But gravity does much more than that, according to Brennan Spiegel, MD, MSHS, director of Health Services Research for Cedars-Sinai, whose new book makes the case that gravity affects every system in our bodies, and especially our digestive health. 

Spiegel, a gastroenterologist, is the author of a new theory—published in the American Journal of Gastroenterology and detailed in his book—that irritable bowel syndrome (IBS) and other digestive system conditions could be the result of the body’s inability to manage gravity.

Spiegel’s book, Pull: How Gravity Shapes Your Body, Steadies the Mind and Guides Our Health, expands on his theory, using the term “gravity intolerance” and describing how every part of our body—not just the gut— evolved to manage this fundamental force.

“If you’ve ever felt unusually fatigued after a long day on your feet, gotten dizzy standing up too quickly, dealt with persistent back pain, noticed swelling around your ankles, or had indigestion lying flat in bed—you’ve felt the effects of what I call gravity intolerance,” Spiegel said.

Spiegel, Cedars-Sinai’s George and Dorothy Gourrich Chair in Digital Health Ethics, describes how a family member’s declining health led him to his gravity intolerance theory.  

Spiegel’s mother-in-law was living in an assisted living facility and spending much of her time lying down in bed. Simultaneously, she was experiencing depression and worsening digestive issues like bloating and constipation. Spiegel theorized that human bodies aren’t designed to lie flat all day but are meant to get up and move.

“Our abdominal contents are heavy, like carrying a sack of potatoes in our bellies for a lifetime. Thankfully, evolution equipped us with systems to manage this load when we’re standing upright,” Spiegel said. “But lying down for too long compresses the intestines, slows digestion, and can create a feedback loop of discomfort between the gut and brain. I started to wonder: Was my mother-in-law’s time in bed causing her symptoms, or was it the other way around? Her story revealed a much larger picture to me about how gravity affects the body—and how many of my patients’ struggles might connect back to it.”

“The human relationship to gravity is much like a fish’s relationship to water,” Spiegel explained. “We live our entire lives in it, are shaped by it, yet rarely notice its constant influence on our existence.”

This insight led Spiegel to think more about gravity and the gut. “Might gravity intolerance explain why physical activity—like core strengthening, tai chi or aerobic activity—can often improve IBS symptoms, more than some medication? Could it also explain why some patients get lightheaded when they stand up quickly, or why so many also suffer from lower back pain—a consequence of gravity strain—or get worse at high altitude, where gravity’s grip on the atmosphere is diminished, or have abdominal obesity, weighing down the belly?” Spiegel said. “I began to suspect that gravity’s relentless pull might be a common thread in conditions I’d been studying for years.”  

Gravity intolerance, according to Spiegel, can affect our mental wellbeing as well. He describes mental gravity as a condition in which negative thoughts and emotions make us feel weighed down, as if gravity’s pull has intensified. More than a metaphor, Spiegel explains how the “gut feelings” many people feel when anxious also occur when falling on a roller coaster, or even when “falling” in love, revealing a deeper link between mind, body and gravity.

In Pull, Spiegel discusses gravity management and how to build gravity resilience to improve health and overall wellness, not just for gut health, but for overall mind-body resilience. He mentions flotation tanks, standing desks, inverted yoga poses, core strengthening and small adjustments people can make to improving gut health, like using footstools to create a more gravity-friendly posture. He also explains the idea of biogravitational medicine, a new field he hopes to develop to understand how gravity influences the human body and mind.

Other Cedars-Sinai leaders are intrigued by the new theory. Shelly Lu, MD, the Women's Guild Chair in Gastroenterology and director of the Division of Digestive and Liver Diseases at Cedars-Sinai, looks forward to the hypothesis being tested. “This could be a game changer in how we think about IBS and possibly how it’s treated.”

Itai Danovitch, MD, chair of the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences, says it offers a unifying framework for understanding why so many psychiatric conditions involve both mental and physical symptoms. “We've long known that gut health affects mood, that posture influences confidence, that movement helps depression—but conceptualizing these through the lens of gravity management is genuinely novel. This framework could  point toward new interventions that can be rigorously tested and evaluated.”

