Are we Working Ourselves to Death?

Stuart Higgins is on the case in this week's Down to Earth...

‘Biolab’ is a semi-automatic biology testing laboratory in the Columbus module of the International Space Station. Launched on board the Space Shuttle Atlantis in 2008, the lab allows both astronauts, and scientists back on earth, to understand how weightlessness affects living organisms. Once set going, the experiments are largely automated, freeing up the astronauts to do other things.

One of these tasks includes carefully measuring out liquid nutrients for samples. And  it turns out that the expertise used to develop the machine for doing this, has found other uses back down on earth.

A Belgian biomedical company was looking for help to develop a machine that could automatically run tests for infectious diseases such as HIV and Syphilis.

The types of tests they use are called immunoassays. The test detects disease molecules, known as antigens, which are found in the blood when somebody has an infection.

While the tests can work in lots of different ways, a common approach is to take a thin strip of a special paper, and selectively coat it with antibodies. These are molecules produced by the body as it responds to an infection, and attach strongly to the disease antigens.

A sample from a patient can then be washed over the paper strip. Any disease antigens present in the sample will stick to the antibodies on the surface of the paper. A second, different antibody is then washed over the strip again, which sticks to the other side of the antigen, forming a kind of sandwich.

Attached to this second antibody is an enzyme. The strip is finally washed in another chemical which is broken down by this enzyme producing a coloured dye, which is then visible to the human eye.

The end result is a paper strip with lines that change colour depending on whether the disease is present or not. It’s a similar principle to how pregnancy tests work.

However, the process of running the test can be pretty laborious – it relies upon washing precise quantities of different liquids at different times over the strips. The Belgian biomedical company was trying to work out how to build a machine that could run these tests automatically, a few at a time. It ended up working with the engineers responsible for developing part of the automated tests on the space station’s biolab, who used the same tech and know how to produce an automatic testing machine, freeing up lab scientists to do get more done.

So that’s how experiments designed to test the impact of microgravity on organisms in space, led to automated testing for infectious diseases back on earth.

More than a third of the brain in a human is devoted just to decoding what we see, and although brain scans can show us the parts of the brain that switch on when we look at certain things, they can't tell us what tasks those active areas are actually carrying out. But, very rarely, an opportunity arises for scientists to literally get inside the human mind. Chris Smith heard how this happened recently to neuroscientist Nancy Kanwisher…

Nancy - I’ve been studying a region on the bottom of the back of the right hemisphere for about 20 years - it’s called the fusiform face area. It’s a little region that’s about the size of a penny and it responds quite strongly when you look at faces and we’ve known that for quite a while. The question is: what does it do with faces and does it also play a little bit of role in the perception of other things that aren't faces?

What I wanted to know is when that region of the brain is stimulated and a person is looking at something that isn’t a face, does it affect their perception of that other thing? We can’t do things to people’s brains. That’s not ethical, so what we have to do when we study humans is wait for clinical opportunities where a neurosurgeon is going to do something for clinical reasons.

This patient had intractable epilepsy and you can’t live a normal life that way. In these situations, what neurosurgeons do is first map out the brain, find out the focus of the epilepsy seizures, and take it out surgically. So the neurosurgeons placed tiny electrodes all over the surface of his brain, including a lot of electrodes right in an area I happen to be interested in. It was an opportunity to find out what happens when the patient looks at different things and when those electrodes are stimulated electrically.

Chris - Right. So you’re both eavesdropping on what’s going on in those areas natively and you can also then reverse the equation and put electricity, and therefore stimulus, into those areas and ask well, if I change the activity in that area, what does it do to the patient’s experience?

Nancy - Exactly. So we gave the neurosurgeons a bunch of pictures of faces, and words, and objects, and different kinds of things, both in colour and in grayscale. We said “please show these images to the patient and we think we’ll be able to find out what exactly each electrode responds to.” And, sure enough, there were ten electrodes right next to each other that responded nearly exclusively to faces.

Chris - What happened when you then stimulated those areas, so you know I’m recording from this particular area underneath at the back of the brain, and I’m seeing it becoming very excitable when this person looks at faces? But when you then put energy into that area, what does the patient see?

Nancy - What the person saw was he saw a face on top of whatever he was looking at. So, when he was looking at a box, he saw a face on top of the box. When he was looking at this orange soccer ball, he saw a face on top of the soccer ball. He reported that the face looked like an anime character; it wasn’t a person familiar to him. Now that may be because when you electrically stimulate the brain, you are essentially activating tens of thousands of neurons in that region. It may be that when you do that, what that codes for is a very general presence of a face, not a particular face which might require activating a subset of those neurons.

