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"content": "\u003cp>Much like shoes or skinny jeans, heart attacks can fit women a little differently than men. Their symptoms don’t always look the same, and for a meshwork of reasons, physicians all too often fail to diagnose heart attacks in women with enough time to intervene.\u003c/p>\n\u003cp>The consequence: Women are more likely to die from heart attacks than men are. But, according to a new study, not if they’re treated by female doctors.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, published Monday in Proceedings of the National Academy of Sciences, found that female patients are two to three times more likely to survive a heart attack when the doctor overseeing their care is also a woman. 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The answers are more convoluted than the questions.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Previous research has found better outcomes among hospitalized Medicare patients treated by women, but the underlying reasons remain murky at best.\u003c/p>\n\u003cp>“It’s important to not get caught up in the idea that women are better doctors,” said Dr. Klea Bertakis, a physician and researcher at the University of California, Davis, who studies gender dynamics in health care. “It’s not a men-against-women kind of thing, it’s what are the best practice styles and how can we teach them.”\u003c/p>\n\u003cp>Bertakis pointed to specific practice behaviors – female physicians tend to share more information with patients and to focus more on partnership and patient participation. Male physicians, on the other hand, tend to stick to “the facts,” emphasizing the patient history and physical exam, she said.\u003c/p>\n\u003cp>Dr. Sharonne Hayes, a cardiologist at the Mayo Women’s Heart Clinic, broke down one common explanation for the differences in outcomes for male and female heart attack patients — the symptoms.\u003c/p>\n\u003cp>During a heart attack, women are less likely to experience chest pain, and are more likely to present with nausea and vomiting. But Hayes pointed out that there are more similarities than differences: 30 percent of both men and women won’t experience chest pain, and men can have nausea, too. The symptom hypothesis doesn’t fully explain the different rates of diagnosis and survival.\u003c/p>\n\u003cp>Hayes suggested that part of the problem is that physicians and people in general are “still stuck with some confirmation bias about who gets a heart attack.”\u003c/p>\n\u003cp>The new study, conducted by three business school professors at the University of Minnesota, Washington University in St. Louis, and Harvard, started by looking at whether gender concordance between patients and the attending physicians in the emergency department influenced survival.\u003c/p>\n\u003cp>“There’s relatively deep streams of literature in economics, political science, and sociology that suggest when advocates differ from the people they advocate for, there are often penalties,” said lead author Brad Greenwood of Minnesota’s Carlson School of Management.\u003c/p>\n\u003cp>“Penalties” are business-speak that, when applied in an emergency room, refer to mortality. And “advocacy,” in this case, translates to physician care.\u003c/p>\n\u003cp>Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, Greenwood and his colleagues found that when the gender of the patient matched the gender of the physician, both male and female patients were more likely to survive.\u003c/p>\n\u003cp>Looking more closely at the data revealed that female patients treated by male physicians were the least likely to survive a heart attack.\u003c/p>\n\u003cp>The magnitude of the difference impressed Greenwood, but he was not surprised by its existence.\u003c/p>\n\u003cp>Greenwood and his co-authors took their research one step further, studying not only the physicians’ gender, but their environment. They found that patients were more likely to survive heart attacks when treated in emergency departments with higher percentages of female physicians.\u003c/p>\n\u003cp>Greenwood and co-author Seth Carnahan, of Washington University, were both hesitant to speculate about the reasons underlying their observations. Carnahan — who compared the patient-physician relationship to an employee-customer one — acknowledged that, as business professors, he and his colleagues lack the perspective of clinicians.\u003c/p>\n\u003cp>“We have expertise in analyzing data like this and thinking about organizational problems, but we don’t have the firsthand experience and knowledge that doctors have,” he said.\u003c/p>\n\u003cp>Hayes said their statistical analysis went beyond what most doctors could even “conceptualize,” but she and Bertakis expressed some concern over the study’s methods and conclusions. The data, now eight years old, might miss the impact of recent efforts to educate physicians and the public about gender differences in cardiovascular disease.\u003c/p>\n\u003cp>Both physicians also noted that the attending doctor used in the data analysis was likely the physician that discharged the patient — or signed their death certificate — which might not be the same doctor who treated the patient in the emergency room.\u003c/p>\n\u003cp>Bertakis took issue with the the study’s recommendation that one way to improve outcomes would be to increase the number of female physicians in the emergency department.\u003c/p>\n\u003cp>“These approaches are not likely to be feasible,” she said. Instead, she would focus on continuing to improve the curriculum in medical schools and in residency programs to teach physicians about gender differences — both at the patient and physician level — in cardiovascular care.