Transcripts For CSPAN2 Dr. Kelli Harding The Rabbit Effect 2

And discussions just like the one tonight, and even tonight we have four events. So its just really fun. So [applause] thank you. And thank you, cspan, for filming this. Happiness is the best medicine, yet americans will spend 3 billion on medicine and health care this year. A sum thats large enough of to send every family of four a check for 40,000 for their care. And we all know that happiness is not a big ticket item. Our guest tonight, dr. Kelli harding, will discuss this. She is an assistant professor of psychiatry at Columbia University Medical Center and a diplomat to the american board of psychiatric and neurology. Dr. Hardings work in the emergency room at the New York Presbyterian Hospital and as the daughter of a 91yearold, i spend a lot of time there, so i have a lot of admiration. She has appeared on today, good morning america, npr, New York Times and the u. S. News and world report. Dr. Harding is here as the author of the rabbit effect. Yea. [applause] starting with the story of a nurtureing postdoc treatment of rabbits, dr. Hardings book discusses the Ground Breaking new research that shows how love, friendship, community and environment and our lifes purpose can have a greater impact on our health than anything that happens in a Doctors Office. Joining dr. Harding in conversation is dr. Lloyd federer. He is an adjunct professor at the Columbia School of Public Health and was for 12 years the chief medical officer for the new York State Office of Mental Health, the nations largest state Mental Health agency, where he continues there as a distinguished psychiatric adviser. Hes written many books, including one we have here tonight, addiction solution treating our dependency on opiates and other drugs. Hes also written a family guide to Mental Health care and improving Mental Health four secrets in plain sight. Please welcome me in please welcome dr. S harding and dr. Felderer to the strand for this important discussion. [applause] so, first of all, nancy, thank you so much for having us and that beautiful introduction. It is such an honor to be at this famed bookstore. I mean, really, you know, i didnt grow up in new york, and the strand has this mystique to it that to actually be sitting here and to be sitting among these books is just really one of the highlights of my life. So thank you so much. And to be surrounded by so many people that i absolutely love, this is just an incredible treat. So i just cant im seeing so many faces from so many different periods. So thank you, thank you so much. Because this is a book about kindness, we also just wanted to take one second, and if you could just say hello to your neighbor and introduce yourself if you dont know them. [inaudible conversations] okay. Good evening. We wanted to get to know you as our guests a little bit more, so how many of you are scientists . Okay. How many of you are from the Mental Health field . Okay, good representation. How many of you are writers . Ah, good. Journalists . Journalists are a special form of writers. How many let me ask this, how many of you are here tonight because youre a relative of dr. Harding . [laughter] [applause] how many of you are here because youre her neighbor, and you rely on her medical advice . Laugh advice . Laugh [laughter] and is anybody here because they think this is a book about vampires . [laughter] because its not. It must be in one of the other function rooms. So shall we and i guess probably also some of you are wondering what thes the deal with these rabbits, right . So well talk about that. So and lets, lets learn a little bit more about you, kelli. We heard that your, you have a pretty busy life as a emergency room doctor. You have three children. How in the world did you gather the time and energy to write this book . Well, i have to say this book is an incredibly important message, and it got i know that many of you in the room actually know this. It became something that it felt urgent. I actually get the message out. And i know, dr. Federer lloyd. Lloyd, that this is something that you also share a passion about, and that comes down to Public Health. Theres an important story that we are not talking about in this story, and it affects every Single Person sitting in this room. So tell us about the rabbits. [laughter] sure. Central characters in this story. Before i get to the rabbits, actually, i to want to say something. So as clinicians, raise your hand if youre a clinician again . Okay. So weve got a lot of clinicians in the room. So, you know, asically missions clinicians, theres a lot of mystery between the mismatch that we expect when we know about a disease and what actually transpires in life and in the hospital. And, you know, its the patients who have serious diagnoses that on paper they sound really not doing well, but then you meet them and, in fact, theyre actually functioning and living their lives fully. Its also the flip side of that. You know, patients who maybe when you look at all their labs and their imaging and Everything Else looks okay, but then theyre not functioning in life. And so this mystery propelled me through many, many years of education, you know, starting in internal medicine, psychiatry, something to do with the mind body connection. Then i ended up in a Research Fellowship looking at medically unexplained symptoms at columbia, and i still didnt really feel i had a full answer until i heard about the rabbits. [laughter] so, in effect, this book was part of your discovery of what you had been searching for. Exactly. Tell us about it. So the rabbits, one of my mentors, a lovely fellow named dr. Arthur barsky whos at a harvard, told me one day, you know, i think you might want to hear about these rabbit studies. I heard something about them how the social world impacts health, but he didnt quite know