Talking Geckos, Gowns, and Electrodes: An Eclectic, Electric, Informative Evening at the Fitler

Maiken Scott, host of the evening, getting fitted with an electrode headband as program guest, Dr. Roy Hamilton, explains how brain stimulation works.

By: Chris Satullo

November's program of the Sunday Breakfast Club ranged far and wide - from waters off the California coast where sea urchins cling to reefs ... to the intricate folds of the human brain ... to a hospital room where a frustrated patient duels with the balky strings on a misbehaving gown.

Maybe the best part of the evening for an election-weary audience of about 70 club members and guests was that, for 90 minutes, no one uttered the phrases battleground state, exit poll, or Electoral College.

Three Philadelphia-area scientists shared tales of innovative research that holds huge promise to improve human well-being.  They were interviewed by the guest emcee for the evening, Maiken Scott, host of the WHYY program/podcast The Pulse.

Scott was so committed to her task that she served as a guinea pig as Dr. Roy Hamilton, director of the University of Pennsylvania's Brain Science, Innovation, Translation and Modulation (brainSTIM) Center, demonstrated vividly how electrical brain stimulation works.

With an electrode strapped to her skull via a headband, Scott listened as Hamilton explained that electrical brain stimulation of the type she was receiving shows promise for treating depression, anxiety, migraines, cognitive loss, and other ills.

"For a hundred years, we've known a lot about how the brain is organized," Hamilton said, "but we're always discovering more nuances of its structure and location systems."

The neurons that fire in our brains respond to electrical stimuli, whether delivered by electro-magnets or, as Scott experienced, by current running through her brain from anode to cathode.

"We can tap on the brain - zap it if you prefer - to interrogate different parts of the brain, to see how they respond," Hamilton said. "Do it enough times and sometimes we can change how that part of the brain functions."

The goal now is to figure out how to micro-target the exact parts of the brain that handle  a given function or drive a condition, as well as how to regulate precisely the strength, duration and frequency of the electrical dose,

Part of the promise Hamilton and other researchers see in these techniques is, as he put it,  "we're not going into the brain."  It's not invasive surgery; there are no drugs with serious side effects.  In clinical trials, negative impacts on brain function have been rare to non-existent.

"The promised land of this technology is that it's readily available, affordable, can be administered in homes, and is entirely safe," he said.

A current focus of Hamilton's research is aphasia - the loss of speech either through a trauma such as stroke or a degenerative condition.  Clinical trials have shown some promise.

"It doesn't return people with aphasia to no problems, but they tell us that they can tell they're doing better," he said.

If Alyssa Stark's research in the field of "biomimicry" consisted only of plunging to ocean depths to gather sea urchins to study how they can so readily both attach and detach themselves from surfaces on the ocean floor, that alone would be pretty cool.

But the Villanova University professor doesn't settle just for that aquatic adventure.  She also climbs to the tippy-tops of huge tropical trees to study how myriad types of ants are able to scurry so confidently around those steaming-hot heights without tumbling. 

And she chases geckos around their native habitats, seeking specimens to explore how the little creatures use an adhesive system with no glue to navigate diverse habitats, from rainforest to desert to mountain slopes.

"Gecko toes have millions of tiny hairs that allow them to stick to surfaces that are not only smooth, but also rough or dirty," Stark explained.

Biomimicry is the process of humans learning by observing nature how to do something new or make something new.  It goes back in history at least as far as Leonardo DaVinci obsessively studying birds in flight as he designed his flying machines.  Bio-mimicry has led humankind to everything from 747s to Velcro, she said.

"We're in a period of reinvestment, of reimagining biomimicry to tackle many difficult challenges," Stark said. "Often, the natural world has already solved these challenges.  We're behind. If you think about it, it's hard to catch up to Nature. The time the gecko, for example, has had to evolve is far longer than the time we've spent on the task."

Stark said she hopes her research into the gecko toe might lead, for example, to a different type of adhesive-free medical bandage that wouldn't make patients scream in pain when nurses yank it off.

Sea urchins (which have no brains) somehow know how to emit a glue that doesn't dissolve even in salt water, then to detach themselves from the adhesive to move to a new location.

A versatile glue that works underwater ... you can imagine a lot of uses for that.

The ants in the tropical treetops may provide clues to an opposite challenge:

"When I'm a hundred feet up in a tropical tree, you'd be amazed how hot to the touch those branches are," she said.  Yet the glue on tropical ants' legs stands up to the test.

"We humans so often try to force our way to solutions, using intense heat or harsh chemicals to create them," Stark said.  "Our research aims to curve the way we design products, by using the natural systems that various living things use."

While Stark is chasing geckos, Dr. Bon Ku is thinking about that hospital patient struggling to keep his rear end from hanging out the back end of a hospital gown of infernally bad design.

Solving these and other mistakes of bad design in the healthcare sector is the mission of the Advanced Research Projects Agency for Health, a federal entity, where Ku is the general manager.

Ku is a physician - so into his craft that he volunteered to work in the emergency room at Jefferson Hospital on Election Night - but he is also an aficionado and advocate of a discipline known as user-focused design.   It's a type of thinking long familiar to architects, which then stampeded through Silicon Valley in the first part of this century and has seeped into sectors from hospitality to journalism since.

But it's been slow to take hold in health care - a lag that Ku is devoted to curing.

The core principle of user-focused design is to shape a system's processes and products to meet the needs of customers who use the system, not of the people who work inside it.  It's to ask constantly what obstacles or irritations are damaging the customer experience, then to redesign processes or products to reduce that friction.

Doing that requires people positioned like Ku - a practitioner familiar with the pressures and goals that led health-care delivery systems to be designed the way they are, but also skilled at seeing the system through the eyes of an anxious, confused, exasperated patient.

"We're working to bring medicine and design together," he told the audience. "When I think about design, there are so many products that are brilliantly designed, with so much skill and intention. By contrast, the user experience with the health care system is not so great. So I ask: Why is that? And I go on a journey to find examples of good design we can begin to use in our space."

Ku said he just had one of the classic bad user experiences of modern health care: "At my most recent visit with my physician - and this is a good professional - he spent more time looking at the computer screen than he did looking at me.  The electronic health records system was intended to improve care, but due to bad design, it leaves patients wondering if their doctor is really listening to them."

Ku gave examples of initiatives to move medical care outside the forbidding walls and corridors of brick-and-mortar hospitals:

• Creating mobile vaccine clinics that, during the pandemic, took the doses directly into neighborhoods full of at-risk populations that were reluctant or unable to travel to research hospitals or convention centers where mass clinics were being offered.

• Portable CAT scanners that mimic the tech of airport security machines, to bring the diagnostic tools closer to the people who need them.

 One issue is getting people to trust that these mobile operations deliver care of the same quality that's offered at the fancy, billion-dollar campuses many miles away. You don't want your mobile unit to look like a Mr. Softee truck, he said, adding, "Good design helps convey that sense of trust."

The evening ended with a robust ovation for the panelists and emcee Scott.  As club president Oscar Wang observed, people appreciated the opportunity to come together in a community of peers and friends to be reminded that much more good work gets done in our world than ever gets discussed in the average modern election.