\u003c/p>\n\u003cp>Hayes would like future research to focus on understanding why male physicians who work among more female doctors have better patient survival rates. “Where’s the education coming from? Is it in the hallways and at the watercooler?” she asked. “Or are there policy changes and practice changes?”\u003c/p>\n\u003cp>The new study is a launchpad to address these questions, she said: “Understanding differences in how we need to care for men and women — particularly with heart disease, but for many other conditions — is something we should all be teaching our medical students, and learning, and incorporating in our daily practice.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/06/heart-attacks-women-female-doctors/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Much like shoes or skinny jeans, heart attacks can fit women a little differently than men. Their symptoms don’t always look the same, and for a meshwork of reasons, physicians all too often fail to diagnose heart attacks in women with enough time to intervene.\u003c/p>\n\u003cp>The consequence: Women are more likely to die from heart attacks than men are. But, according to a new study, not if they’re treated by female doctors.\u003c/p>\n\u003cp>The \u003ca href=\"http://www.pnas.org/cgi/doi/10.1073/pnas.1800097115\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, published Monday in Proceedings of the National Academy of Sciences, found that female patients are two to three times more likely to survive a heart attack when the doctor overseeing their care is also a woman. But the difference diminished when male doctors worked in emergency rooms with a higher percentage of female physicians.\u003c/p>\n\u003cp>In fact, both men and women suffering heart attacks fared better when treated by female doctors or when treated by men working alongside more female clinicians, the authors reported.\u003c/p>\n\u003cp>These findings raise an unavoidable question: Are women better doctors? And, does rubbing elbows with women physicians help men become better clinicians? The answers are more convoluted than the questions.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Previous research has found better outcomes among hospitalized Medicare patients treated by women, but the underlying reasons remain murky at best.\u003c/p>\n\u003cp>“It’s important to not get caught up in the idea that women are better doctors,” said Dr. Klea Bertakis, a physician and researcher at the University of California, Davis, who studies gender dynamics in health care. “It’s not a men-against-women kind of thing, it’s what are the best practice styles and how can we teach them.”\u003c/p>\n\u003cp>Bertakis pointed to specific practice behaviors – female physicians tend to share more information with patients and to focus more on partnership and patient participation. Male physicians, on the other hand, tend to stick to “the facts,” emphasizing the patient history and physical exam, she said.\u003c/p>\n\u003cp>Dr. Sharonne Hayes, a cardiologist at the Mayo Women’s Heart Clinic, broke down one common explanation for the differences in outcomes for male and female heart attack patients — the symptoms.\u003c/p>\n\u003cp>During a heart attack, women are less likely to experience chest pain, and are more likely to present with nausea and vomiting. But Hayes pointed out that there are more similarities than differences: 30 percent of both men and women won’t experience chest pain, and men can have nausea, too. The symptom hypothesis doesn’t fully explain the different rates of diagnosis and survival.\u003c/p>\n\u003cp>Hayes suggested that part of the problem is that physicians and people in general are “still stuck with some confirmation bias about who gets a heart attack.”\u003c/p>\n\u003cp>The new study, conducted by three business school professors at the University of Minnesota, Washington University in St. Louis, and Harvard, started by looking at whether gender concordance between patients and the attending physicians in the emergency department influenced survival.\u003c/p>\n\u003cp>“There’s relatively deep streams of literature in economics, political science, and sociology that suggest when advocates differ from the people they advocate for, there are often penalties,” said lead author Brad Greenwood of Minnesota’s Carlson School of Management.\u003c/p>\n\u003cp>“Penalties” are business-speak that, when applied in an emergency room, refer to mortality. And “advocacy,” in this case, translates to physician care.\u003c/p>\n\u003cp>Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, Greenwood and his colleagues found that when the gender of the patient matched the gender of the physician, both male and female patients were more likely to survive.\u003c/p>\n\u003cp>Looking more closely at the data revealed that female patients treated by male physicians were the least likely to survive a heart attack.\u003c/p>\n\u003cp>The magnitude of the difference impressed Greenwood, but he was not surprised by its existence.\u003c/p>\n\u003cp>Greenwood and his co-authors took their research one step further, studying not only the physicians’ gender, but their environment. They found that patients were more likely to survive heart attacks when treated in emergency departments with higher percentages of female physicians.\u003c/p>\n\u003cp>Greenwood and co-author Seth Carnahan, of Washington University, were both hesitant to speculate about the reasons underlying their observations. Carnahan — who compared the patient-physician relationship to an employee-customer one — acknowledged that, as business professors, he and his colleagues lack the perspective of clinicians.\u003c/p>\n\u003cp>“We have expertise in analyzing data like this and thinking about organizational problems, but we don’t have the firsthand experience and knowledge that doctors have,” he said.