Zoobiquitous Medicine: Q&A with Barbara Natterson-Horowitz

Barbara Natterson-Horowitz, Professor of Medicine in the Division of Cardiology at UCLA Medical School, offered an unusual perspective on how human patients, including those suffering from mental illnesses, can be helped by applying insights from animal health. We caught up with Barbara to learn more about how her Zoobiquity idea improves understanding of ourselves and the natural world.

Zoobiquitous Medicine. Barbara Natterson-Horowitz at TEDMED2014. Photo: Sandy Huffaker for TEDMED.
“When I see a human patient, I always ask, ‘What do the animal doctors know about this problem that I don’t know?'” Barbara Natterson-Horowitz at TEDMED2014. [Photo: Sandy Huffaker for TEDMED.]

What motivated you to speak at TEDMED?

After 20 years of practicing cardiology taking care of patients with heart attacks and high cholesterol, I was thrust into the world of veterinary medicine. Seeing my human patients as human-animal patients completely changed how I practice medicine and understand health and disease. Insights from this species-spanning approach to medicine can benefit human and animal practitioners and patients alike. It’s thrilling to introduce this approach to physicians, psychologists, dentists, nurses, etc. and watch their viewpoints transform; the exposure at TEDMED led to a collaboration between a celebrated human breast cancer physician studying a mutation that causes breast cancer in women with a veterinary oncologist working on the same mutation that causes breast cancer in jaguars and other animals!

Why does this talk matter now?

Animals and humans get basically the same diseases. From heart failure, diabetes and brain tumors to anxiety disorders and compulsions, the challenges we face aren’t uniquely human. Discovering why, where, and how non-human animals get sick reveals crucial but hidden clues to human health and illness. For instance:

Breast cancer: When beluga whales began dying of breast and colon cancer in the St. Lawrence estuary, a parallel epidemic of breast cancers in women was discovered in the same region. This species-spanning breast cancer outbreak was ultimately linked to toxins from local aluminum smelting plants.

Obesity: Medical insights into obesity — which challenges physicians and veterinarians alike as animal and human patients are becoming more fat — are generated by a zoobiquitous approach.  Awareness of worsening obesity in domestic and wild animal populations challenges us to consider environmental factors including endocrine disrupting chemicals,  antibiotics, and even climate change as contributors to the “plurality of obesity epidemics.”

Infectious disease: The majority of infections that could create human pandemics come from animal communities. From Ebola to West Nile Virus, SARS to H1N1, some of most worrisome threats to human health and survival are encountered first by veterinarians and animal experts. If we fail to pay attention to these experts and miss out on the opportunity to collaborate, we lose crucial information and increase unnecessary risk for human populations.

How do you see your work fitting into species-survival, wildlife preservation and conservation?

Zoobiquity emphasizes the interconnectedness of animal and human lives and ecosystems. Animals can be sentinels of disease in humans. When horses in Venezuela start to die, it can mean equine encephalitis may threaten local human populations. When cormorants and crows get sick with West Nile virus in Queens and the Bronx, elderly and immunocompromised patients may also be at risk for the virus. On the other hand, humans can be sentinels of disease in animals. Human outbreaks of Brucellosis often lead to identification of sick and suffering animals. The detection of lead poisoning in a child often leads to exposure and disease in local wildlife. Bringing practitioners of animal and human health together encourages the transfer of information from the world of human medicine that is vitally relevant and important to wild animal populations.

What do you hope for the legacy of Zoobiquity? 

Zoobiquity Conferences have now been held across the US and internationally. At these events human health practitioners including physicians, nurses, dentists, psychologists and others come together with animal health practitioners including veterinarians, behaviorists, nutritionists and others to discuss the shared diseases of their different species. I’ve heard some veterinarians joke, “real doctors take care of many species.” Bringing the comparative approach to the human medical community has the power to transform how physicians, nurses, psychotherapists and others understand disease, their patients and the environmental and evolutionary factors that link us all together.  I hope Zoobiquity is successful in bridging the worlds of animal and human health, ecology and evolutionary biology.

Check out our archived Facebook chat with Barbara about species-spanning medicine. 

Examined Lives: A teenager’s long journey to mental health

By Alexa Ellenthal

My whole life it has been apparent that I am different. Some would even say that something is wrong with me.

I was a weird kid (I was highly precocious and inquisitive to the point that it was obnoxious) and my parents started taking me to a variety of specialists, mostly psychologists, and getting me tested when I was about six. At first the diagnosis was ADHD. The doctors and my parents started medicating me for it. Then they realized I had a mood disorder, too, and put me on pills for that. I remember my near-daily tantrums in first grade. I remember feeling like a zombie for most of second grade. All through elementary school they were putting me on different medication cocktails, taking me from doctor to doctor, hoping by some magic the pills would make me a normal kid or one of the doctors would be able to understand me.

shutterstock_53312143When I was nine I had my first major depressive episode. I was being severely bullied and it really got to me. I also developed insomnia. I would stay up late into the night crying, not even being sure why I was so upset. That’s when “mood disorder not otherwise specified” (MDNOS) morphed into depression in my medical records. The problem was that I was feeling impossibly sad and hollow and unmotivated, and because I was so young, I couldn’t always relay what I was experiencing in a way others could understand. That’s the problem  doctors have to try to diagnose patients based on introspective ramblings, symptoms, observations, but they only really know what their patients tell them and even then, they don’t know anything for a fact because patients might lie or omit some key details.

