for sense of purpose, ikigai, like the 9kinawans. :ou know the two most dangerous years in your life are the year you're born, because of infant mortality, and the year you retire. #hese people know their sense of purpose, and they activate in their life, that's worth about seven years of e(tra life e(pectancy. #here's no longevity diet. nstead, these people drink a little bit every day, not a hard sell to the American population. CLaughterD #hey tend to eat a plant,based diet. .oesn't mean they don't eat meat, but lots of beans and nuts. And they have strategies to keep from overeating, little things that nudge them away from the table at the right time. And then the foundation of all this is how they connect. #hey put their families first, take care of their children and their aging parents. #hey all tend to belong to a faith,based community, which is worth between four and -* e(tra years of life e(pectancy if you do it four times a month. And the biggest thing here is they also belong to the right tribe. #hey were either born into or they proactively surrounded themselves with the right people. We know from the ;ramingham studies, that if your three best friends are obese there is a "& percent better chance that you'll be overweight. So, if you hang out with unhealthy people, that's going to have a measurable impact over time. nstead, if your friend's idea of recreation is physical activity, bowling, or playing hockey, biking or gardening, if your friends drink a little, but not too much, and they eat right, and they're engaged, and they're trusting and trustworthy, that is going to have the biggest impact over time.

.iets don't work. 5o diet in the history of the world has ever worked for more than two percent of the population. 3(ercise programs usually start in @anuary? they're usually done by 9ctober. When it comes to longevity there is no short term fi( in a pill or anything else. 8ut when you think about it, your friends are long,term adventures, and therefore, perhaps the most significant thing you can do to add more years to your life, and life to your years. #hank you very much. CApplauseD <A2E 8 ##<A5 , W)A#KS W295B W #) W)A# W3 3A#?

write about food. write about cooking. take it Auite seriously, but 'm here to talk about something that's become very important to me in the last year or two. t is about food, but it's not about cooking, per se. 'm going to start with this picture of a beautiful cow. 'm not a vegetarian ,, this is the old 5i(on line, right? 8ut still think that this ,, CLaughterD ,, may be this year's version of this. 5ow, that is only a little bit hyperbolic. And why do say it? 8ecause only once before has the fate of individual people and the fate of all of humanity been so intertwined. #here was the bomb, and there's now. And where we go from here is going to determine not only the Auality and the length of our individual lives, but whether, if we could see the 3arth a century from now, we'd recogni6e it. t's a holocaust of a different kind, and hiding under our desks isn't going to help. Start with the notion that global warming is not only real, but dangerous. Since every scientist in the world now believes this, and even >resident 8ush has seen the light, or pretends to, we can take this is a given. #hen hear this, please. After energy production, livestock is the second,highest contributor to atmosphere,altering gases. 5early one,fifth of all greenhouse gas is generated by livestock production ,, more than transportation. 5ow, you can make all the /okes you want about cow farts, but methane is $& times more poisonous than G9$, and it's not /ust methane. Livestock is also one of the biggest culprits in land degradation, air and water pollution, water shortages and loss of biodiversity. #here's more. Like half the antibiotics in this country are not administered to people, but to animals. 8ut lists like this become kind of numbing, so let me /ust say this7 if you're a progressive, if you're driving a >rius, or you're shopping green, or you're looking for organic, you should probably be a semi,vegetarian. 5ow, 'm no more anti,cattle than am anti,atom, but it's all in the way we use these things. #here's another piece of the pu66le, which Ann Gooper talked about beautifully yesterday, and one you already know. #here's no Auestion, none, that so,called lifestyle diseases ,, diabetes, heart disease, stroke, some cancers ,, are diseases that are far more prevalent here than anywhere in the rest of the world. And that's the direct result of eating a Western diet. 9ur demand for meat, dairy and refined carbohydrates ,, the world consumes one billion cans or bottles of Goke a day ,, our demand for these things, not our need, our want, drives us to consume way more calories than are good for us. And those calories are in foods that cause, not prevent, disease. 5ow global warming was unforeseen. We didn't know that pollution did