\u003c/p>\n\u003cp>Hayes said their statistical analysis went beyond what most doctors could even “conceptualize,” but she and Bertakis expressed some concern over the study’s methods and conclusions. The data, now eight years old, might miss the impact of recent efforts to educate physicians and the public about gender differences in cardiovascular disease.\u003c/p>\n\u003cp>Both physicians also noted that the attending doctor used in the data analysis was likely the physician that discharged the patient — or signed their death certificate — which might not be the same doctor who treated the patient in the emergency room.\u003c/p>\n\u003cp>Bertakis took issue with the the study’s recommendation that one way to improve outcomes would be to increase the number of female physicians in the emergency department.\u003c/p>\n\u003cp>“These approaches are not likely to be feasible,” she said. Instead, she would focus on continuing to improve the curriculum in medical schools and in residency programs to teach physicians about gender differences — both at the patient and physician level — in cardiovascular care.\u003c/p>\n\u003cp>Hayes would like future research to focus on understanding why male physicians who work among more female doctors have better patient survival rates. “Where’s the education coming from? Is it in the hallways and at the watercooler?” she asked. “Or are there policy changes and practice changes?”\u003c/p>\n\u003cp>The new study is a launchpad to address these questions, she said: “Understanding differences in how we need to care for men and women — particularly with heart disease, but for many other conditions — is something we should all be teaching our medical students, and learning, and incorporating in our daily practice.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/06/heart-attacks-women-female-doctors/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Calls to Suicide Prevention Lifeline Surge Amid Under-Resourced Centers",
"title": "Calls to Suicide Prevention Lifeline Surge Amid Under-Resourced Centers",
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"content": "\u003cp>On the day of Anthony Bourdain’s death by suicide, calls to Community Crisis Services, Inc. (CCSI), a crisis center that answers calls to the National Suicide Prevention Lifeline, went up 500 percent. Across the country, counselors scrambled to field the spike in calls. Tim Jansen, the center’s executive director, brought in extra staff and answered calls himself. It wasn’t enough.\u003c/p>\n\u003cp>In the half hour it took Jansen to drive home, he heard the Lifeline number announced seven times on the radio. He checked his phone, watching as calls at the center queued up, knowing that after a long day, he “wasn’t in the mental place to be able to dial in and help them.”\u003c/p>\n\u003cp>On July 23, the House passed the National Suicide Hotline Improvement Act, which seeks to evaluate the effectiveness of the Lifeline and the feasibility of implementing a 3-digit dialing code like 911, a number that could be easier to remember than the current 10-digit number. But some local crisis center directors that field Lifeline calls and advocates say this could place more pressure on an overwhelmed and underfunded network.\u003c/p>\n\u003cp>Now, the bill sits on President Donald Trump’s desk, awaiting action.\u003c/p>\n\u003cp>Already, calls to the Lifeline are on the rise. Over the next four years, the Lifeline expects 12 million calls, the same number of calls it previously received for the 12-year period between 2005 and 2017.\u003c/p>\n\u003cfigure id=\"attachment_1928764\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928764\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/20180802_175639-1-1200x900-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Community Crisis Services, Inc. in Hyattsville, Maryland, is a backup center for the National Suicide Prevention Lifeline.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Local Crisis Centers on the Front Lines\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>CCSI is housed in an unassuming, one-story orange brick and glass building. Tucked behind slightly overgrown, dark green shrubbery at the end of a peaceful residential block in Hyattsville, Maryland, CCSI acts as one of more than 150 local crisis centers across the country that answers calls from the Lifeline.\u003c/p>\n\u003cp>The building’s quiet exterior belies the activity inside. In the main “bullpen,” as Jansen calls it, overlapping conversations from counselors fill the room as they type rapidly, and with a quiet urgency, into call reports on their dual-monitor desktop computers. Occasionally, a single voice rises above the others, punctuating the regulated hum and rhythm of the room.\u003c/p>\n\u003cp>“You know, somebody who’s never been in that position, somebody who’s never struggled with their mental health might not be able to understand when you say ‘I’m frustrated and I know I’m taking it out on you, but it’s not your fault,’” a counselor says.\u003c/p>\n\u003cfigure id=\"attachment_1928763\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928763\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/20180802_162115-1-1200x900-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Counselors answer calls at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>Colorful cork boards refer to homeless shelters and bear prominently displayed phone numbers for social services. A plastic Mickey Mouse phone and an early 20th century rotary wall phone decorate a window that looks out onto the side of the tidy, gray stone house next to the center.