Spiegel is already looking ahead to proving his theory.

“Gravity was here long before we were, and it will remain long after we’re gone,” Spiegel said. “It stands to reason that mastering gravity was essential for life to evolve on Earth, and we survive and thrive by standing up and staying up as long as we can, and as well as we can.”

Read More on the Cedars-Sinai Blog: Causes and Treatments for Irritable Bowel Syndrome

Both studies used an application, developed at Cedars-Sinai, that combines AI and virtual reality (VR) goggles. It features avatars that are “trained” by AI to conduct talk therapy with patients in virtual and relaxing environments.

In the first study, published in the Journal of Medical Extended Reality, investigators used the VR application to deliver mental health therapy to 20 patients with alcohol-associated cirrhosis, a serious liver disease that can result from long-term excessive alcohol consumption.

Each patient received a 30-minute counseling session from a virtual therapist avatar that had received AI training in motivational interviewing, cognitive behavioral therapy and other techniques to help patients alter their behaviors. More than 85% of the patients said they found the sessions beneficial and 90% expressed interest in using virtual therapists again.

“For individuals awaiting liver transplants for cirrhosis, alcohol addiction remains a high-risk factor,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and the corresponding author for both studies. “We see VR as a way to augment traditional interventions, which often fall short due to a shortage of mental health professionals, societal stigmatizing of alcoholism and other factors.” Spiegel also participated in recent research demonstrating that VR experiences can even modulate stress levels and immune responses in participants.

In the second study, published in the journal Cyberpsychology, Behavior, and Social Networking, investigators presented virtual therapists with virtual patients that had been trained by AI to emulate people seeking professional help for anxiety or depression. In each simulated conversation, the virtual therapist was randomly informed of a different sociodemographic profile of the patient based on age, gender, race, ethnicity and annual income. A control group without assigned identities was also included.

The investigators used a standard scale known as “tone analytics” to rate the tone or mood of the language used by the virtual therapist. In repeated samplings involving more than 400 conversations, no significant difference was found in the therapist’s tone score based on a virtual patient’s profile or the absence of a profile. “This data suggests that with thoughtful design, AI can offer equitable and personalized care,” Spiegel said.

These studies highlight the leading role Cedars-Sinai is taking to adopt new technologies and to develop patient-centered approaches to health challenges, said  Peter Chen, MD, professor of Medicine, the Medallion Chair in Molecular Medicine and interim chair of the Cedars-Sinai Department of Medicine.

“These two studies underscore Cedars-Sinai’s commitment to exploring the tremendous potential of artificial intelligence for mental health therapy while ensuring that this technology does not perpetuate human biases in delivering healthcare,” Chen said.  “Cedars-Sinai has become a world leader in tackling this formidable challenge.”

Other Cedars-Sinai authors of the Journal of Medical Extended Reality study include Yee Hui Yeo, Allistair Clark, Muskaan Mehra, Itai Danovitch, Ju Dong Yang, Alexander Kuo, Hyun-Seok Kim, Aarshi Vipani, Yun Wang, Walid Ayoub, Hirsh Trivedi, Jamil S. Samaan and Omer Liran. Additional authors were Karen Osilla, Tiffany Wu, and Vijay H. Shah.

Disclosures: Spiegel and Liran are faculty members at Cedars-Sinai Medical Center and co-founders of VRx Health, Inc. Spiegel has no role in the company, has received no payments, royalties, or proceeds from the company, has fully divested all equity and interests in VRx Health, Inc., and has divested from any interest and any potential royalties. Liran is on the Board of VRx Health and maintains equity; he is also eligible to receive future royalties. The AI algorithm in this study was exclusively licensed by Cedars-Sinai to VRx Health for commercialization. Cedars-Sinai has the right to receive future royalty payments from VRx Health under this license agreement and owns stock in VRx Health. All other authors do not have conflict of interest.

