“Can there be a future without Alzheimer’s disease, without multiple sclerosis, without Parkinson’s disease? Yeah”
Jaume Sastre-Garriga. Neurologist from Val d’Hebron, director of the journal Multiple Sclerosis. (Palma, 1971) – member of the Department of Neurology at Vall d’Hebron in Barcelona, published more than 250 articles on multiple sclerosis. He defended his dissertation in London, and from January he will direct the leading journal Multiple Sclerosis Journal.
Does being a doctor mean delivering bad news?
Some bad news is brought, but we are increasingly reporting good news, all practicing doctors experience this. I didn’t need to study this in statistics; I touched it with my own hands in my specialty and in others.
Is it possible to exclude concepts like Parkinson’s disease or Alzheimer’s disease and just talk about aging?
They cannot be suppressed, but these diseases increase with age. Our body becomes more and more fragile in their face. Their frequency increases significantly with age, but they are not equivalent to aging, even if the relationship is intimate.
We are taught that if we are old enough, we will eventually suffer from all diseases.
Our body is programmed to a limit that we usually don’t reach because we always find a stone along the way. If we were to eliminate the stones, it would lead to aging, but we usually don’t give it time. Pathologies get in the way, but sooner or later we will be able to stop them. Could there be a future without Alzheimer’s, without multiple sclerosis, without Parkinson’s? Yeah.
How to distinguish multiple sclerosis from others?
Multiple sclerosis is an autoimmune pathology similar to rheumatoid arthritis. Its target is the central nervous system, which is attacked by the patient’s own immune system. In amyotrophic lateral sclerosis or ALS, the main problem is the central nervous system due to degeneration of parts of it. In many cases, like mine, it can also lead to degradation, but due to the attack of the body itself. It’s as if the police became corrupt and instead of protecting us, they began to attack parts of our structure.
“Doctors who use artificial intelligence will replace those who do not use it”
Is multiple sclerosis a chronic disease?
This is a chronic disease. Today we have no way to cure it, we can only minimize it, calm it down, introduce remissions and deal with side effects, but we cannot eliminate it.
Is it deadly?
No, in itself it is not fatal, but it weakens our body so much that it can lead to death from pneumonia, from infection… The prospects are very good, since the last thirty years, in which we have practically gone from no treatment to a long list of change if it causes side effects. We increasingly have more effective and powerful drugs, as well as more effective strategies to minimize risks. We diagnose the disease closer to its onset, and expectations improve. I like the metaphor of a flame for an inflammatory disease, and it is not the same as having a hose when a hectare has already burned, or that at the first spark you can release ten tons of water.
Do we already agree that mind does not exist?
The mind exists, but it is not in the pineal gland, as Descartes said, or in the diaphragm, as the Greeks said. It is a product of our brain, neural networks and all the activities we maintain while we are alive.
You talk about “product” because mind is something concrete, does it have an essence?
If you are talking to me about consciousness through the mind, then this is the creation of our neural networks. Now he has no definite place at all, no “I” or soul is located. Cognitive processes operate online. Another thing is that in such specific matters as the movement of the little finger of the right hand, we know the neurons most responsible for sending the signal. Now that I’m thinking about this step, a network emerges.
And do we agree that the brain can never understand the brain?
The brain never hurts. When you have a migraine, the blood vessels in your brain hurt. Our brain is the only one that can try to understand itself. Consciousness allows you to examine your relationship with the outside world and with the past.
What has Covid done to our neurons?
Covid has been a pretty significant global experiment. It can cause inflammatory diseases of the central nervous system, although it is rare. We have also learned about the impact of vaccines on these inflammatory pathologies. It exists, but it is minimal, and we should never, ever stop vaccinating in a situation where it is absolutely necessary. This is an indisputable fact. It has also taught us that viruses can cause many reactions in the nervous system, as evidenced by the great debate that has gone on for a long time about Covid-19.
Does solving crossword puzzles help prevent neurological diseases?
This is very important. The modern concept of brain reserve is so simple that it seems incredible. People with structural reserve, with larger heads, to put it bluntly, with a higher cranial perimeter, have a lower risk of developing clinical Alzheimer’s disease, suffering from its symptoms when they have them. I can’t change that, I can’t come and make your head bigger, although the jibaro could make it smaller. But there is one more caveat, a functional one. People with a higher level of education and professions that require intellectual effort also enjoy protection from symptoms. They will suffer from the disease, but will not experience symptoms to the same extent as other people without these parameters. Therefore, solving crossword puzzles, Sudoku, reading, everything that intellectually enriches leisure time is protective.