\u003c/p>\n\u003cp>A counselor sits at her desk, recommending to a caller ways to cope in moments of crisis: snapping a rubber band, drawing on your legs, listening to music. She shares her own struggles with anxiety. “If I’m out in a public space, and I just get overwhelmed, I just kind of find somewhere I can sit down and write.”\u003c/p>\n\u003cp>Sometimes ripping up that writing and throwing it away can serve as “another release of ‘this is me throwing away my anxieties’ or those inspirational things you hear all the time,” she tells the caller with a chuckle.\u003c/p>\n\u003cp>Another counselor starting her shift places her Frappuccino on her desk, puts on a bright pink headset, and begins talking to a caller. “It’s okay to struggle, you’re human,” she says.\u003c/p>\n\u003cp>Counselors at CCSI normally answer around 40-50 calls per shift. Most shifts are eight hours.\u003c/p>\n\u003cp>The camaraderie of the room is palpable. Jansen, who has trained people in crisis intervention for 20 years, circles his staff at work, chatting with one counselor about her upcoming trip to Las Vegas and listening to calls. “It’s so awesome to hear my training words come out of people’s mouths,” he says.\u003c/p>\n\u003cfigure id=\"attachment_1928762\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928762\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9433-2-1200x783-800x522.jpg\" alt=\"\" width=\"800\" height=\"522\">\u003cfigcaption class=\"wp-caption-text\">Counselors at Community Crisis Services, Inc. take calls.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Current Funding and Lifeline calls\u003c/strong>\u003c/p>\n\u003cp>Some centers, like CCSI, are “national backup centers,” which are meant to handle their local volume of calls along with overflow calls from other centers across the country.\u003c/p>\n\u003cp>The Lifeline receives around $5.3 million a year in an infrastructure grant from the Substance Abuse and Mental Health Services Association (SAMHSA). From that, crisis centers receive an annual stipend of $1,500, and an extra $1,000 if they collect data on veteran calls to their center. Backup centers receive $17,500 quarterly plus $10 for every call over 3,000 they answer through the backup routing system.\u003c/p>\n\u003cp>According to James Wright, the Lifeline project officer for SAMHSA, this amount is mainly meant to offset the costs of accreditation, a process required for operation within the Lifeline network. It assesses if the center is achieving base level practices and standards in their services.\u003c/p>\n\u003cp>The stipend is “more of a gesture,” said Wright. It’s not intended to serve as direct support for centers’ work. “I’ve never heard a single crisis center report back to me and say that $1,500 a month supported the calls being answered,” said Wright.\u003c/p>\n\u003cfigure id=\"attachment_1928761\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928761\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9397-1-1200x674-800x449.jpg\" alt=\"\" width=\"800\" height=\"449\">\u003cfigcaption class=\"wp-caption-text\">Suicide prevention information appears on the fridge at Community Crisis Services, Inc.\u003c/figcaption>\u003c/figure>\n\u003cp>To accommodate the rising call volume, Dr. Draper, the director of the Lifeline, says local crisis centers need more resources–and that a lack of resources contributes to centers leaving the network or shutting down. From 2008-2012, nine centers dropped out of the network and from 2013-2017, 23 centers dropped out. Just this year, three centers shut down.\u003c/p>\n\u003cp>Remaining centers do what they can to stay functioning. This often means taking on extra contracts, like running local crisis lines, to support their suicide prevention work.\u003c/p>\n\u003cp>Crisis Call Center, a Lifeline backup center in Nevada, operates a sexual assault support service program and a substance abuse hotline. They also provide child protective service reports and take elder protective service reports after hours. Rachelle Pellissier, its executive director, says they have to “cobble together” these different funding streams to offset the costs of the suicide prevention calls they take.\u003c/p>\n\u003cp>“We really need about $1.1 million to run this organization,” said Pellissier.\u003c/p>\n\u003cp>Centers like Provident in Missouri rely on their local United Way. The money they receive from the Lifeline, even as a backup center with more support, “pays for maybe two salaries of my 15 person team,” said Jane Smith, the director of life crisis services for Provident. “We’re a money-losing entity at Provident.”\u003c/p>\n\u003cp>If backup centers are unable to take a call, that call is routed from one backup center to the next, until a counselor can talk. “All the calls can be answered. The only question is, how long do people wait?” Draper said.\u003c/p>\n\u003cfigure id=\"attachment_1928760\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928760\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/20180802_161929-1-1200x949-800x633.jpg\" alt=\"\" width=\"800\" height=\"633\">\u003cfigcaption class=\"wp-caption-text\">Office supplies sit in an empty room, which will soon become additional space for counselors, at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>For January to March of 2018, the average wait time for a caller after the Lifeline’s automated greeting was 36 seconds at a local center and 88 seconds at a backup center. “It’s simply a supply and demand challenge,” Draper said.\u003c/p>\n\u003cp>\u003cstrong>Distance, Low Pay, and Pressure\u003c/strong>\u003c/p>\n\u003cp>Answering calls from all across the nation at backup centers can create barriers to getting help. With no local centers serving Minnesota, for example, all callers in the state are routed to an out-of-state backup center. It’s a solution that both increases the call volume pressure on backup centers and makes it difficult for centers to connect callers to resources in their area.