Other Cedars-Sinai authors of the Cyberpsychology, Behavior, and Social Networking study include Yee Hui Yeo, Muskaan Mehra, Jamil S. Samaan, Joshua Hakimian, Allistair Clark, Karisma Suchak, Zoe Krut, Taiga Andersson and Omer Liran. Additional authors were Yuxin Peng and Susan Persky.

Disclosures: Spiegel and Liran are faculty members at Cedars-Sinai Medical Center and co-founders of VRx Health, Inc. The AI algorithm in this study was exclusively licensed by Cedars-Sinai to VRx Health for commercialization. Cedars-Sinai has the right to receive future royalty payments from VRx Health under this license agreement, and owns stock in VRx Health. All other authors do not have conflict of interest.

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. The eight-week program, known as IBS VR, makes use of cognitive behavioral therapy (CBT) to help patients manage symptoms such as pain and stress.

In an ongoing clinical trial, Cedars-Sinai gives VR headsets and the IBS VR app to patients, who get access to new virtual “treatment rooms” every few days. In the treatment rooms, patients learn relaxation strategies and other tactics to help manage their IBS symptoms.

“We want to raise awareness of the opportunity to think beyond the pill and particularly think about VR,” said Brennan Spiegel, MD, MSHS, director of Health Services Research at Cedars-Sinai and senior author of the study. “IBS is a gut-brain interaction disorder, and we know that calming the nervous system using cognitive behavioral therapy helps keep the gut calm. We want to add IBS VR to the cognitive behavioral therapy toolbox, particularly because IBS VR is more easily accessible to all patients. We are bringing the clinic to the patient.”

The app-based treatment will now undergo testing funded by a $1 million, three-year grant from the National Institutes of Health.

Additional authors: Karisma K. Suchak, Christopher V. Almario, Omer Liran, Robert Chernoff

Funding: Drs. Brennan Spiegel and Omer Liran co-developed SynerGI using internal resources from Cedars-Sinai Medical Center with additional support from the Marc and Sheri Rapaport Fund for Digital Health Science and Precision Health at Cedars-Sinai.

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Spiegel told Healio that evidence suggests cognitive behavioral therapy accessed through VR could help manage hot flashes caused by hormonal fluctuations, as well as resulting distress and anxiety.

“We are working with women experiencing menopause and learning from them to co-develop a new therapy, currently underway,” said Spiegel, who is the George and Dorothy Gourrich Chair in Digital Health Ethics.

Spiegel told Healio that headsets with immersive virtual content—such as snowy scenes or the sound of wind blowing—could help cool the body.

“There is evidence that when the brain is immersed in VR, it thinks it is there,” he said, referencing other studies involving VR and symptom management. “Even if you know it is a simulation, the brain acts as if it is real. You hear wind rustling in your ears and literally start to feel your body cooling down.”

Spiegel told Healio that women experiencing menopause symptoms also can use VR headsets to play games or to meditate, helping divert attention away from bothersome symptoms.

“The mind is medicine,” he said. “This is an easy thing to say—and it sounds a little woo-woo—but the brain and the body are connected. The brain will send signals through the vagus nerve and if we modify the brain in moments of distress, we do modify the body.”

Spiegel told Healio the goal is to help patients eventually manage symptoms without a headset.

“What VR is teaching people is that you do have this ability to control your body’s physiology, through your own mind,” he said.

Click here to read the complete article from Healio. 

, the official journal of the American Medical Extended Reality Association (AMXRA) and the world’s first peer-reviewed publication focused on extended reality.

MXR represents the intersection of healthcare and immersive technology, including virtual, augmented and mixed reality applications across a wide range of medical specialties, designed to extend or enhance the medical experience.

As technology has advanced in the past 30 years, research in this field has broadened considerably with some applications gaining recognition from regulatory bodies such as the U.S. Food and Drug Administration, and others becoming standard healthcare practice.