the details. So i searched and searched, and i finally tracked down these rabbit studies that were down in the late 1970sing early 80s. The study oring were studies were actually done with the intention of looking at heart health in rabbits. These sort of genetically identical rabbits, they were all fed a highfat diet, and then they looked at the results, and something was wrong. One of the groups of rabbits had far Better Health Outcomes Using different marketers than the other markers than the other groups of rabbits. He looked at it again, and then nothing everything checked occupant. They looked at who was caring for the rabbits, and they noticed that one of the post docs was a very caring rabbits. She was petting them, she was loving them, she was talking to them, and they realized could it be that the social environment is actually changing their physiology hike this . Like this . So to their credit, because at the time it was ad radical idea, they went ahead and replicated the study, this time with tightly controlled conditions, and they got the exact same results. And they published it in the very prestigious journal of science. I just want to take a step back because a lot of the studies are somewhat serendipitous, and i think this was an example of one of those. It was showing that the social world was having an impact. But the thing is it was just the beginning of a much bigger story. And then this is the nature of really good science is when something doesnt make sense, you dont dismiss it, you pursue it. And thats what they did. And the, so this is a protective effect in a way that the nurtureance that this colony of rabbits helped protect them from disease. Thats a phenomenal thing to discover. Right. First, its sort of seeing whats going on, in fact, that somehow our social world is changing our physiology, and that sort of defies our understanding of how the body works right there. So were trying to think about the mechanism, and whats amazing is we now have, you know, four decades of science since then that really show, and this is all through the field of Public Health, that really show how our social world is impacting all of our lives. Every Single Person in this room, every Single Person listening on cspan, their lives are impacted by the kindness that they are giving others and the kindness that they are receiving. And its, you know, it comes back to so many different factors representing to Mental Health. And i guess thats where we enter the discussion, right in. And did somebody hide them or are they there and jet to be discovered . Whats hidden . So i describe them as hidden factors, and its what the field of Public Health calls the social determinants of health or the social dimensions of health, which is a bit of a mouthful. But i think, you know, the thing to keep in mind is that its really all these hidden things in our daytoday relationships. So were talking about whats happening in our homes, you know, whats happening in our workplaces, whats happening in our schools, whats happening in our communities, whats happening in our neighborhoods, whats happening in our broader social environment. Its, it really comes down to how do we take care of one another. And if you dont mind, im just going to stop for one second. So i just wanted to take a second to think about kindness in your life for a second and my life. So lets just take a second and think about somebody whos shown you kindness recently just for a couple seconds. You know, for me, this exercise is very easy because im looking out at a sea of people [laughter] that have done that and sitting next to me. So thank you. I think, you know, its those things though that we dont, you know, kindness makes us feel so good, but theres actually all this amazing, awesome science, and its emerging science too. The really cool stuff about how the body workses and how our social world is actually changing who we are. And youre saying that these moments of kindness actually are protective. Theyre going to make a difference in how we lead our lives, how we feel our bodies. And it seems like such a ready resource, yet youre saying that its one thats hardly used. I think, actually, im curious too your thoughts on it. Why do you think it is is underused . I wont let you get away with this. [laughter] i have to say so after i wrote my book, dr. Federer, lloyd, sent me a book. And it covers a lot of the same things. Finish i think, you know, there are all these secrets that are hidden in plain sight, basically. But, you know, its, its hard sometimes to take science and actually implement it into the daytoday when you have a certain mindset. So the goal of this book, like, i realized once i crossed the street from the Medical Center, started the school of Public Health, i realized this is information that needs to be in every Single Person in this rooms hands because they need to recognize that, actually, their actions do matter, you know . It turns out that, you know, a bigger predicter of your health by far is your workplace. But we dont really think we think about health usually like diet, sleep, exercise, an occasional trip to the doctor. But were not really thinking about our workplace as having such an important impact on our health. And were not necessarily thinking about our neighborhood where we live, the access to the food that we have, you know, for better, for worse what thats like, how our stress levels are impacting our health on a daytoday basis. And its a conversation that we need to be talking about because the other thing thats a big piece of this is Mental Health. And we know in this country Mental Health is not something thats been theres a lot of stigma around Mental Health, for sure. And youve seen that firsthand throughout your career. Yeah. The how is yet another Public Health problem widely talked about related; namely, loneliness. How do