I was a difficult child, and not a particularly trusting one. I didn’t just open up to strangers who were being paid to listen to me and decide how to deal with me. I also didn’t understand why it was so important to talk to them. So they guessed at my condition, putting me on meds that zapped my emotions, or that made me either severely under  or significantly overweight. It was confusing and overwhelming, and by the end of middle school I’d been through at least a dozen doctors and probably just as many medicines. It’s so hard to find not only a good doctor, but also a doctor you click with. Especially as a young child, when most of them condescend to you, and even if you point out to them that you’re young, not stupid, they’ve still got you drawing pie charts of your emotions and playing with miniature Zen gardens.

-1I had developed severe body image issues due to med-induced weight fluctuations and my self-esteem was frighteningly low due to the bullying I endured daily, as I had been since kindergarten. Elementary school aged children are like lemmings; if one walks off the cliff, the rest follow; and if one picks on the bossy, weird, nerdy girl then the rest do the same. I started reading a lot of books about eating disorders and visiting websites like sixbillionsecrets and learning about self-injury and other such horrors. When high school rolled around, I got really stressed and my own practices of self-injury began. I used thumbtacks and paper clips to hurt myself, and I starved and binged and tried to purge but nothing ever came up. Things got worse.

The real depression hit, though, around late fall of my sophomore year in high school. I was seeing a psychologist whom I liked, but I never let her see how bad of a place I was in. She threw in a couple more diagnoses to my ever-expanding list: Anxiety and obsessive-compulsive disorder (OCD). As a nervous compulsion, I started pinching my skin, leaving ugly, moon-shaped scabs and scars. I started missing a lot of school and trying to lose myself into other worlds and lives, sleeping a lot (for the dreams) and reading a lot of love stories (for the happy endings) and watching a lot of emotional TV shows (to feel something). My grades slipped and so did my façade of happiness. My peers began to notice that something wasn’t right with me, my friends were always asking what was wrong, and my parents, who had been under the impression that I was recovered, started noticing my symptoms.

Then it all started again, with going from doctor to doctor and pill to pill. My parents had me see this one awful woman who I’m quite sure truly hated me and tried to say I was bipolar, called me manipulative, said I was faking and said my mom was stupid for believing me and a bad parent. It was a psychiatric horror story. Going into junior year of high school I was beyond stressed and self-harming pretty badly; my eating habits were totally screwed up and I was positively miserable. I didn’t want to exist. As the holiday season set in, suicide weighed on my mind more and more.

Then, one Friday night in mid-December, I arrived at a friend’s house only to be greeted with the news that a boy I had been friends with two years prior had died. He had killed himself. In the wake of his death there was utter devastation. I saw what a suicide did to a family, to a community, to the friends of the deceased. I chose to live. I didn’t think the world could afford to lose us both. I went to a psychiatric hospital a month later for my depression and self-harm. I kept the eating disorder to myself. The hospital brought in guest speakers  former patients who had recovered and begun living happily, and they had us do a lot of art therapy. We went to the gym every day and sometimes there was animal therapy, where they brought dogs in for us to pet and play with. We also set recovery daily goals and discussed whether or not we were successful at the end of each day. Since being discharged, I’ve been in therapy two to three times per week. I have started dialectical behavioral therapy, which I find immensely helpful. I finally have medications that work for me. I do group therapy, which is awesome.

But then, on the first day of school this year, a sophomore killed himself. I realized that the problem was bigger than me, and bigger than Henry. It is a challenge that so many people face. It is something that so many people suffer through silently. They’re ashamed of their illness due to the stigma that society attaches to being mentally ill, or their family rejects the idea that they could be sick because they perceive that as something being wrong with the person.

According to the National Institute of Mental Health, more than one in four adults suffer from some sort of mental illness. And many people can’t get the help the need and deserve, due to the shame put upon those of us who need this sort of help, as well as the exorbitant cost of mental healthcare. I want to change that. I want people to understand what it’s like to be mentally ill or bullied and I want the people who are suffering to know how far from alone they are. I still want all of that. That’s why I started You Never Know Who, an online community for kids struggling with mental illness. That’s why I’m writing my novel, which is about a 16-year-old girl trying to recover from a major depressive episode while struggling with several other disorders. The main character is based off of not only my own experiences, but also those of the many girls and young women I interviewed about their struggles. I want to educate people about the reality of mental illness. I want the mentally ill to know that there’s nothing wrong with who they are and they aren’t alone. I want people to move on from their struggles the way I’m moving on from mine.

Alexa Ellenthal will be a guest at TEDMED’s Great Challenges Google+ Hangout this Wednesday, December 18 at 2:00 pm EST.  Join us to discuss how mental health treatment is being integrated into primary care.