“Even with more than 20,000 MXR studies published to date, the field lacked a universal language—a way to classify and communicate the diverse research and breakthroughs happening around the globe,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and first and corresponding author of the study. “Our study addresses this crucial gap by introducing a detailed framework that categorizes the vast array of research and applications within MXR.”

Spiegel, editor-in-chief of the journal, said the taxonomy’s purpose is to categorize existing work and provide a framework for future research, development and discussion.

The initial taxonomy outlines five core domains, encompassing 13 primary topics and 180 secondary topics. These guidelines offer a tool for researchers, practitioners, funders, industry, and other groups to systematically classify and navigate the complexities of the field. Due to the constantly evolving nature of MXR, the taxonomy is a “living document,” Spiegel said, requiring future modifications and expansions in response to new developments and insights.

Experts were selected to participate in the development of the taxonomy based on their track record for MXR-related publications and contributions to the field as well as their international and multidisciplinary perspectives. Additionally, Spiegel shared a draft taxonomy on X (formerly Twitter) to solicit feedback from the general community with a goal to ensure a thorough and inclusive approach.  

“The field of MXR is now a legitimate, stand-alone field of medicine that requires a comprehensive, standardized framework and common language to support its continued growth,” said Paul W. Noble, MD, chair of the Department of Medicine at Cedars-Sinai. “The work Dr. Spiegel and his expert collaborators have put into defining this dynamic field is astounding.”

Another Cedars-Sinai author involved in the study is Omer Liran, MD, MHDS. Additional authors include Albert Rizzo, PhD; Susan Persky, PhD; Brenda Wiederhold, PhD, MBA; Susan Woods, MD, MPH; Kate Donovan, PhD; Korak Sarkar, MD, MHDS; Henry Xiang, MD, MPH, PhD, MBA; Sun Joo (Grace) Ahn, PHD; Rohan Jotwani, MD, MBA; Min Lang, MD, MSc; Margot Paul, PsyD; Mike Senter-Zapata, MD; Keith Widmeier, BA, NRP; and Mark Zhang, DO.

Conflicts of Interest: Spiegel and Liran are co-founders of VRx Health.

Funding: No funding was received for this article.

Read more from Cedars-Sinai Discoveries Magazine: Virtual Reality and the Brain-Body Connection

The application—called Xaia, for eXtended-Reality Artificially Intelligent Ally—expands access to mental health support for patients, furthering Cedars-Sinai’s mission to elevate the health of communities it serves in Los Angeles and beyond.

Cedars-Sinai investigators created Xaia as a way to offer patients self-administered, AI-enabled, conversational therapy in relaxing spatial environments such as a creek-side meadow or a sunny beach retreat where patients also can do deep breathing exercises and meditation.

The Xaia application offers users an immersive therapy session led by a trained digital avatar, programmed to simulate a human therapist.

“Apple Vision Pro offers a gateway into Xaia’s world of immersive, interactive behavioral health support—making strides that I can only describe as a quantum leap beyond previous technologies,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and co-founder of the Xaia technology. “With Xaia and the stunning display in Apple Vision Pro, we are able to leverage every pixel of that remarkable resolution and the full spectrum of vivid colors to craft a form of immersive therapy that’s engaging and deeply personal.”

While developing the app for Apple Vision Pro, Spiegel said, his Cedars-Sinai team reimagined how spatial computing can support behavioral health and overall wellbeing in ways never before possible.

Omer Liran, MD, a psychiatrist at Cedars-Sinai and co-founder of Xaia, says the app represents a transformative step in making quality therapy accessible to all.

“Apple Vision Pro has allowed us to create a platform where technology fades into the background and the user's healing journey comes to the forefront,” Liran said. “This application is a culmination of years of rigorous research, clinical expertise and a vision to democratize mental wellness in a way that respects the uniqueness of every individual's experience. Using the powerful capabilities of Vision Pro, we’re now able to bring this experience to life with its full potential.”

