Call welcome to both visionaries me sophie shevardnadze. Or greater ideas are born in our bodies one of the most fascinating and complex. Today i speak to a man who literally looks into and works with the human brain. Dr henry marsh one of the worlds top neurosurgeon. Dr henry marsh great pleasure to be here with you and your wonderful lovely home thanks for having us so i had all of the questions 1st of all i know that youve sat Something Like in medicine in general. You can never really be too certain and its like if you go to a general practitioner ok he pursued a drug and lets see maybe it worse than if it doesnt then he tried other drugs but was you know. Couldnt try it wouldnt quite work that way what it was doctors we deal in probabilities nothing is ever certain with any as a surgeon an office is a mere assertion was tied to is not representative of all events and. When you if you recommend surgery to somebody what youre saying is well the probability of the operation doing more good than all is a bit better than the probability of you coming to home with you doing to the operation but these are probabilities so lets say i say well theres a 95 percent or chance the operational be successful removing a difficult brain tumor which is what i specialized in doing and the 5 percent chance he will die and then the patient dies because of the operation and the family will be very cross theyll say you said there was a 95 percent chance of success and i said yes but i said there was a 5 percent chose disaster and same with the where the full cost and then they were wrong because it was a probability but from a patients point of view as patients and ive been a patient myself and my own son had a brain tumor we want certainty we want to know what would happen to me not a 95 percent this or a 5 percent that so it was a huge difference between the doctors perspective and the patients perspective were going to actually swap roles and a little bit before i do that i know that you specialize in. Brain surgery when local anesthesia yes theres a little patient isnt sleeping you know youre throwing him what is the reasoning behind it because with is any applies for certain sorts of jumah tumors which are actually part of the brain in the brain itself consisting in effect to bring tissue not of nerve tissue where the cells called lisl cells surround and support and kind a look off to the nerve cells and the tumor looks very much like the brain feels like the brain it doesnt come with little sort dotted black lines in the pairs saying think of that and if the tumor is in the very important part of the brain for instance the speech area most. Most most of us have speech or movement here just looking at the brain with the patient a nice that doesnt tell you where to stop because the age of the tumor looks that huge the brain. Is the patients awake you can ask the patient to do things you can also position to talk you can use electrical stimulation to work out roughly where you are and so do you ever seeing a significant change in a persons brain as you operate live so for say i gonna like yes and of it occasionally. Was this common reason is something that has an epileptic fit while youre operating and then they can become unconscious or paralyzed or stop talking things like that if if theres a problem of the operation and you actually start a new start damaging important brain the patient will start to lose the function of that part of the brains or occasion the patients to start to lose the ability to talk or become paralyzed on the opposite side of the body if its a real risk it happens not very often that happens what makes operating brain much more difficult and sensitive than operating Something Like heart and or. Do you think 1st of all the brain does not heal in the way bones and muscle and skin heals when you win you win every time you. The brain you damage it and they wont recover and secondly the brain is incredibly sent delicate if you can damage some parts of the brain you can kill the patient does by damaging in one of 2 millimeters the brain tissue other parts of the brain you can actually other parts of the brain can sustain quite a lot of damage in particular at the front on the right without the persons leaving to suffer in a home. But is very vulnerable its very delicate it has the it is the consistency of. Creans is the main the main surgical instrument is a socket the minutes of action clean the brain surgery is horribly crude actually people think its all terribly well hes high tech but with actual reality is actually quite crude compared to the incredible complexity of the brain he did how to like cut the skull something right you know thats easy answer i meant that simple bits and thats bets that you can do with the patient awake it like that and see it in the skin the problems all start once you open the membrane that covers the brain injuries and thats where the trouble starts so it would become very dangerous but its a bit like if someone has been doing this over and over again for years and years evan you know it is a job like anything else and youve said it yourself its not the person is not a job like and the thing else because youre dealing in peoples lives and if you make mistakes the consequence is a terrible night. And some doctors become very detached from their patients and it depends on the culture you work in ive worked in