Chris - What is your interpretation: the fact that you see the face on top of the object you were looking at, and the object itself is not changed in your perception when you do this?

Nancy - My interpretation is that region is only involved in face perception. Not even a little bit in the perception of objects. So this is the strongest possible evidence that the kinds of minds we have are these very specialised minds that have special purpose machinery for solving very particular problems.

Chris - When the visual system is looking at things, can one sort of summarise by saying well, if you look at something and there is a face somewhere in it, then the right bit of the brain extracts the face shape, tell your consciousness ah, that must be a face by activating this area you’ve been looking at, so it’s like a trip switch? When you’re area you're interested in goes active that says the the brain yep, that’s a face?

Nancy - Exactly.

Chris - Does your findings suggest then that if you had done the opposite of stimulating that area and you deactivated it, that this person wouldn’t be able to recognise a fact for what it was; they would just see a shape like any other shape?

Nancy - Exactly. I think what would happen is the patient would probably know that the face was a face, but probably would not know which face it was. Actually, we didn’t have time or the neurosurgeons to test that in this patient, but my guess is that when the patient was looking at a face, if we had asked him which person is that while stimulating that region he would probably be disrupted with that function. He’s probably know it was a face, but not know which face either if you deactivated the region or if you stimulate a lot of neurons in that region. Both of those things are kinds of disruption that interfere with processing in that region.

There are many lengths that people go to in order to improve their performance in the workplace, and increasingly there amongst them are reports of ‘smart drugs’ being taken at work, but what are they and who is taking them? Chris Smith heard from Barbara Sahakian from the University of Cambridge where she studies these agents and how they work...

Barbara -  They’re cognitive enhancing drugs, so they improve the focusing of your attention and concentration, or maybe your memory, or maybe your planning problem solving. All the different forms of cognitive function that we have. In America, people frequently use adderall (amphetamine salts). In the UK and Europe, it tends to be more methylphenidate which is Ritalin or Modafinil.

Georgia - We actually put a call out for people’s experiences with smart drugs and were surprised by the number of responses we got. This one came to us from someone who works in a tech startup in London and this is what she wrote to us…

My current regime is that I will take half a tablet of Modafinil at around 8am once every two or three weeks as needed, and then I will go through phases of taking twelve micrograms of LSD every three days.
For me, Modafinil lowers my activation threshold, which means all those jobs I’ve been putting off because of doubt or anxiety become much easier.
The night before a planned Modafinil day I will writeato do list of these kind of tasks, along with any menial work I just need to plough through. It will start to work after about 20 minutes and I will feel an active focus and interest in what I am doing, without the slightest desire to procrastinate. I find myself irritated by needing to go to the bathroom and break my flow.
Sometimes I might accidentally get sent down the wrong path and find myself spending an hour tidying my desktop and document files, which is whytheto do list is so important to keep on track. By early afternoon I’ll noticeably begin to run out of steam and develop a minor headache in the front of my skull. Focus will fade, and by around 3pm I’ll find it difficult to work. It  makes the day shorter and more intense, often achieving a huge bundle of things that have been mounting in a pile of procrastination.
However, you definitely feel like you’ve been on a drug, like a supercharged coffee followed by a daytime hangover. That feeling,ofI’ve been ‘on’ a substance and made a trade-off for the instant problem fix, means that Modafinil isn’t something I do often or view in a particularly positive light.
Microdosing LSD is different. I’ll feel a general sense of positivity towards my colleagues and begin to see problems from their perspective, even when we’ve disagreed in the past. I’ll be focused on my work, and again feel less anxiety about difficult issues, but without that adrenalised focus of modafinil.

Chris - Barbara, am I alone in feeling mildly alarmed by hearing that?

Barbara - Well it is surprising that so many people are using these drugs but, actually, the two reports accord quite well. In our studies where we’ve looked at cognitive enhancing effects, we’ve found that the 200mg dose is most successful and that’s what one of the people commented on using. They also commented on using it “to get into the flow” to actually get focused and also with tasks often that they’re trying to avoid, or they don’t find very enjoyable, or they’ve been putting off.

We’ve shown in our studies that are double-blind placebo controlled that when we ask people to rate say how interesting they found doing a test, that under placebo the test is okay, but under modafinil they rated it as really pleasurable or enjoyable. So, somehow, it makes these tasks seem a lot easier to get through that you’ve been putting off for some reason.