Before the launch of Apple Vision Pro, the Xaia technology was featured in a first-of-its-kind study published in the peer-reviewed journal Nature Digital Medicine. Findings from the study showed Xaia as both beneficial and safe for patient use.

To develop Xaia, Spiegel and Liran enlisted the support of Cedars-Sinai’s Technology Ventures—the enterprise that protects and supports the commercialization of discoveries and technologies. Technology Ventures also facilitates access to promising inventions—like Xaia—that improve the quality of life for patients around the world.

The managing director of Cedars-Sinai’s Technology Ventures, Nirdesh Gupta, PhD, said that ideas developed in an academic medical center environment like Cedars-Sinai offer a one-of-a-kind perspective—focused both on advancing research and expediting clinical care needs.

James Laur, JD, vice president of Intellectual Property at Cedars-Sinai, echoed that sentiment.

“The hospital ecosystem is at the heart of care delivery, and Cedars-Sinai has the unique advantage of being closest to the patients and their varying needs,” said Laur. “Xaia is the result of several years of support and funding, and we are elated to see the technology come to life in this meaningful and clinically relevant way.”

Conflicts of Interest: Spiegel and Liran are co-founders of VRx Health. The Xaia technology is exclusively licensed from Cedars-Sinai to VRx Health for commercialization.

Read more from the Cedars-Sinai Blog: Virtual Reality and the Brain-Body Connection

Known as the eXtended-Reality Artificially Intelligent Ally, or XAIA, the program offers users an immersive therapy session led by a trained digital avatar. Findings from a first-of-its-kind study were published today and showed that participants benefited from the sessions.

“To our knowledge, this is the first time mental health therapy has been studied using generative artificial intelligence within immersive virtual reality,” said Brennan Spiegel, MD, MSHS, professor of Medicine, director of Health Services Research at Cedars-Sinai and first and corresponding author of the study published in the peer-reviewed journal Nature Digital Medicine.

Cedars-Sinai investigators created XAIA as a way to offer patients self-administered, AI-enabled, conversational therapy in relaxing virtual reality environments—such as a creek-side meadow or a sunny beach retreat where patients can also do deep breathing exercises and meditation.

As highlighted in the study, participants interacted with XAIA, which employs a large language model programmed to resemble a human therapist. The avatar was developed by Cedars-Sinai psychiatrist Omer Liran, MD, with input from Cedars-Sinai clinical psychologist Robert Chernoff, PhD, who co-authored the paper and helped assess the program for safety.

Expert mock therapy sessions were performed and transcribed to hear firsthand how a trained psychologist can—and should—interact with patients. From these sessions, recurring exchanges and patterns were identified and encoded into the large language model as rules and preferred responses for XAIA to emulate. These findings were then used to train the generative AI technology behind XAIA while incorporating over 70 best practices for mental health therapy.

“After teaching XAIA these skills, she offered therapy in a more empathetic, compassionate and meaningful way,” Chernoff said. “She handled a range of situations very well and did not show evidence of safety concerns during our testing.”

Fourteen participants with mild to moderate anxiety or depression interacted with XAIA for 30 minutes, then participated in debriefing interviews. Researchers then provided an analysis of the interview transcripts. Therapy topics ranged from loneliness and family problems to financial distress.

Participants frequently responded to the avatar as if it were a person and shared raw emotions. For example, one study participant told XAIA, “I feel like I’m a failure. The only thing I have to look forward to—I know you're going to laugh—is to go see Taylor Swift … and she's like the only thing that's keeping me alive. I'm sorry I'm crying.”

XAIA responded with comments like, “Firstly, there’s no need to apologize for crying. These feelings are valid.”

In another exchange, a participant told XAIA, “I think I look to other people to validate my self-worth and so rejection is especially painful. So, I am reluctant to put myself in situations where I could be rejected.”

XAIA responded, saying, “That's quite an insightful observation about yourself. It can be challenging when our self-worth is tied to the approval or validation of others. Fear of rejection can indeed make social interactions daunting. Could you share a little more about where you think this need for validation comes from?”