countries all over the world and some countries. Really seem to have minimal human emotional contact with it was better to be emotionally involved. Volved or to do that its a question the balance its a question of what patients expect. In countries like don and nepal under certain stand ukraine all of it china will the patients and certainly the patients families often do not want to move troops and they really dont want to be told. How bad the disease is. In england and in america on the whole patients and their families ones and they have a truth more all this but even then. With with diseases like cancer where we cant cure if its accounts we cant cure or to get the balance right between. Giving the patient who can being realistic is very difficult and to get that balance right and you often fail you have to have some emotional rapport with the patients if you are completely cold detached technician you will not you will not handle these problems well but what about the process itself i mean if you had someone in your life that you really laugh when you get a brain surgery would you rather do it yourself oh no you couldnt youll fall to him and my son had a brain tumor so thats what im really would ask of these roles that i linked i was a jet i was doing general surgery and training at the time he was only 3 months old and some people say who did you operate yourself missing the way you couldnt because all your oriel detached all your mechanisms of selfpreservation and the taps meant it was simply too anxious i once operated on a close personal friend one of my daughters im godmother with a malignant brain tumor so unusual going to die and the operation was simply well schooled a biopsy confirm the diagnosis and a very very simple operations a bit reluctant agreed to do it because the family were very keen i should because we were Close Friends and even that i found almost impossible. I was so anxious because i was not detached its just whats the hardest decision you had to me because i understand brain surgeries all are about Decision Making events will problems i had to make many difficult decisions i think some of the ones. Many regrets. Over 40 years of practice i think some of the most difficult decisions. When i treated people too much i should have stopped i operated really when there was no realistic hope and all i did was add to the patients and the families suffering and i can think of quite a few patients where i did that on the other hand with surgeons who are cold and detached theyll do that and it doesnt doesnt trouble them so youve sat they will actually never know how the brain works i think is unlikely i mean the whole point about the future is unpredictable so i think its unlikely it will ever understand the brain and the way we can understand how a computer works or a clock works and i think its unlikely that somebody once said you cant cut butter with a knife made of butter. But but i think nick with the present technology we have. M. R. I. Brain scanning electret implantation in monkeys and a certain extent and human beings is very limited to how much it will tell us and we cant experiment on ourselves now so we cant we cant say from our fellow humans brains and sit around them the experiments on them we can do a certain extent on chimpanzees and i feel rather sort of chimpanzees and who is becoming increasingly difficult ethical reasons so there are a major limits to what we can do this or actual Scientific Research we can do on the brain so following that logic you never really actually know what a patients brain will do after the surgery surgery and all that has to be well i you know you know it was stents because i mean. We understand how various parts of the brain more important to some times that we know the areas the speech and the vision sure will tie. I didnt to get in the complicated ways we didnt understand. But there it was with the operation of a pretty good idea what you what you can get away with speak without damaging the patient and when it all permission is impossible and we were going to take a break right now when were back well continue talking to one of the worlds top surgeons dr henry marsh stay with us. In this community there are people who believe that its ok. Its really hard there are no jobs and you see that ive got kids that ask and as a parent. I can come up with lots of arguments theres a lot of conflict within the game between the close of the conflict i would say over balls around money and most of them money is made. Close one on each of those he knows each other is Good Business the state of california alone makes 6000000000. 