more than cause bad visibility. <aybe a few lung diseases here and there, but, you know, that's not such a big deal. #he current health crisis, however, is a little more the work of the evil empire. We were told, we were assured, that the more meat and dairy and poultry we ate, the healthier we'd be. 5o. 9verconsumption of animals, and of course, /unk food, is the problem, along with our paltry consumption of plants. 5ow, there's no time to get into the benefits of eating plants here, but the evidence is that plants ,, and want to make this clear ,, it's not the ingredients in plants, it's the plants. t's not the beta,carotene, it's the carrot. #he evidence is very clear that plants promote health. #his evidence is overwhelming at this point. :ou eat more plants, you eat less other stuff, you live longer. 5ot bad. 8ut back to animals and /unk food. What do they have in common? 9ne7 we don't need either of them for health. We don't need animal products, and we certainly don't need white bread or Goke. #wo7 both have been marketed heavily, creating unnatural demand. We're not born craving Whoppers or Skittles. #hree7 their production has been supported by government agencies at the e(pense of a more health, and 3arth,friendly diet. 5ow, let's imagine a parallel. Let's pretend that our government supported an oil,based economy, while discouraging more sustainable forms of energy, knowing all the while that the result would be pollution, war and rising costs. ncredible, isn't it? :et they do that. And they do this here. t's the same deal. #he sad thing is, when it comes to diet, is that even when well,intentioned ;eds try to do right by us, they fail. 3ither they're outvoted by puppets of agribusiness, or they are puppets of agribusiness. So, when the 4S.A finally acknowledged that it was plants, rather than animals, that made people healthy, they encouraged us, via their overly simplistic food pyramid, to eat five servings of fruits and vegetables a day, along with more carbs. What they didn't tell us is that some carbs are better than others, and that plants and whole grains should be supplanting eating /unk food. 8ut industry lobbyists would never let that happen. And guess what? )alf the people who developed the food pyramid have ties to agribusiness. So, instead of substituting plants for animals, our swollen appetites simply became larger, and the most dangerous aspects of them remained unchanged. So,called low,fat diets, so,called low, carb diets ,, these are not solutions. 8ut with lots of intelligent people focusing on whether food is organic or local, or whether we're being nice to animals, the most important issues /ust aren't being addressed. 5ow, don't get me wrong. like animals, and don't think it's /ust fine to industriali6e their production and to churn them out like they were wrenches. 8ut there's no way to treat animals well, when you're killing -& billion of them a year. #hat's our number. -& billion. f you strung all of them ,, chickens, cows, pigs and lambs ,, to the moon, they'd go there and back five times, there and back. 5ow, my math's a little shaky, but this is pretty good, and it depends whether a pig is four feet long or five feet long, but you get the idea. #hat's /ust the 4nited States. And with our hyper,consumption of those animals producing greenhouse gases and heart disease, kindness might /ust be a bit of a red herring. Let's get the numbers of the animals we're killing for eating down, and then we'll worry about being nice to the ones that are left.