I wanted to give a counterexample of sages like Cioran or Beckett who went crazy.
Intellectual activity protects not from the disease, but from the symptoms. Under different circumstances, Cioran and Beckett would have developed symptoms five years earlier. Therefore you can always enjoy the wise a little more than those who are not wise.
“Patients must be experts in their diseases from the moment of diagnosis.”
What is the meaning of early diagnosis of an incurable disease?
If it is an incurable disease where nothing can be done to change its course, I fully agree that it is a person’s decision. If it is an incurable disease with a genetic component and which can be transmitted, one needs to plan whether he wants to have offspring, and here the diagnosis is also important. If the disease is incurable, but there is much we can do to reduce its impact, early diagnosis is necessary. I can avoid many problems if I start treatment on time. This is exactly what happens in multiple sclerosis.
What is the Holy Grail of modern neuroscience?
Carry medications for specific neurodegenerative processes associated with diseases such as Alzheimer’s, Parkinson’s, multiple sclerosis or ALS. We are unable to stop this process. And we also have no drugs that can reverse the disease; today it is an unmet need, an unmet need because we are struggling with the mechanisms of neuroprotection. We cannot stop the destruction of a neuron or restore it once we have lost it. This is my field of work.
Is the border between neurology and psychiatry insurmountable?
It’s like the boundary between barbers and barbers, sometimes unnecessary. The central organ of the diseases is the same – the brain, but the manifestations are different, although many pathologies affect both areas, and some debut in the psychiatric aspect, although they are neurological. The disease does not know whether it is from a psychiatrist or a neurologist, it is it. We do not make classifications arbitrarily, but based on historical reasons.
Did that basketball player from San Agustin de Palma imagine such a gift?
Little did he know, he was missing free throws like it was a shotgun at a fair. And the doctor, who began working almost thirty years ago, also did not imagine what success he experienced. People with multiple sclerosis have a before and an after. Let this continue and let the shot finally happen.
When you read, do you think about the neural process of reading?
I always try to keep an outside perspective on what I’m doing, but when I eat, I don’t think about the mental process of tasting. I like the somewhat phenomenological spirit of experience and the boundary between will and fact, but it takes me away from what I’m reading. With Heidegger, Husserl or Sartre, the question “what am I doing now?”, Dasein, awakens in you.
Will a single artificial intelligence be able to replace all doctors?
Doctors who use artificial intelligence will replace those who do not use it, and who will make many more mistakes. In the Weimar Republic, demonstrations were organized because people were scared of cinemas. AI will be just a tool, like nuclear fusion. Humans will always be needed to check and be able to override these machine decisions; he cannot decide for himself whether to give the patient any injection.
Do you hate patients who come into the office reading Wikipedia?
No, on the contrary. If we want to provide people with information and be transparent, which is our responsibility, we need them to be trained to understand it. Mental pie, no, read Wikipedia, I don’t know, but patients should be experts in their illnesses from the moment of diagnosis. We need to educate people in this process, and it is better to have another outpatient, a peer, do it.
Can a doctor focused on research neglect the patient?
This shouldn’t happen, and hospitals that focus more on research have been proven to also have better health outcomes. This is not an opinion, this is science. The more you know about a disease and the more it is at your fingertips, the better you will care for the patient – a truth that applies to doctors and surgeons, without putting researchers above it.
Why did you focus on one disease?
Because at the moment this is the best way to go deeper into therapy, because I wanted to devote myself to research and because ninety percent of neurological services in hospitals of a certain volume are divided into subspecialties. A general neurologist is necessary, but in large centers he is a somewhat residual figure.
Why don’t you work in Mallorca?
I don’t know if I can answer this question. Life takes you, but I wouldn’t mind working in Mallorca because it’s my land. Or, if necessary, in Minorca, my mother is from Fornells.
What does an amateur ornithologist think about bird coordination?
Bird identification is similar to differential diagnosis of diseases, why this one and not another. In addition, they have a nervous system that is superior to ours in some aspects. When you see soriger’s whole body move but his head stays still, I don’t know what gives him the ability that only Michael Jackson among us had.
The body is all we have and it always betrays us?
Betrayal, no, that’s what it says. Panset said that “it has not been proven that I should die”, but all the people who have lived so far have died, including the Mallorcans.
Do you feel chills when you hear the word “God” associated with the brain?
The need for spirituality is an important part of our physiological response, so I respect all its manifestations. It’s like hunger or cold, some are colder than others, there are those who undergo intermittent fasting. Spiritually, some read Kierkegaard, others go to mass.
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