\u003c/p>\n\u003cp>At CCSI, a counselor asks, “Do you have any community centers in your area or anything like that?”\u003c/p>\n\u003cp>In an emergency, it’s often more difficult to initiate an “active rescue” for someone who may be at imminent risk of attempted suicide because of the lack of an established relationship between the center and the out-of-state law enforcement.\u003c/p>\n\u003cp>Sometimes, counselors get this response from police: “‘Well, if they’re going to do it they’re going to need to do it. We’ll hear about it on the news,’” said Jansen. He says those responses typically occur a couple of times a week.\u003c/p>\n\u003cp>The stress of the job and the pay can drive high turnover rates for counselors in some centers. Even taking a day off can make answering calls more difficult for other staff. Counselors often “feel concerned for their fellow staff members” when they’re out of the office because “they know the impact that them not being there is going to cause,” said Victoria Graham, chief program officer at Action in Community Through Service in Dumfries, Virginia.\u003c/p>\n\u003cp>Gene Dobrzynski, the assistant call center director at CCC, sees a direct link between lack of funding and staff turnover. He says with more funding, the center could hire more staff and counselors’ mentality of “I gotta be at my desk because there’s going to be another call coming in” could be eased. “They could get a little bit of relief and be able to walk away,” he said.\u003c/p>\n\u003cp>Low pay for counselors is also a function of funding woes. “Let’s be serious, we’re paying frontline staff $11-12 an hour to do this crisis intervention, this life-and-death work,” said Pellissier.\u003c/p>\n\u003cp>\u003cstrong>In Arizona, Adjusting to Increased Calls\u003c/strong>\u003c/p>\n\u003cp>Not all Lifeline centers feel the same strain: Crisis Response Network in Arizona, for example, receives Medicaid funding and other social service funding from the state.\u003c/p>\n\u003cp>Like other centers, they’ve also seen an increase in calls. In June of 2017, Crisis Response Network and La Frontera Empact, another Arizona-based crisis center, fielded around 2,800 Lifeline calls. This past June, it was more than 4,400 calls. Unlike many other centers, they were able to increase their staffing to adjust to the increase in calls. At the busiest part of its day, Crisis Response Network might have 30 people on the phones.\u003c/p>\n\u003cp>Crisis Response Network also has “compassion rooms” where staff can go “to decompress after a tough call,” said Alex Zavala, its chief experience officer. Ocean noises play in the background and staff are encouraged to take a break or meditate.\u003c/p>\n\u003cp>The difference between Crisis Response Network and Crisis Call Center is stark. At Crisis Call Center, they can’t afford to replace the constantly-used chairs in their office when they wear down or clean their bathrooms as much as they’d like.\u003c/p>\n\u003cp>The numbers reveal Crisis Response Network’s success. Based on numbers collected from June 2017 to June 2018, less than 1 percent of callers hang up or lose their call before a counselor answers them. The center attributes this to its “consistent and stable” funding that allows for effective staffing with changing call volume, said Sarah Schol, the senior director of contact center operations.\u003c/p>\n\u003cfigure id=\"attachment_1928759\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928759\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9315-1-1200x800-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">An award sits on a display case at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to solve unknowns in suicide prevention\u003cbr>\nThe circumstances of each call center are wide-ranging, and so are reactions to the National Suicide Hotline Improvement Act.\u003c/p>\n\u003cp>The leadership of several centers told the NewsHour Weekend that a 3-digit number for the Lifeline would probably allow people to more easily access the help that they need. But the accessibility is a double-edged sword for centers like Crisis Call Center–they want more callers to have access to the Lifeline, but “do not have enough capacity to take the increase in calls,” said Pellissier.\u003c/p>\n\u003cp>Draper says “it’s a fair presumption that [a 3-digit number] would increase calls, we just don’t know by how much.” But not everyone agrees that a 3-digit number would mean a greater volume of calls. Graham says that she couldn’t predict that, while Crisis Response Network believes an increase in call volume is possible, it doesn’t see a change to a 3-digit number impacting their day-to-day operations.\u003c/p>\n\u003cp>The bill’s lead House sponsor, Rep. Chris Stewart (R-UT), told the NewsHour Weekend that the legislation seeks to “increase awareness of resources and save lives,” and co-sponsor Rep. Eddie Bernice Johnson (D-TX) added that “ease” in access is critical. Sen. Joe Donnelly (D-IN), who co-sponsored the bill in the Senate, believes the legislation will examine if there’s a “simpler way” to “help in moments of crisis,” according to his office. Sen. Orrin Hatch (R-UT) did not respond to request for comment via email.\u003c/p>\n\u003cp>John Madigan, the Senior Vice President of Public Policy for the American Foundation for Suicide Prevention, said he hopes the bill’s study will answer “the million dollar question” of the current suicide prevention network’s reach and “holes” in the system.