Today we are re-running an episode exploring a question that seems super straightforward, but that on closer examination reveals incredible complexity, and that is "how do we put the patient at the center of the healthcare system?” It almost seems counterintuitive, since aren’t patients always the center of healthcare? But healthcare is a strange industry, in that it is built with the fundamental goal of serving patients, but in many ways, the patient isn’t always the end customer of the system. In fact, the patient — and the patient’s voice — can often be lost or overlooked in the enormous, complex, convoluted business flows between a huge system of providers, in elaborate clinical work flows, in insurance coverage and reimbursements, and in high level policy debates. In this episode, a16z general partner Julie Yoo and deal team partner Jay Rughani talk with Freda Lewis Hall — a physician who was formerly Pfizer’s Chief Patient Officer and Chief Medical Officer; and who among many other roles was appointed by the Obama Administration to the Board of the Patient-Centered Outcomes Research Institute. They discuss what happens when you rethink the entire healthcare system from the patient’s point of view, from drug development to clinical trials to care delivery. What tools and new approaches can we use to truly put the patient at the center of the healthcare system? And how do we update our Flintstones healthcare system to match our Star Wars medicines?

In 1994, 29 bald eagles were found dead at DeGray Lake in Arkansas. This mass mortality event kicked off a search for the culprit which has last over 25 years. On this episode of the Bio Eats World Journal Club, host Lauren Richardson talks to Susan B. Wilde of the University of Georgia about her group's work finally identifying the eagle killer, and revealing a complex web of ecosystem dysfunction. Solving this mystery required a fresh point of view, a wide range of techniques and technologies, and an international collaborative effort.  Susan B. Wilde, Ph.D, Associate Professor of Aquatic Science at the University of Georgia, joins host Lauren Richardson to discuss the results and implications of the article "Hunting the eagle killer: A cyanobacterial neurotoxin causes vacuolar myelinopathy" by Steffen Breinlinger, Tabitha J. Phillips, Brigette N. Haram, Jan Mareš, José A. Martínez Yerena, Pavel Hrouzek, Roman Sobotka, W. Matthew Henderson, Peter Schmieder, Susan M. Williams, James D. Lauderdale, H. Dayton Wilde, Wesley Gerrin, Andreja Kust, John W. Washington, Christoph Wagner, Benedikt Geier, Manuel Liebeke, Heike Enke, Timo H. J. Niedermeyer and Susan B. Wilde, published in Science.

Understanding how plants have adapted to natural climate change over millions of years provides a playbook of evolutionary strategies to help us prepare for and respond to man-made climate change. On this episode, host Lauren Richardson talks to Thomas Juenger, Associate Professor at the University of Texas in Austin and co-senior author of the recent article “Genomic mechanisms of climate adaptation in polyploid bioenergy switchgrass”, published in Nature. They discuss how studying native plants — like switchgrass — can inform crop improvement strategies, the import role of switchgrass as a possible future source of biofuels, how advances in sequencing technology have unlocked the secrets hidden in plant genomes, and more. Thomas Juenger, Ph.D, Associate Professor of Integrative Biology at the University of Texas at Austin, joins host Lauren Richardson (@lr_bio) to discuss the results and implications of the article “Genomic mechanisms of climate adaptation in polyploid bioenergy switchgrass”, by John T. Lovell, Alice H. MacQueen, Sujan Mamidi, Jason Bonnette, Jerry Jenkins, Joseph D. Napier, Avinash Sreedasyam, Adam Healey, Adam Session, Shengqiang Shu, Kerrie Barry, Stacy Bonos, LoriBeth Boston, Christopher Daum, Shweta Deshpande, Aren Ewing, Paul P. Grabowski, Taslima Haque, Melanie Harrison, Jiming Jiang, Dave Kudrna, Anna Lipzen, Thomas H. Pendergast IV, Chris Plott, Peng Qi, Christopher A. Saski1, Eugene V. Shakirov, David Sims, Manoj Sharma, Rita Sharma, Ada Stewart, Vasanth R. Singan, Yuhong Tang, Sandra Thibivillier, Jenell Webber, Xiaoyu Weng, Melissa Williams, Guohong Albert Wu, Yuko Yoshinaga, Matthew Zane, Li Zhang, Jiyi Zhang, Kathrine D. Behrman, Arvid R. Boe, Philip A. Fay, Felix B. Fritschi, Julie D. Jastrow, John Lloyd-Reilley, Juan Manuel Martínez-Reyna, Roser Matamala, Robert B. Mitchell, Francis M. Rouquette Jr, Pamela Ronald, Malay Saha, Christian M. Tobias, Michael Udvardi, Rod A. Wing, Yanqi Wu, Laura E. Bartley, Michael Casler, Katrien M. Devos, David B. Lowry, Daniel S. Rokhsar, Jane Grimwood, Thomas E. Juenger & Jeremy Schmutz published in Nature.