Participants described the program as easy to maneuver, and indicated that XAIA was “friendly,” “approachable,” “calming,” “empathic,” “empowering,” “unbiased” and “intelligent.” Participants also reported perceived advantages over traditional talk therapy, and all participants said they would recommend the program to others, although some indicated they would still prefer a human therapist if given the choice.

“These results provide initial evidence that VR and AI therapy has the potential to provide automated mental health support within immersive environments,” said Spiegel, director of the Cedars-Sinai master's degree program in health delivery science (MHDS) and the George and Dorothy Gourrich Chair in Digital Health Ethics. “By harnessing the potential of technology in an evidence-based and safe manner, we can build a more accessible mental healthcare system.”

When creating XAIA, investigators sought to help address a national shortage of psychotherapists, especially in rural areas where access to mental health services is often delayed or nonexistent.

“The prevalence of mental health disorders is rising, yet there is a shortage of psychotherapists and a shortage of access for lower income, rural communities,” Spiegel said. “While this technology is not intended to replace psychologists—but rather augment them—we created XAIA with access in mind, ensuring the technology can provide meaningful mental health support across communities.”  

Conflicts of Interest: Spiegel and Liran are co-founders of VRx Health. The XAIA technology is exclusively licensed from Cedars-Sinai to VRx Health for commercialization.

Funding: The study was conducted using internal resources from Cedars-Sinai with additional support from the Marc and Sheri Rapaport Fund for Digital Health Science and Precision Health at Cedars-Sinai.

Other Cedars-Sinai authors involved in the study include Omer Liran, MD, Allistair Clark, MA; Jamil S. Samaan, MD; Carine Khalil, PhD; Kavya Reddy, MD; and Muskaan Mehra, BS.

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Read more from the Cedars-Sinai Blog: Virtual Reality and the Brain-Body Connection

Spiegel is well known as a leader in medical extended reality, or MXR, a new field of medicine focused on using technologies such as virtual reality (VR) and augmented reality (AR), to treat patients with a range of conditions. He has published seminal studies in MXR through his research at Cedars-Sinai, with a focus on using VR to help manage pain and anxiety. 

The new, open-access and peer-reviewed research journal will be the official journal of the American Medical Extended Reality Association (AMXRA) and will cover virtual, augmented, and mixed-reality research, alongside that of other emerging technologies. The first articles are scheduled to be published in January 2024.

“The significance of the Journal of Medical Extended Reality (JMXR) lies in our collective pursuit of unlocking the potential of MXR, while ensuring rigorous scientific scrutiny and the highest standards of evidence-based research,” said Spiegel. “The journal will serve as an essential catalyst to clinicians, researchers, technologists and policymakers for the accelerated growth of medical XR, promoting critical dialogue, ethical considerations, and the dissemination of invaluable expertise.”

At Cedars-Sinai, Spiegel, the George and Dorothy Gourrich Chair in Digital Health Ethics and director of Health Services Research, created the Virtual Medicine Program dedicated to studying XR in medicine.

“The Cedars-Sinai program offers education, clinical care, and research into virtual reality and other extended reality technologies,” said Spiegel. “As part of that program, we’ve treated over 3,000 patients with different forms of virtual reality and are actively developing new programs for conditions ranging from irritable bowel syndrome to anxiety.” Cedars-Sinai is also home to the annual Virtual Medicine Conference, a leading symposium advancing the science of medical extended reality.

With the launch of JMXR, Spiegel hopes to foster collaborations among a wide range of professionals developing MXR hardware and software programs, including physicians, computer scientists, engineers and psychologists, among others. His goal with the journal is to stimulate innovative approaches, promote evidence-based practices, and drive the adoption of extended reality technologies in healthcare settings around the world.

“Dr. Spiegel is well poised to accelerate his national leadership in this rapidly evolving field of medicine,” said Shlomo Melmed, MB, ChB, executive vice president of Academic Affairs and dean of the Medical Faculty at Cedars-Sinai. “His impactful research in the field of extended reality will be immeasurably accelerated with the launch of this journal.”