Another red herring might be e(emplified by the word =locavore,= which was /ust named word of the year by the 5ew 9(ford American .ictionary. Seriously. And locavore, for those of you who don't know, is someone who eats only locally grown food ,, which is fine if you live in Galifornia, but for the rest of us it's a bit of a sad /oke. 8etween the official story ,, the food pyramid ,, and the hip locavore vision, you have two versions of how to improve our eating. CLaughterD. #hey both get it wrong, though. #he first at least is populist, and the second is elitist. )ow we got to this place is the history of food in the 4nited States. And 'm going to go through that, at least the last hundred years or so, very Auickly right now. A hundred years ago, guess what? 3veryone was a locavore7 even 5ew :ork had pig farms nearby, and shipping food all over the place was a ridiculous notion. 3very family had a cook, usually a mom. And those moms bought and prepared food. t was like your romantic vision of 3urope. <argarine didn't e(ist. n fact, when margarine was invented, several states passed laws declaring that it had to be dyed pink, so we'd all know that it was a fake. #here was no snack food, and until the '$&s, until Glarence 8irdseye came along, there was no fro6en food. #here were no restaurant chains. #here were neighborhood restaurants run by local people, but none of them would think to open another one. 3ating ethnic was unheard of unless you were ethnic. And fancy food was entirely ;rench. As an aside, those of you who remember .an Aykroyd in the -!1&s doing @ulia Ghild imitations can see where he got the idea of stabbing himself from this fabulous slide. CLaughterD 8ack in those days, before even @ulia, back in those days, there was no philosophy of food. :ou /ust ate. :ou didn't claim to be anything. #here was no marketing. #here were no national brands. 0itamins had not been invented. #here were no health claims, at least not federally sanctioned ones. ;ats, carbs, proteins ,, they weren't bad or good, they were food. :ou ate food. )ardly anything contained more than one ingredient, because it was an ingredient. #he cornflake hadn't been invented. CLaughterD #he >op,#art, the >ringle, Ghee6 Whi6, none of that stuff. Boldfish swam. CLaughterD t's hard to imagine. >eople grew food, and they ate food. And again, everyone ate local. n 5ew :ork, an orange was a common Ghristmas present, because it came all the way from ;lorida. ;rom the '%&s on, road systems e(panded, trucks took the place of railroads, fresh food began to travel more. 9ranges became common in 5ew :ork. #he South and West became agricultural hubs, and in other parts of the country, suburbs took over farmland. #he effects of this are well known. #hey are everywhere. And the death of family farms is part of this pu66le, as is almost everything from the demise of the real community to the challenge of finding a good tomato, even in summer. 3ventually, Galifornia produced too much food to ship fresh, so it became critical to market canned and fro6en foods. #hus arrived convenience. t was sold to proto,feminist housewives as a way to cut down on housework. 5ow, know everybody over the age of, like *" ,, their mouths are watering at this point. CLaughterD CApplauseD f we had a slide of Salisbury steak, even more so, right? CLaughterD 8ut this may have cut down on housework, but it cut down on the variety of food we ate as well. <any of us grew up never eating a fresh vegetable e(cept the occasional raw carrot or maybe an odd lettuce salad. , for one ,, and 'm not kidding ,,

didn't eat real spinach or broccoli till was -!. Who needed it though? <eat was everywhere. What could be easier, more filling or healthier for your family than broiling a steak? 8ut by then cattle were already raised unnaturally. 2ather than spending their lives eating grass, for which their stomachs were designed, they were forced to eat soy and corn. #hey have trouble digesting those grains, of course, but that wasn't a problem for producers. 5ew drugs kept them healthy. Well, they kept them alive. )ealthy was another story. #hanks to farm subsidies, the fine collaboration between agribusiness and Gongress, soy, corn and cattle became king. And chicken soon /oined them on the throne. t was during this period that the cycle of dietary and planetary destruction began, the thing we're only reali6ing /ust now. Listen to this, between -!"& and $&&&, the world's population doubled. <eat consumption increased five,fold. 5ow, someone had to eat all that stuff, so we got fast food. And this took care of the situation resoundingly. )ome cooking remained the norm, but its Auality was down the tubes. #here were fewer meals with home,cooked breads, desserts and soups, because all of them could be bought at any store. 5ot that they were any good, but they were there. <ost moms cooked like mine7 a piece of broiled meat, a Auickly made salad with bottled dressing, canned soup, canned fruit salad. <aybe baked or mashed potatoes, or perhaps the stupidest food ever, <inute 2ice. ;or dessert, store,bought ice cream or cookies. <y mom is not here, so can say this now. #his kind of cooking drove me to learn how to cook for myself. CLaughterD t wasn't all bad. 8y the '1&s, forward,thinking people began to recogni6e the value of local ingredients. We tended gardens, we became interested in organic food, we knew or we were vegetarians. We weren't all hippies, either. Some of us were eating in good restaurants and learning how to cook well. <eanwhile, food production had become industrial. ndustrial. >erhaps because it was being produced rationally, as if it were plastic, food gained magical or poisonous powers, or both. <any people became fat, phobic. 9thers worshiped broccoli, as if it were Bod,like. 8ut mostly they didn't eat broccoli. nstead they were sold on yogurt, yogurt being almost as good as broccoli. 3(cept, in reality, the way the industry sold yogurt was to convert it to something much more akin to ice cream. Similarly, let's look at a granola bar. :ou think that that might be healthy food, but in fact, if you look at the ingredient list, it's closer in form to a Snickers than it is to oatmeal. Sadly, it was at this time that the family dinner was put in a coma, if not actually killed ,, the beginning of the heyday of value,added food, which contained as many soy and corn products as could be crammed into it. #hink of the fro6en chicken nugget. #he chicken is fed corn, and then its meat is ground up, and mi(ed with more corn products to add bulk and binder, and then it's fried in corn oil. All you do is nuke it. What could be better? And 6apped horribly, pathetically. 8y the '1&s, home cooking was in such a sad state that the high fat and spice contents of foods like <c5uggets and )ot >ockets ,, and we all have our favorites, actually ,, made this stuff more appealing than the bland things that people were serving at home. At the same time, masses of women were entering the workforce, and cooking simply wasn't important enough for men to share the burden. So now, you've got your pi66a nights,