\u003c/p>\n\u003cfigure id=\"attachment_1928758\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928758\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9376-1-1200x765-800x510.jpg\" alt=\"\" width=\"800\" height=\"510\">\u003cfigcaption class=\"wp-caption-text\">Tim Jansen sits at his desk at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>Meanwhile, local crisis centers will continue to draw people who feel called to act and those who need to call.\u003c/p>\n\u003cp>Jansen entered the world of suicide prevention when he was 25 years old, after coming out as gay. He felt “fortunate” not to “lose people in [his] life.”\u003c/p>\n\u003cp>“I started thinking, ‘Gosh what happens when folks don’t have somebody?’” he said. Then, he saw an ad for crisis counselors. A few weeks later, he was a volunteer. Now, he’s spent 13 years as executive director at CCSI, which also takes backup calls for the Trevor Project, an organization that helps LGBTQ people in crisis.\u003c/p>\n\u003cp>Sometimes, on those calls, Jansen tells callers what it was like for him to come out–the fear he felt and the unexpected acceptance he found.\u003c/p>\n\u003cp>“I think when somebody needs to hear that you can actually come to the other side of it, hearing that somebody has done that can be powerful,” he said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>If you are having thoughts of suicide, go to SpeakingOfSuicide.com/resources or call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>On the day of Anthony Bourdain’s death by suicide, calls to Community Crisis Services, Inc. (CCSI), a crisis center that answers calls to the National Suicide Prevention Lifeline, went up 500 percent. Across the country, counselors scrambled to field the spike in calls. Tim Jansen, the center’s executive director, brought in extra staff and answered calls himself. It wasn’t enough.\u003c/p>\n\u003cp>In the half hour it took Jansen to drive home, he heard the Lifeline number announced seven times on the radio. He checked his phone, watching as calls at the center queued up, knowing that after a long day, he “wasn’t in the mental place to be able to dial in and help them.”\u003c/p>\n\u003cp>On July 23, the House passed the National Suicide Hotline Improvement Act, which seeks to evaluate the effectiveness of the Lifeline and the feasibility of implementing a 3-digit dialing code like 911, a number that could be easier to remember than the current 10-digit number. But some local crisis center directors that field Lifeline calls and advocates say this could place more pressure on an overwhelmed and underfunded network.\u003c/p>\n\u003cp>Now, the bill sits on President Donald Trump’s desk, awaiting action.\u003c/p>\n\u003cp>Already, calls to the Lifeline are on the rise. Over the next four years, the Lifeline expects 12 million calls, the same number of calls it previously received for the 12-year period between 2005 and 2017.\u003c/p>\n\u003cfigure id=\"attachment_1928764\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928764\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/20180802_175639-1-1200x900-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Community Crisis Services, Inc. in Hyattsville, Maryland, is a backup center for the National Suicide Prevention Lifeline.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Local Crisis Centers on the Front Lines\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>CCSI is housed in an unassuming, one-story orange brick and glass building. Tucked behind slightly overgrown, dark green shrubbery at the end of a peaceful residential block in Hyattsville, Maryland, CCSI acts as one of more than 150 local crisis centers across the country that answers calls from the Lifeline.\u003c/p>\n\u003cp>The building’s quiet exterior belies the activity inside. In the main “bullpen,” as Jansen calls it, overlapping conversations from counselors fill the room as they type rapidly, and with a quiet urgency, into call reports on their dual-monitor desktop computers. Occasionally, a single voice rises above the others, punctuating the regulated hum and rhythm of the room.\u003c/p>\n\u003cp>“You know, somebody who’s never been in that position, somebody who’s never struggled with their mental health might not be able to understand when you say ‘I’m frustrated and I know I’m taking it out on you, but it’s not your fault,’” a counselor says.\u003c/p>\n\u003cfigure id=\"attachment_1928763\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928763\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/20180802_162115-1-1200x900-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Counselors answer calls at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>Colorful cork boards refer to homeless shelters and bear prominently displayed phone numbers for social services. A plastic Mickey Mouse phone and an early 20th century rotary wall phone decorate a window that looks out onto the side of the tidy, gray stone house next to the center.\u003c/p>\n\u003cp>A counselor sits at her desk, recommending to a caller ways to cope in moments of crisis: snapping a rubber band, drawing on your legs, listening to music. She shares her own struggles with anxiety. “If I’m out in a public space, and I just get overwhelmed, I just kind of find somewhere I can sit down and write.”\u003c/p>\n\u003cp>Sometimes ripping up that writing and throwing it away can serve as “another release of ‘this is me throwing away my anxieties’ or those inspirational things you hear all the time,” she tells the caller with a chuckle.\u003c/p>\n\u003cp>Another counselor starting her shift places her Frappuccino on her desk, puts on a bright pink headset, and begins talking to a caller. “It’s okay to struggle, you’re human,” she says.\u003c/p>\n\u003cp>Counselors at CCSI normally answer around 40-50 calls per shift. Most shifts are eight hours.