00 a year of prison complex just to get some point in your life where. You dont care anymore nobody cares about your so you. Join me every. Time im sure and ill be speaking to guest. Im sure ill see you then. And were back with dr henry marsh one of the worlds top neurosurgeons henry how closely are new or science and nearest surgery elated and in sense that discoveries in your science actually make advances in your search well not not very whats called functional neurosurgery where you put electrodes into the brain for conditions like parkinsons disease and things like that. And again and on very epilepsy surgery because it was quite literally involved you can take a look cool record and some single brain cells and the planning to do but in terms of the v. A. Every day problems i go parading on patients of haemorrhages head injuries things like that people in here is is a completely different is a world away from the everyday world of the news so you dont think of a human brain quake near scientists think of the huge computer you know on the on the as a as a surgeon im more like a plumber i mean the difficulty with the relationship between neurosurgeons and mirrors is rather like the relationship between plumbers and physicists who deal in the make the quantum mechanical properties of the metals in a way is a big gap so when youre operating on brains you can remove something great you can remove a belated to tongue or to see you know or to hear you at something at some of their press and they are and this has been there been sort of fashions for implantation maybe using fetal brains from feet to fetuses the stems. But none of this really work to get in terms of literally compliance not really i mean there are there are there are there is computer brain interfaces we put electrodes on the brain i mean has been you. Some people can paralyzed and then some of them can then by thinking can actually move a reporting reporter gum ive read this crazy magical surgical records where its at that human brain can be cut in half well it partially because in them that they dont have a name for that brendan cold callous or to me exactly brain is famous Research Done of a 19 eighties get sneaker in spirit for certain sorts of epilepsy dividing part of the brain in the middle the 2 cerebral hemispheres the joint the 2 halls of the brain up here which then joined together with like the trunk of a tree the brain stem is the trunk you cant touch that if you touch that people die or lift terrible disabled but then the trunk splits into 2 main hemispheres like that and theyre joined. I think all the copas collision which is billions of nerve fibers connecting the top of the right side of the brain the top of the brain and if you cut part of that it can help certain sorts of epilepsy in particular a form of epilepsy where people as full on the ground called a drop attack and these people appear normal if you met them you wouldnt know a part of their brain had been cut in half but you can carry out experiments on them where. Theres a sort of barrier which divides the view what theyre seeing the visual field so the right side of the brain can and you see things on the left and molests to the brain can and see things on the right and supposedly they also suffer from split personality was not able to do in the sense this because i mean sort of with this special experimental set set up its thought to separate people in to a certain extent the same already so it out back. I think you got but the story is told of one man who had a split brain operation and lost his temper with his wife and wanted to hit with his left hand which was controlled by the right hemisphere and then his right hand pulled it back that may not be true but its an illustration of the way you end up with this sort of split personality so lets just roll forward i know you dont like this whole Science Fiction but were not there yet im tired of something else. Lets say we do have this Crazy Technology to achieve it where 2 people its a you and i we want to swap one hand this fair with another is it possible. No way and it was ok there. 85000000000 nerve cells in the human brain one cubic millimeter of the serval cortex but this is a brain that can contain after 100000 nerves and 1000000000 electrical connections that is seriously complicated complicate what is the a radically. Theoretically the i mean the brain i didnt i didnt believe in the human so i believe everything you and i thinking and feeling at the moment is generated by their activity of our brains but we really dont. I mean yes we can we understand a certain about vision the movement but how consciousness arises how pain arises. And theres no way it happens it definitely in a form is people like myself with a not knowledge of the brain. Thought and feeling of physical physical phenomena but the fact the matter is contemporary science even a little of Quantum Mechanics cannot explain it which means theres a big. Though a very theres a huge gap in our Scientific Understanding of the world already by the time wonders if where were understand thats where evolution of human race ends probably to thats why we dont know much about it anyway as you told me dont watch much t. V. So i dont assume youve watched this series altered carbon you know its pretty much about how you can take one persons brain and transplant it into another one sensor like shockley im sure you were at hand this is an. Inspiration this is funny its theres no way we can ever achieve well the way that im not not in the foreseeable future more than the fools who were future likewise the idea that some people have we can download all brains on the computer thats what it one mosque is saying or say that you can and hence human. Brain with us its that spirit thats variously because theyre saying theyre already experimenting on the show this to this fairy tales im not saying its impossible but our present level of mirrors and technology theres no way we can do it so this whole new fashion of maybe becoming a more to look at where were trying to miss yeah yeah. Its fairytales. Fear of death written in another form you know youve given people whove lost we have a