 Read more from Discoveries: Virtual Reality and the Brain-Body Connection

The philanthropy of the Gourrich Foundation will strengthen and galvanize Spiegel’s pioneering studies in digital health innovation. The late George Gourrich, MD, and his wife Dorothy have been loyal supporters of Cedars-Sinai—Dr. Gourrich practiced internal medicine at Cedars-Sinai for most of his storied career spanning five decades.

Spiegel is a widely-respected authority in gastroenterology and health technology, spearheading groundbreaking research in digital health and the use of virtual reality to help patients manage pain and anxiety. His research shows that using virtual reality environments can help relieve discomfort and support positive emotions. Earlier this year, Spiegel gained widespread attention for his theory that gravity may be a causative factor for irritable bowel syndrome, the most common gastrointestinal disorder.  

“I thank the Gourrich family for their incredible vision and legacy in supporting our research at Cedars-Sinai,” Spiegel said. “We’re working to find ways to deploy digital technologies in ways that are equitable and cost effective so that all populations can benefit from them.”

Ethics, Spiegel adds, factor prominently in these developing technologies. “As we unlock new methods of treating patients, particularly with massive advances in artificial intelligence, we must ensure that these technologies are used in an ethical and equitable manner,” he said.

Spiegel’s work has helped broaden a new field of medicine called Medical Extended Reality, or MXR, in which doctors use immersive tools like virtual reality goggles to help treat a patient’s pain, anxiety, depression and other medical conditions.

Spiegel leads the Cedars-Sinai Center for Outcomes Research and Education, a multidisciplinary team investigating the clinical uses of digital health technologies—from wearable biosensors and smartphone applications to social media. Spiegel and his team are exploring the role these technologies play in establishing greater levels of understanding and empathy between doctors and patients.

The team brings together specialists, including clinicians, computer scientists and health services researchers to test and implement digital therapies to improve the health of patients at Cedars-Sinai and around the world.

“Dr. Spiegel is well poised to accelerate his national leadership in this rapidly evolving field of medicine,” said Shlomo Melmed, MB, ChB, executive vice president of Academic Affairs and dean of the Medical Faculty at Cedars-Sinai.

Spiegel has published several best-selling medical textbooks, including VRx: How Virtual Therapeutics Revolutionize Medicine. His scientific findings also have been featured in more than 260 peer-reviewed articles.

“Dr. Spiegel’s impactful research underscores the value of establishing this endowed chair and highlights how deserving he is of this recognition,” said Arthur J. Ochoa, JD, senior vice president of Advancement and chief advancement officer for Cedars-Sinai. “Cedars-Sinai is so thankful to the Gourrich Foundation for this incredible gift that promises to sustain research in the burgeoning field of digital health ethics today and far into the future.”

Read more on the Cedars-Sinai Blog: Virtual Reality in Healthcare: Pain Relief

The results of the representative study are published in the journal Gastroenterology.

“This new study is among the largest population-based evaluations of IBS epidemiology. The results reveal that the condition is more prevalent than previously thought and varies by race and ethnicity,” said the study’s corresponding author, Brennan Spiegel, MD, MSHS, director of Health Services Research and the Dorothy and George Gourrich Chair in Digital Health Ethics at Cedars-Sinai.

In May and June of 2020, investigators conducted online surveys of adults age 18 and older. A large cross section of people living in the U.S. were asked to complete the Rome IV IBS questionnaire and the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) survey to assess the presence and severity of their gastrointestinal symptoms.

“We wanted to update our understanding of how common IBS is in the U.S. and to get a sense of the associated burden of the illness. Because diagnosis is symptom-based, we used the Rome IV validated IBS questionnaire to survey respondents about their abdominal pain and changes in bowel habits. We also used the PROMIS survey to see what other symptoms they were experiencing,” said gastroenterologist and co-first author of the study Christopher Almario, MD, MSHPM, who is also an assistant professor of Medicine at Cedars-Sinai.