you've got your microwave nights, you've got your gra6ing nights, you've got your fend, for,yourself nights and so on. Leading the way ,, what's leading the way? <eat, /unk food, cheese7 the very stuff that will kill you. So, now we clamor for organic food. #hat's good. And as evidence that things can actually change, you can now find organic food in supermarkets, and even in fast,food outlets. 8ut organic food isn't the answer either, at least not the way it's currently defined. Let me pose you a Auestion. Gan farm,raised salmon be organic, when its feed has nothing to do with its natural diet, even if the feed itself is supposedly organic, and the fish themselves are packed tightly in pens, swimming in their own filth? And if that salmon's from Ghile, and it's killed down there and then flown ",&&& miles, whatever, dumping how much carbon into the atmosphere? don't know. >acked in Styrofoam, of course, before landing somewhere in the 4nited States, and then being trucked a few hundred more miles. #his may be organic in letter, but it's surely not organic in spirit. 5ow here is where we all meet. #he locavores, the organivores, the vegetarians, the vegans, the gourmets and those of us who are /ust plain interested in good food. 3ven though we've come to this from different points, we all have to act on our knowledge to change the way that everyone thinks about food. We need to start acting. And this is not only an issue of social /ustice, as Ann Gooper said ,, and, of course, she's completely right ,, but it's also one of global survival. Which bring me full circle and points directly to the core issue, the overproduction and overconsumption of meat and /unk food. As said, -' percent of greenhouse gases are attributed to livestock production. )ow much livestock do you need to produce this? 1& percent of the agricultural land on 3arth, %& percent of the 3arth's land surface is directly or indirectly devoted to raising the animals we'll eat. And this amount is predicted to double in the ne(t *& years or so. And if the numbers coming in from Ghina are anything like what they look like now, it's not going to be *& years. #here is no good reason for eating as much meat as we do. And say this as a man who has eaten a fair share of corned beef in his life. #he most common argument is that we need nutrients ,, even though we eat, on average, twice as much protein as even the industry,obsessed 4S.A recommends. 8ut listen7 e(perts who are serious about disease reduction recommend that adults eat /ust over half a pound of meat per week. What do you think we eat per day? )alf a pound. 8ut don't we need meat to be big and strong? sn't meat eating essential to health? Won't a diet heavy in fruit and vegetables turn us into godless, sissy, liberals? CLaughterD Some of us might think that would be a good thing. 8ut, no, even if we were all steroid,filled football players, the answer is no. n fact, there's no diet on 3arth that meets basic nutritional needs that won't promote growth, and many will make you much healthier than ours does. We don't eat animal products for sufficient nutrition, we eat them to have an odd form of malnutrition, and it's killing us. #o suggest that in the interests of personal and human health Americans eat "& percent less meat ,, it's not enough of a cut, but it's a start.

t would seem absurd, but that's e(actly what should happen, and what progressive people, forward,thinking people should be doing and advocating, along with the corresponding increase in the consumption of plants. 've been writing about food more or less omnivorously ,, one might say indiscriminately ,, for about %& years. .uring that time, 've eaten and recommended eating /ust about everything. 'll never stop eating animals, 'm sure, but do think that for the benefit of everyone, the time has come to stop raising them industrially and stop eating them thoughtlessly. Ann Gooper's right. #he 4S.A is not our ally here. We have to take matters into our own hands, not only by advocating for a better diet for everyone ,, and that's the hard part ,, but by improving our own. And that happens to be Auite easy. Less meat, less /unk, more plants. t's a simple formula7 eat food. 3at real food. We can continue to en/oy our food, and we continue to eat well, and we can eat even better. We can continue the search for the ingredients we love, and we can continue to spin yarns about our favorite meals. We'll reduce not only calories, but our carbon footprint. We can make food more important, not less, and save ourselves by doing so. We have to choose that path. #hank you.

Andres Lozano: Parkinson's, depression and the switch that might turn them off