deep fear of death we have is the need to feel will live forever which until the modern age took the form of religious belief in an afterlife the need for that belief is still the some people dress it up in suit pseudo scientific terms all im saying is that when we seem to days in medicine how people are being rather test for for me its like you can replace an organ when artificial or a girl so then youre asking yourself maybe someday in theory its possible i wont say its impossible but 85000000000 cells trillions of connections between them its quite quite difficult so that like put this cyber port in your brain thats like not happening and there is sense certain sensory so tell us something if we do understand how memory is stored in a brain or in a very little theres no way we can remove what we dont want from the brain or i mean we understand some of the has a limited understanding but if this way we know which bits of the brain if they get damaged where we lose the ability to make new short term memories in particular parts of the brain called the hippocampus in the form of these so called experiments of nature you see people whove had damage either from a head in real from an operation they cant make short term memories or long term memories which is what eventually we lose without sinus disease and dementia seem to be more to do with the brain as a whole row than any individual points but maybe he can theyve kate. A memory in the brain there having said that we know that maps. To the hippocampus is a famous study done on london taxi drivers you have an m. R. I. Scanning which is a london taxi drivers you have to pass this examination called the knowledge they have made the entire road map for london and not just the layout which a one way road which is the quickest way of getting from known from belsize park to. Brompton road or something they take this to live and the hippocampus in these london taxi drivers runs a pos the test a bigger than the ones of people who failed the test likewise you know that professional pianists have bigger hand in the move and hair of the brain than the norm in nonprofessional pinnace so i dont know if youve operated any real time geniuses but what their brain be any different from not what you can see i mean as i go as idea of an a lenins brain was kept and einsteins brain was cut into slices this is a very simplistic show but by definition everybodys brain is different because we are all different we are all brains every time we think a thought that is a physical process in our brains so an awful lot of current mirrors take the. Cognitive neuroscience which is what psychologists call themselves is really does saying well yes when we think certain thoughts certain parts of the brain a more active than that individual explain a thing because you know already but everything we think and feel is a physical process in our brains so youre a man of science i dont suppose you believe in anything like that afterlife or in so what it will put it this way i think its unlikely that you cant prove or disprove it but it seems unlikely to me and and why is the nearest seems unlikely because i see. And have seen many many people who suffered damage to the front part of the brain which is where all social behavior and moral behavior seems to be organized because people have suffered particular head injuries and suffer damage to the front of the brain they suffer a personality change they saw the personality change in terms of the. Behavior towards other people is also almost always for the worse they become crude of. Course disinhibited and you can reverse it any way and and if if the moral is what we think makes us particularly human can be omitted by physical damage to our brain well when our brains die i reckon we die well i dont necessarily i mean the moral part is more like a religious part but im just saying it could be anything but what would that mean that those billions and billions and billions of nerves that are connected to each other and their existence the minute persons heart stops to be well. There are some rather alarming work done recently in america looking at dead pigs brains where they went to an average. Of this and took some brains out of pigs that have been killed if you. Can show that some of the brain cells are still alive theyll die in time and or to means goodness no. Likewise you knew some patients in whats called persistent vegetative state because life without moving have been to be fit in is a bit they were a new live because of medical treatment some of them seen as a some kind of activity in their brains that we dont know what it means. All right harry thanks solar is free so it is very strange but still thanks a lot for said at least some light into this strange world this for a myriad surgery costing lives is to say its even more of the whole science on the dole and then you find out a new dual is on the of a side religion is the other way rudd is a closed door and that all the christians are all was you all stood question you have an answer and then the whole lot of new questions of him thats whats so interesting i suppose thats how life works in general. As we get older kind of thing and i think our lives are going to hell chads plan or time for change good could last or everything thank you very much right. Now to tell you we needed to. 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