The search for and conjecture about alien life has evolved, from science fiction to just plain science. On this episode, host Lauren Richardson talks to Arik Kershenbaum, Ph.D, author of the new book “The Zoologist’s Guide to the Galaxy: What Animals on Earth Reveal about Aliens — and Ourselves”, about what we can conjecture about alien life, based on the laws that govern life on Earth, and the universe at large. The conversation covers big questions like: Does biology have universal properties like physics does? Will the process of evolution be distinct on different planets? Are limbs, sex, and intelligence Earth-specific features of evolution? And importantly, what does the study of alien life teach us about our place on here on earth.  Arik Kershenbaum, Ph.D, zoologist, and fellow at the University of Cambridge is the author of the new book “The Zoologist’s Guide to the Galaxy: What Animals on Earth Reveal about Aliens — and Ourselves”.  To learn more, check out https://www.zoo.cam.ac.uk/directory/dr-arik-kershenbaum or follow him on twitter at @arikkershenbaum

Today we are re-running a previous episode of Journal Club — our show where we curate breakthrough research and bridge paper to practice — in light of a recent article published in the journal Nature (see show notes below). In this episode, host Lauren Richardson talks to Professor Anthony Atala from the Wake Forest School of Medicine about his lab’s work creating an engineered uterus that can support live births. This work represents a major milestone in regenerative medicine and could be used to address a pressing unmet clinical need — and it might even be laying the groundwork for the ability to gestate babies outside of the body. That is where the recent Nature article, entitled “Ex utero mouse embryogenesis from pre-gastrulation to late organogenesis” by Aguilera-Castrejon et al., comes in. That article describes the creation of a cell culture system that can support embryonic development — up to a certain point, that is. So in this episode we are talking about creating a tissue engineered uterus, that could be used to replace a defective uterus and that might one day possibly support pregnancy out of the body — whereas in the recent Nature article, they do away with the uterus entirely and culture the embryos in a fully mechanical set up. While this kind of ex vivo pregnancy still seems like sci-fi, both of these articles make steps in that general direction, and more importantly, increase our understanding of the female reproductive system and early development.  Anthony Atala, MD (the G. Link Professor and Director of the Wake Forest Institute for Regenerative Medicine, and the W. Boyce Professor and Chair of Urology), joins host Lauren Richardson (@lr_bio) to discuss the results and implications of the article "A tissue-engineered uterus supports live births in rabbits" by Renata S. Magalhaes, J. Koudy Williams, Kyung W. Yoo, James J. Yoo & Anthony Atala, published in Nature Biotechnology.In the introduction, we also discuss the new article "Ex utero mouse embryogenesis from pre-gastrulation to late organogenesis" by Alejandro Aguilera-Castrejon, Bernardo Oldak, Tom Shani, Nadir Ghanem, Chen Itzkovich, Sharon Slomovich, Shadi Tarazi, Jonathan Bayerl, Valeriya Chugaeva, Muneef Ayyash, Shahd Ashouokhi, Daoud Sheban, Nir Livnat, Lior Lasman, Sergey Viukov, Mirie Zerbib, Yoseph Addadi, Yoach Rais, Saifeng Cheng, Yonatan Stelzer, Hadas Keren-Shaul, Raanan Shlomo, Rada Massarwa, Noa Novershtern, Itay Maza & Jacob H. Hanna, published in Nature.

In this conversation, Stanford Professor Euan Ashley—geneticist, cardiologist, author of the new book, The Genome Odyssey, and first co-chair of the Undiagnosed Diseases Network—talks with Bio Eats World host Hanne Winarsky about one of the first places that genomic sequencing began to dramatically impact patients’ lives, and those of their families around them: in rare disease. Rare disease is by definition, well, rare. But collectively, it’s surprisingly common: 1 in 15. In this episode, we talk about how rare disease became the clear first use case for genome or exome-scale sequencing, and how sequencing—and other new technologies, and the new information they give us—is changing how rare disease gets diagnosed. Ashley tells the stories of how the Undiagnosed Disease Network solved some of the most perplexing medical mysteries with cutting edge tools and technologies; and the lessons learned from the world of rare disease that we can use to impact our knowledge and our treatment of those with common disease.

Mosquitoes are the deadliest animals on Earth and for millennia humans have tried to rid themselves of these disease-spreading pests, with shockingly little success. On this episode of the Bio Eats World Journal Club, host Lauren Richardson talks to Leslie Vosshall of Rockefeller University about two articles from her lab investigating the neural and genetic basis of the mosquito's love for us and our blood. The conversation covers how mosquitoes taste blood, the critical differences between male mosquitoes and female mosquitoes, and of course, what this all means for controlling the spread of the deadly pathogens transmitted by the mosquito. Leslie Vosshall, Ph.D, Professor at Rockefeller University and Howard Hughes Medical Institute (@leslievosshall) joins host Lauren Richardson (@lr_bio) to discuss the results and implications of two recent articles from her lab. First, "Sensory Discrimination of Blood and Floral Nectar by Aedes aegypti Mosquitoes" by Veronica Jove, Zhongyan Gong, Felix J.H. Hol, Zhilei Zhao, Trevor R. Sorrells, Thomas S. Carroll, Manu Prakash, Carolyn S. McBride, and Leslie B. Vosshall, published in Neuron. Second, "Fruitless mutant male mosquitoes gain attraction to human odor" by Nipun S Basrur, Maria Elena De Obaldia, Takeshi Morita, Margaret Herre, Ricarda K von Heynitz, Yael N Tsitohay, and Leslie B Vosshall, published in eLife.