\u003c/p>\n\u003cp>The camaraderie of the room is palpable. Jansen, who has trained people in crisis intervention for 20 years, circles his staff at work, chatting with one counselor about her upcoming trip to Las Vegas and listening to calls. “It’s so awesome to hear my training words come out of people’s mouths,” he says.\u003c/p>\n\u003cfigure id=\"attachment_1928762\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928762\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9433-2-1200x783-800x522.jpg\" alt=\"\" width=\"800\" height=\"522\">\u003cfigcaption class=\"wp-caption-text\">Counselors at Community Crisis Services, Inc. take calls.\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Current Funding and Lifeline calls\u003c/strong>\u003c/p>\n\u003cp>Some centers, like CCSI, are “national backup centers,” which are meant to handle their local volume of calls along with overflow calls from other centers across the country.\u003c/p>\n\u003cp>The Lifeline receives around $5.3 million a year in an infrastructure grant from the Substance Abuse and Mental Health Services Association (SAMHSA). From that, crisis centers receive an annual stipend of $1,500, and an extra $1,000 if they collect data on veteran calls to their center. Backup centers receive $17,500 quarterly plus $10 for every call over 3,000 they answer through the backup routing system.\u003c/p>\n\u003cp>According to James Wright, the Lifeline project officer for SAMHSA, this amount is mainly meant to offset the costs of accreditation, a process required for operation within the Lifeline network. It assesses if the center is achieving base level practices and standards in their services.\u003c/p>\n\u003cp>The stipend is “more of a gesture,” said Wright. It’s not intended to serve as direct support for centers’ work. “I’ve never heard a single crisis center report back to me and say that $1,500 a month supported the calls being answered,” said Wright.\u003c/p>\n\u003cfigure id=\"attachment_1928761\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928761\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9397-1-1200x674-800x449.jpg\" alt=\"\" width=\"800\" height=\"449\">\u003cfigcaption class=\"wp-caption-text\">Suicide prevention information appears on the fridge at Community Crisis Services, Inc.\u003c/figcaption>\u003c/figure>\n\u003cp>To accommodate the rising call volume, Dr. Draper, the director of the Lifeline, says local crisis centers need more resources–and that a lack of resources contributes to centers leaving the network or shutting down. From 2008-2012, nine centers dropped out of the network and from 2013-2017, 23 centers dropped out. Just this year, three centers shut down.\u003c/p>\n\u003cp>Remaining centers do what they can to stay functioning. This often means taking on extra contracts, like running local crisis lines, to support their suicide prevention work.\u003c/p>\n\u003cp>Crisis Call Center, a Lifeline backup center in Nevada, operates a sexual assault support service program and a substance abuse hotline. They also provide child protective service reports and take elder protective service reports after hours. Rachelle Pellissier, its executive director, says they have to “cobble together” these different funding streams to offset the costs of the suicide prevention calls they take.\u003c/p>\n\u003cp>“We really need about $1.1 million to run this organization,” said Pellissier.\u003c/p>\n\u003cp>Centers like Provident in Missouri rely on their local United Way. The money they receive from the Lifeline, even as a backup center with more support, “pays for maybe two salaries of my 15 person team,” said Jane Smith, the director of life crisis services for Provident. “We’re a money-losing entity at Provident.”\u003c/p>\n\u003cp>If backup centers are unable to take a call, that call is routed from one backup center to the next, until a counselor can talk. “All the calls can be answered. The only question is, how long do people wait?” Draper said.\u003c/p>\n\u003cfigure id=\"attachment_1928760\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928760\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/20180802_161929-1-1200x949-800x633.jpg\" alt=\"\" width=\"800\" height=\"633\">\u003cfigcaption class=\"wp-caption-text\">Office supplies sit in an empty room, which will soon become additional space for counselors, at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>For January to March of 2018, the average wait time for a caller after the Lifeline’s automated greeting was 36 seconds at a local center and 88 seconds at a backup center. “It’s simply a supply and demand challenge,” Draper said.\u003c/p>\n\u003cp>\u003cstrong>Distance, Low Pay, and Pressure\u003c/strong>\u003c/p>\n\u003cp>Answering calls from all across the nation at backup centers can create barriers to getting help. With no local centers serving Minnesota, for example, all callers in the state are routed to an out-of-state backup center. It’s a solution that both increases the call volume pressure on backup centers and makes it difficult for centers to connect callers to resources in their area.\u003c/p>\n\u003cp>At CCSI, a counselor asks, “Do you have any community centers in your area or anything like that?”\u003c/p>\n\u003cp>In an emergency, it’s often more difficult to initiate an “active rescue” for someone who may be at imminent risk of attempted suicide because of the lack of an established relationship between the center and the out-of-state law enforcement.\u003c/p>\n\u003cp>Sometimes, counselors get this response from police: “‘Well, if they’re going to do it they’re going to need to do it. We’ll hear about it on the news,’” said Jansen. He says those responses typically occur a couple of times a week.