In addition to the significant size of the study cohort, investigators point out there have been few large-scale studies looking at racial and ethnic differences in IBS.

“Our findings showed that non-Hispanic Black people, Hispanics and non-Hispanic Asian people all were less likely to have IBS when compared to non-Hispanic white people,” said Almario.

“But some of the non-white participants who did have IBS experienced more severe symptoms. For example, Hispanics and non-Hispanic Black people with a form of IBS where diarrhea is common had more severe belly pain than their non-Hispanic white counterparts,” said Almario.

Since the prevalence of IBS appears to be on the rise, Almario suggests physicians may be seeing more patients with associated symptoms in their clinics.

“In addition to abdominal pain and changes in bowel habits, patients with IBS may experience bloating, excess gas and heartburn. It is important for healthcare providers to take a thorough patient history in order to identify and manage these treatable symptoms,” said Almario.

According to the study authors, the COVID-19 pandemic may have played a role in the increased prevalence of IBS, and they are performing additional data analysis to examine the potential connection.

“It is possible that both direct infection with the virus that causes COVID-19 and the psychological stress associated with living through a pandemic contributed to the rise in IBS prevalence through a number of mechanisms worthy of further investigation,” said Spiegel.

DOI: https://doi.org/10.1053/j.gastro.2023.08.010

Funding: Support for this study was provided by Ironwood Pharmaceuticals in the form of an institutional research grant to Cedars-Sinai.

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Read more on the Cedars-Sinai Blog: When to See a Doctor for Constipation

While lower-income communities had lower vaccination rates than higher-income communities, the impact of vaccination on disease incidence was larger in lower-income communities. As a result, investigators say, vaccination led to reduced income-related disparities in COVID-19 incidence. 

The findings were published today in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC).

“This study is a unique demonstration of how vaccination promotes health equity,” said Timothy Daskivich, MD, assistant professor of Surgery at Cedars-Sinai and senior author of the study. “Through this investigation, we also found that disparities in COVID-19 incidence between low- and high-income communities in the first two surges in Los Angeles were not observed in the first surge that occurred after vaccines were widely distributed.” 

The findings also serve as a model for future pandemics and mass vaccination needs across the country, said Daskivich.

“This study shows the benefit of prioritizing vaccine efforts in underserved communities to reduce disparities and improve overall population health,” Daskivich said.

The analysis included vaccination and reported COVID-19 illness data from 81 Los Angeles communities, representing more than 5 million people.

Community-level COVID-19 vaccination coverage and incidence data from April 2020 through September 2021 was obtained from the Los Angeles Times COVID-19 data repository, which is populated with California Department of Public Health data.

Key findings from the Cedars-Sinai analysis include:

• In 81 assessed Los Angeles communities, COVID-19 incidence during two surges before the availability of vaccines—July 2020 and January 2021—was higher in lower-income communities relative to higher-income communities.
• During the first surge after vaccines became available—September 2021—the disparity in COVID-19 incidence between the highest- and lowest-income communities disappeared.
• The impact of vaccination on COVID-19 incidence was highest in the lowest-income communities despite lower vaccination coverage.

Study authors point to public health programs that helped reduce disease incidence disparities. For instance, efforts in California included allocating 40% of vaccination appointments to communities in the lowest quartile of the California Healthy Places Index early in the vaccine rollout.

“Our study, alongside California's initiative to target vaccine rollouts, highlight the importance of improving vaccination access and reducing vaccine hesitancy in underserved communities to reduce disparities in COVID-19 incidence,” said Brennan Spiegel, MD, MSHS, director of Health Services Research at Cedars-Sinai and an author of the study. “Reducing barriers to vaccination in lower-income communities, including providing updated COVID-19 vaccine boosters, is critical to reducing disparities in disease burden and decreasing COVID-19–related illness in the United States.”

Other Cedars-Sinai authors involved in the study include John Masterson, MD, and Michael Luu, MPH.

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