i you connect loneliness to this, to these problems with our health and these problems with reaching one another and kindness . So kindness comes down to really taking care of one another. And so when we think about it as a society, were not doing a great job of this. And loneliness is a big piece of this. So, you know, theres all this data now that actually loneliness is as detrimental to your health as very wellestablished respecters like smoking 15 cigarettes a day, heavy alcohol use, even high blood pressure. But the question is, you know, how many times does your doctor maybe ask you do you smoke, do you drink, but are they asking you, you know, whens the last time you called ad good friend or saw someone you cared about . If things got rough, would you have somebody to turn to . It turns out thats really critical. Its time we started talking about and have you gotten a hard time from your colleagues for saying that were missing the boat, that, you know, when were asking about smoking or were asking about drinking or were asking about that were missing this whole aspect of the relationship parts of our lives, when was the last time a doctor asked about that . Has that given you a hard time with some of your colleagues . I would actually say this, and im happy i would love to hear from colleagues in the room about this too. You know, there are record i was just talking about this with the medical students. Actually, there are record numbers of burnout among physicians and people who work in medical care. And i think a big piece of that is because our Current System is just sum my not acknowledging system is just simply not acknowledging the determinants. Which brings me to a statistic. Medical care probably only accounts for about 1020 of our overall health. Just think about that for a second, 1020 . But when it comes to how we spend on health care in this country and how we think about health care, were spending 995 of our 95 of our dollars on medical care and administrative costs. That being said, of course, access to medical care is absolutely critical, but at the same time we have to start looking at a Bigger Picture of health, and that includes whats happening in our communities and thinking about about our School Systems and talking about all these other things that typically we somewhat minimized in sort of the glare of the razzledazzle of biomedicine. Which, i mean, i love it too. Im a total science nerd. And has, is it hard to be kind . What are the barriers what do you guys think . [laughter] whats getting in the way . Yeah. So, well, i would say this has been my experience writing this book, and as many of you have seen, you know, its kindness is a practice. And its something you have to absolutely do every day. And because were human beings, we fail at it all the time. I think whats exciting though is just recognizing that its something that we can continually strive for. And im not talking about, like, grand measures of kindness, you know, where youre donating buildings to various places or things like that. Im talking about, like, looking the person who gives you a cup of coffee in the morning in the eye and saying, good morning. Like, were talking really basic human decency things. And also thinking about how were treating other people, the promise of our society, you know . How are we treating people are who arent as forchew as we are . Fortunate as we are. Is kindness different from niceness . [laughter] thats a good question. I dont know the answer to that. What do you think . [laughter] once again, youre not going to [laughter] talk me into answering my own question. I think its closely enough related that we could probably put it together. So kindness im using somewhat loosely because, you know, i think the thing is when we sort of in the Public Health world or in the medical world too when talk about it, its really happening more in the Public Health world, said i. When we i would say. Really when it boils down to it, it was, for me, one of the great pleasures of writing this book was actually hearing my wonderful editors debate sort of how do you talk about this to people, you know, who arent necessarily scientists or academics. [laughter] thats another important idea that youve advanced which is as a practice which is gratitude. Tell us about the practice of gratitude. Oh, measure gosh, whats so cool is about kindness. A variety of different religious backgrounds. Not just toward yourself which is important but also kindness towards others and an easy way to do that is to start with gratitude, you know, its like when we are thinking about that person that was kind to us we are using gratitude and increasingly all the studies, mindfulness, all these things are good for our body, it probably comes down to stress. Stress is inevitable part of life. I love how you talk about stress in your work and one of those things that we have to think about buffers because we know that stuff comes up and thats a big part of the book, reserve of resilience and reserve of stress suffers, stuff comes up. The inflammatory process phenomena in our body that youve emphasized and essential of development of disease and disability. Kindness and anecdote to inflammatory response. What is happening here, help us understand this. This is some of the coolest science, the neuroimmune system basically, not understanding how it was working prior and explains the patients i was seeing in Research Fellowship, they are not feeling well but we cant quite find something wrong because some tests arent measuring the right things, we toned sort of separate the mind and the body, we have separate Mental Health places of care, we dont think of people theres a doctor for every bit of your body and weve gotten so specialized and on the one hand its helpful but on the other stepping back and looking at these Bigger Pictures and its these con