In this episode, we talk with Jeff Hawkins—an entrepreneur and scientist, known for inventing some of the earliest handheld computers, the Palm and the Treo, who then turned his career to neuroscience and founded the Redwood Center for Theoretical Neuroscience in 2002 and Numenta in 2005—about a new theory about how the cells in our brain work to create intelligence. What exactly is happening in the neocortex as our brains process and interpret information and sensory input—like sight, smell, touch, or language, or math—to create a perception of and to navigate through the world around us?  a16z General Partner Vijay Pande and I talk to Jeff about the basic principles in this new idea of the brain’s learning methodology for creating not just human intelligence, but animal intelligence, artificial intelligence, even alien intelligence, which he lays out in his newly just released book, A Thousand Brains: A New Theory of Intelligence. The conversation covers how the neocortex builds models of the world around us, and what this could mean for how we design the next generation of truly intelligent machines. This episode goes all the way from tiny neurons and how they speak to each other to what’s happening in optical illusions to the future of humanity and beyond.

In a healthy person, your body automatically adjusts blood pressure constantly, and this adjustment is governed by what’s called the baroreflex. However, a spinal cord injury can disrupt this reflex, which has both short term consequences, like passing out, but also long term consequences like an increased risk of heart disease and stroke. On this episode of the Bio Eats World Journal Club, host Lauren Richardson is joined by Dr. Aaron Phillips of the University of Calgary to talk about his lab’s work to reinstate this reflex in patients after a spinal cord injury using a neuroprosthetic device. This device both senses blood pressure changes and then activates the necessary neuronal structures to restore the connection to the blood vessels. We discuss how his group determined which neuronal structures to stimulate, how they developed this medical device, and the exciting results from their studies in rats, non-human primates and humans. Aaron Phillips, CEP, MSc, PhD (Medicine), Assistant Professor at the University of Calgary, joins host Lauren Richardson to discuss the results and implications of the article "Neuroprosthetic baroreflex controls haemodynamics after spinal cord injury" by Jordan W. Squair, Matthieu Gautier, Lois Mahe, Jan Elaine Soriano, Andreas Rowald, Arnaud Bichat, Newton Cho, Mark A. Anderson, Nicholas D. James, Jerome Gandar, Anthony V. Incognito, Giuseppe Schiavone, Zoe K. Sarafis, Achilleas Laskaratos, Kay Bartholdi, Robin Demesmaeker, Salif Komi, Charlotte Moerman, Bita Vaseghi, Berkeley Scott, Ryan Rosentreter, Claudia Kathe, Jimmy Ravier, Laura McCracken, Xiaoyang Kang, Nicolas Vachicouras, Florian Fallegger, Ileana Jelescu, YunLong Cheng, Qin Li, Rik Buschman, Nicolas Buse, Tim Denison, Sean Dukelow, Rebecca Charbonneau, Ian Rigby, Steven K. Boyd, Philip J. Millar, Eduardo Martin Moraud, Marco Capogrosso, Fabien B. Wagner, Quentin Barraud, Erwan Bezard, Stéphanie P. Lacour, Jocelyne Bloch, Grégoire Courtine & Aaron A. Phillips, published in Nature.

Sea turtles occupy a very special biological niche in our world. And we still know relatively little about these creatures, one of the very few marine reptiles on the face of the planet. But as population growth and activity on coasts has exploded, so have our encounters with sea turtles... including, unfortunately, those that cause injury and disease. So what advances in technology and healthcare are helping us treat these incredible, 150 million year old animals—and what are we learning about them as a result? Max Polyak, Director of Rehabilitation at Loggerhead Marine Life Center in Juno Beach, Florida, shares with Bio Eats World host Hanne Winarsky the new advances in science and technology that are helping us treat sea turtles when they get sick or injured—and the new understanding about their biology, their behavior, and how they interact with the world around them those advances are leading to. The conversation covers everything from treating boat injuries with sea turtle-specific prosthetics; to using cutting edge human therapeutics on these animals in new ways; to the unique immune systems of these 2,000 pound leatherbacks (immune systems that have dealt with dinosaurs! meteor strikes! ice ages! and more); to how the microbiome of the sea turtle may answer one of the most intriguing mysteries about how these turtles behave; to ultimately, what sea turtle health can teach us about how we are all linked—and about the health of the entire ocean.