Tim Ferriss - Nora Volkow

1) Dr. Nora Volkow discusses her family background and how her father was taken in by Trotsky after his mother committed suicide and his father was sent to a concentration camp by Stalin. Her parents met in Mexico, where they had come to search for their family members who had been brought from Madrid to Mexico during the Spanish Civil War. Nora Volkow describes how she was raised and surrounded by the knowledge of her family history and the extermination of Trotsky by Stalin. This upbringing had influenced the way she relates to the world and thinks about history, and it had affected her decision to study psychiatry.

2) Nora shares about her upbringing and family background, which ingrained in her the values of social responsibility, justice, and helping the most vulnerable. Due to her father’s traumatic experiences, she believed that science provided him with a mechanism of protection and a sense of solidity as it allows for objective and reproducible information. This belief ultimately influenced her career and led her to become director of the National Institute on Drug Abuse, where she can affect policies and knowledge to help people suffering from substance use disorder.

3) Nora discusses her father's aversion to politics and how science provided an ideal profession for him. She also talks about Julian Villarreal, a pharmacologist and physician who greatly influenced her early research career. Villarreal introduced her to analytical methods and technologies allowing her to apply them to measures taken on animal experiments. His unconventional approach to research fueled Dr. Volkow's curiosity for thinking differently and was a major influence in her future success as a scientist.

4) Nora talks about the importance of thinking differently as a mentor and as a scientist, which she learned from her mentor Julian and now teaches her own students. She encourages her team to play with ideas and concepts, even if they seem outrageous, to push scientific creativity and enrich it. She also emphasizes the importance of empowering her mentees and making them feel confident to speak up, as fear of judgment can hinder creativity. The conversation then shifts to Volkow's experience in the 80s when she was studying cocaine addiction and her research was initially dismissed and ignored.

5) Nora talks about the challenges she faced early in her career while trying to prove that cocaine is damaging to blood vessels. At that time, there was a general belief that cocaine was safe, making it difficult for her findings to be accepted by the scientific community. She also shares the advice she gives to younger scientists facing a similar situation, encouraging them to persevere and be daring. She believes that science should push the limits, and individuals should never be afraid to bring a new perspective to the field.

6) Nora and Tim Ferriss share personal experiences with opioids. Dr. Volkow recounts how she was given Demerol after a car accident and describes feeling an extraordinary sense of well-being, but also a scary experience of physical dependence and withdrawal. She warns about the allure of opioids and says that she does not want to be exposed to them unless experiencing severe pain. Ferriss also shares his experience of being given morphine after a terrible shoulder injury and developing a fear of painkillers after being given a collection of different ones post-surgery.

7) Nora discusses the dangers of fentanyl and its pervasive impact on society. She emphasizes the importance of educating people on the dangers of this drug, which is lethal at only two milligrams and has infiltrated every socioeconomic class and neighborhood. Additionally, the War on Drugs is critiqued for perpetuating structural racism and creating an unfair and ineffective punitive system that has led to the incarceration of many young black Americans. Instead, Dr. Volkow suggests that criminalizing drug users does not work and instead exacerbates the problem by increasing the risk of relapse and escalation of drug use.

8) Nora discusses the potential use of psychedelic drugs in treating mental health conditions like depression, PTSD, and substance use disorders. While the evidence thus far is limited, there have been positive results in smaller studies, with psilocybin showing significant improvement in depression scores for patients with terminal illnesses, as well as positive effects in treating nicotine and alcohol use disorders. However, Dr. Volkow emphasizes the need for more research before drawing any conclusions about the efficacy of psychedelic-assisted therapy.

9) Nora talks about the dangers of promoting psychedelic drugs as treatments for mental illnesses without proper scientific data. While some clinical trials have shown potential benefits, there are also potential negative side effects, including suicidal behaviors. Scientists need to conduct further research to determine the proper doses, how to administer the drugs, and what role psychotherapists should play during treatment.

10) Dr. Nora Volkow discusses how she has been studying multiple addictions and morbid obesity to recognize the common elements in the brain. One thing that is common in the neurocircuitry of all addictions, such as cocaine, alcohol, methamphetamine, nicotine, and opioids, is that they create long-term potentiation in reward circuits, which generates an artificial need for the drug. Dr. Volkow is intrigued by the similarities with pain, where the memory of the pain continues even when the insult is no longer there. She suggests that treatments that modify neuroplasticity could be valuable for chronic pain conditions. Tim Ferriss also mentions his experience with ketamine infusions, which helped him relieve his chronic back pain for about six months.

11) Nora discusses the potential of ketamine and psilocybin for the treatment of chronic pain. She also talks about the benefits of transcranial magnetic stimulation (TMS), which administers magnetic currents to modulate specific areas of the brain, and deep brain stimulation, an invasive procedure that targets specific neuroanatomical structures. Dr. Volkow is particularly interested in the use of low-intensity ultrasound for neuromodulation, as it has the potential to reach deeper areas of the brain for the treatment of depression and addiction.

12) Nora explains how low-intensity ultrasounds can be used to modify the tissue in the nucleus accumbens for a long period of time to treat neurological diseases, addiction, and mental illnesses. She claims that the pilot data showed effects that lasted between two to four weeks with a single session of 10 minutes, which could potentially cure addiction. As for Parkinson's, they used high-intensity ultrasound for subthalamic nuclei to damage it precisely without having to undertake surgery, thus bringing psychosurgery to a new level. Overall, Dr. Volkow is excited about these technologies and believes it may open the possibility to cure addiction in the future.

13) Nora discusses the potential of low-intensity ultrasound for treating addiction and mental health issues. While it is still considered pilot data and needs to be replicated, early results show an almost immediate reduction in anxiety and craving for opioids. This low-intensity ultrasound targets the nucleus accumbens, much like deep brain stimulation for opioid addiction. Dr. Volkow emphasizes the importance of addressing comorbid conditions like anxiety and depression, as well as the role of environmental factors, particularly during childhood and adolescence, in understanding addiction and mental illness.