Chris - You’ve been doing these studies for a long time where you put people in brain scanners, put them on these chemicals, and see what changes in their brains when they’re on the chemical and doing a task compared with when they’re not. So what does happen when you take a drug like ritalin or modafinil?

Barbara - For ritalin, what we found was that if they’re doing a working memory task, which is the type of thing we use all the time for what we call higher cognitive function. So planning, problem solving, all of that will have a component which is what we call “working memory” where you’ve got some things in your memory space and then you get rid of them when you don’t need them any more. What we found was that not only on ritalin, in healthy people, do they have a better performance than those people on placebo, but also the brain doesn’t need to act as strongly so there’s more efficacy in the brain activation, but they have a better performance. It seems that your brain doesn’t have to work as hard, but you have a better performance.

I did a study with Lord Ara Darzi at Imperial College, because he was concerned about his surgeons taking too much coffee (caffeine) at night to stay awake and alert. Of course then, you can get hand tremor which is a common side effect of taking caffeine and so he wanted to know whether the surgeons would do better under modafinil. So we sleep deprived doctors and then we gave them modafinil, a placebo in a double-blind placebo controlled study. And we find that the doctors on modafinil who were sleep deprived actually had better cognitive function in terms of their ability to be cognitively flexible when solving problems, so they could switch between problem solving very quickly. We also found that they were less impulsive, so it seems to have these benefits as well.

But it is worrying, as you say, because we don’t know the long term consequences of using these drugs, so there are not long term safety and efficacy studies in healthy people with these drugs. Also, a lot of people are buying it over the internet and you don’t really know what you’re getting.

Chris - I know you’ve said that we don’t actually know what the long term effects are yet. But could one envisage a situation where if you take these chemicals and they enable you to “burn the candle at both ends,” we know that robbing yourself of good restful sleep is is a risk factor for say Alzheimer's disease, do you think that we might encourage people to put themselves at increased risk of things like Alzheimer’s because they adopt a higher risk lifestyle?

Barbara - That’s a very interesting point that you make. And I often worry about students who are taking these drugs and they’re usually cramming for exams because they haven’t done the work consistently. What they do sometimes with ritalin, they might take a tablet and then, as it’s wearing off, take another tablet and then, of course, they don’t sleep at night. We consolidate our memories in our sleep and also we need  that obviously for rest as well. So it’s counterproductive really because you’re not consolidating what your were trying to learn during the day.

I think we do need to put this into perspective and I often say will people in the future use these drugs to have a better work/life balance and to get their work done, and enjoy themselves and go out and exercise and things like that. Or will they just work longer because they can work longer so they just get into a 24/7 cycle.

Chris - Is it habit forming because the initial contributor we heard from said “I did it a certain way because I didn’t want to become dependent”  -are all these drugs habit forming?

Barbara - So far, for modafinil, nobody's demonstrated any abuse potential. But we do know that classic stimulants like amphetamine and the methylphenidate do have potential for abuse, and so there could be a physical aspect to it. But with modafinil, it might be that you become psychologically wanting to use it all the time because it worked for you on one occasion so now you want to try it on another, but it doesn’t seem to have abuse potential.

Chris - You’ve surveyed this, how many people in your surveys in circles like silicon valley and academics are using these agents?

Barbara - We don’t really know about the silicon valley, but what we do know is the surveys they’ve done in the United States they often find some place between 13 and 20% of students using them at colleges. There was a Varsity survey in Cambridge some time ago and they found about 10% of students. In Germany, they’ve done surveys and they’ve found about - and these are insurance surveys so they’re looking at people in the workplace - they’ve found about 7% of people in the workplace were using these drugs because they felt they couldn’t do their jobs otherwise.

We’ve looked at the ways our health is impacted by our physical and our social environment in the workplace, but what if it's simply the time we spend at work that has the biggest impact? Chris Smith heard from Courtney Landers, a mental health researcher interested in the impact of work on our mental health, about how work is affecting our stress levels.

Courtney - More than you’d think. It was really interesting you mentioned gut bacteria before because there’s lots of studies coming out now that indicate that the chemicals that your gut bacteria produce can really affect your mental health. What people don't consider, I think, is that things like stress, diet, exercise all affect your gut bacteria. And so, of course, if you’re working too hard and you’re not looking after yourself, your gut bacteria will be affected and, thus, perhaps your mental health will be affected.

Chris - The other thing that’s changed in the workplace in the last 50 years is a dramatic reduction in the number of jobs which are physical. The number of people doing a physical has dropped from something like 50% down to about 5%. The number of people doing a sedentary role has gone from about 5% to 50%. Do you think that also is playing a role because people are less active, and activity also improves wellbeing? Do you think that could be part of the reason why people might be unhealthy?

Courtney - Absolutely! I think it’s a combination. You’ve seen the rise of people working longer hours in the interest of efficiency perhaps, or productivity - trying to get more done. Because lots of jobs are desk based these days it means that people are spending more time at their desk. Whereas I think before, perhaps, people would work nine to five and then go home and play with their families, go out, do other things. And I think it’s probably that factor, not so much what you’re doing at work, but how long you send and work and what you do afterwards.

Chris - Is there evidence that the problem is getting worse because we are working longer hours on average now than we did historically and that’s largely driven digitally, isn’t it?  Because, historically your inbox filled up at the rate the postman could pedal his bicycle. Nowadays your inbox fills up at the rate a computer can feed you more to do and so you could get this sense of an overwhelming workload that never ends.

Courtney - Yes. I think there was a 2014 study in Australia just recently, and they were looking at work/life balance and, historically, Australia's got one of the best work/life balances.

Chris - It certainly agreed with me when I lived in Sidney. It was fantastic.

Courtney - Yes but over the last five years of this study, they’ve found that 45% of people’s work/life balance had got worse rather than better. So, for some reason, even though it’s this Nirvana, this lovely sunshine country, people, for some reason, were just working more and enjoying themselves less.

Chris - What about this idea because there’s this saying that if you do a job you love, you’ll never do a day’s work in your life - does that hold? So if you take people that really love their job and are workaholics because they are really into it, do they still suffer the same ill effect of long hours as people who don’t have that control?

Courtney - I think it’s a dangerous way to think because it doesn’t really matter how much you love what you’re doing, you still need to sleep, you still need to eat. After a certain number of hours doing these things that you love, eventually everybody needs to take a break.So unless you’re looking after the physical machinery of your body, eventually the mental machinery will breakdown no matter how much you’re enjoying it in the first place.

Chris - What appears to be the duration of work which is most consistent with good health?

Courtney - The interesting thing is that in the age of automation and the iphone, we really haven't looked at how much this is affecting us. There was a study, I think, by the University of Melbourne last year that looked at over 40s, I think, and they established that after about working 30 hours a week, which is 6 hours a day over a five day week, people’s productivity vastly reduced so, essentially, people were already working too hard above the age of 40. And, of course, most people start to work at a very early age these days, but there’s no data for the younger generation at all.

Chris - So something we should probably look into isn’t it.

Georgia - Mindfulness has been one popular method of unwiding from work. If you have not yet tried this then listen up; we asked yoga instructor Sanjay James from CAMYOGA in Cambridge to make us more mindful.

Sanjay - Bring your attention to the physical sensation of breathing. The air moving through your nose, the rising and falling of your belly. Notice when your mind wanders from your breath. When you notice your mind wandering gently return your attention to the breath. Just keep repeating to yourself and breathing in, and breathing in, and breathing in.

Then hold your breath for a little moment and repeat in your mind I’m holding my breath, I’m holding my breath, I’m holding my breath. And then very slowly breath out through your nose and repeat in your mind I’m breathing out, I’m breathing out, I’m breathing out and just stay in this rhythm.

Instead of wrestling with your thoughts practice observing them without reacting to them, Just sit and pay attention.

Georgia - Mindfulness is a bit of buzz word at the moment so Babara, I was wondering, does it actually work? Is there any science behind this - is it a good idea to unwind?

Barbara - Yes, there is evidence based behind it and there is studies showing that it does help and I think it’s particularly good. There are other techniques: exercise, yoga, things that you can use, but some people find it difficult to clear their minds and actually be in the moment and mindfulness helps you do that.

You heard from that little clip that basically you have to focus in on your breathing and when your mind wanders away come back to that again. So it keeps you from thinking about all these other things that distract us during the day and make it difficult to relax and unwind and really have that beneficial effect of wellbeing.

Georgia - So is this “being in the moment” idea, is that beneficial for our actual mental health?

Barbara - It is a good idea to be in the moment because many people miss out on things. They don’t realise they’re missing out on things because they’re not actually focussing on what’s going on at the moment with them. You’ve probably been at restaurants where you see everybody looking at their phones instead of talking to each other, and really enjoying the dinner and talking to their friends, so everybody’s checking their phones. So you lose out on the enjoyment and the well being that you can get from that experience.