\u003c/p>\n\u003cp>The stress of the job and the pay can drive high turnover rates for counselors in some centers. Even taking a day off can make answering calls more difficult for other staff. Counselors often “feel concerned for their fellow staff members” when they’re out of the office because “they know the impact that them not being there is going to cause,” said Victoria Graham, chief program officer at Action in Community Through Service in Dumfries, Virginia.\u003c/p>\n\u003cp>Gene Dobrzynski, the assistant call center director at CCC, sees a direct link between lack of funding and staff turnover. He says with more funding, the center could hire more staff and counselors’ mentality of “I gotta be at my desk because there’s going to be another call coming in” could be eased. “They could get a little bit of relief and be able to walk away,” he said.\u003c/p>\n\u003cp>Low pay for counselors is also a function of funding woes. “Let’s be serious, we’re paying frontline staff $11-12 an hour to do this crisis intervention, this life-and-death work,” said Pellissier.\u003c/p>\n\u003cp>\u003cstrong>In Arizona, Adjusting to Increased Calls\u003c/strong>\u003c/p>\n\u003cp>Not all Lifeline centers feel the same strain: Crisis Response Network in Arizona, for example, receives Medicaid funding and other social service funding from the state.\u003c/p>\n\u003cp>Like other centers, they’ve also seen an increase in calls. In June of 2017, Crisis Response Network and La Frontera Empact, another Arizona-based crisis center, fielded around 2,800 Lifeline calls. This past June, it was more than 4,400 calls. Unlike many other centers, they were able to increase their staffing to adjust to the increase in calls. At the busiest part of its day, Crisis Response Network might have 30 people on the phones.\u003c/p>\n\u003cp>Crisis Response Network also has “compassion rooms” where staff can go “to decompress after a tough call,” said Alex Zavala, its chief experience officer. Ocean noises play in the background and staff are encouraged to take a break or meditate.\u003c/p>\n\u003cp>The difference between Crisis Response Network and Crisis Call Center is stark. At Crisis Call Center, they can’t afford to replace the constantly-used chairs in their office when they wear down or clean their bathrooms as much as they’d like.\u003c/p>\n\u003cp>The numbers reveal Crisis Response Network’s success. Based on numbers collected from June 2017 to June 2018, less than 1 percent of callers hang up or lose their call before a counselor answers them. The center attributes this to its “consistent and stable” funding that allows for effective staffing with changing call volume, said Sarah Schol, the senior director of contact center operations.\u003c/p>\n\u003cfigure id=\"attachment_1928759\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928759\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9315-1-1200x800-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\">\u003cfigcaption class=\"wp-caption-text\">An award sits on a display case at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>Seeking to solve unknowns in suicide prevention\u003cbr>\nThe circumstances of each call center are wide-ranging, and so are reactions to the National Suicide Hotline Improvement Act.\u003c/p>\n\u003cp>The leadership of several centers told the NewsHour Weekend that a 3-digit number for the Lifeline would probably allow people to more easily access the help that they need. But the accessibility is a double-edged sword for centers like Crisis Call Center–they want more callers to have access to the Lifeline, but “do not have enough capacity to take the increase in calls,” said Pellissier.\u003c/p>\n\u003cp>Draper says “it’s a fair presumption that [a 3-digit number] would increase calls, we just don’t know by how much.” But not everyone agrees that a 3-digit number would mean a greater volume of calls. Graham says that she couldn’t predict that, while Crisis Response Network believes an increase in call volume is possible, it doesn’t see a change to a 3-digit number impacting their day-to-day operations.\u003c/p>\n\u003cp>The bill’s lead House sponsor, Rep. Chris Stewart (R-UT), told the NewsHour Weekend that the legislation seeks to “increase awareness of resources and save lives,” and co-sponsor Rep. Eddie Bernice Johnson (D-TX) added that “ease” in access is critical. Sen. Joe Donnelly (D-IN), who co-sponsored the bill in the Senate, believes the legislation will examine if there’s a “simpler way” to “help in moments of crisis,” according to his office. Sen. Orrin Hatch (R-UT) did not respond to request for comment via email.\u003c/p>\n\u003cp>John Madigan, the Senior Vice President of Public Policy for the American Foundation for Suicide Prevention, said he hopes the bill’s study will answer “the million dollar question” of the current suicide prevention network’s reach and “holes” in the system.\u003c/p>\n\u003cfigure id=\"attachment_1928758\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-1928758\" src=\"https://ww2.kqed.org/science/wp-content/uploads/sites/35/2018/08/IMG_9376-1-1200x765-800x510.jpg\" alt=\"\" width=\"800\" height=\"510\">\u003cfigcaption class=\"wp-caption-text\">Tim Jansen sits at his desk at Community Crisis Services, Inc. in Hyattsville, Maryland.\u003c/figcaption>\u003c/figure>\n\u003cp>Meanwhile, local crisis centers will continue to draw people who feel called to act and those who need to call.\u003c/p>\n\u003cp>Jansen entered the world of suicide prevention when he was 25 years old, after coming out as gay. He felt “fortunate” not to “lose people in [his] life.”\u003c/p>\n\u003cp>“I started thinking, ‘Gosh what happens when folks don’t have somebody?’” he said. Then, he saw an ad for crisis counselors. A few weeks later, he was a volunteer. Now, he’s spent 13 years as executive director at CCSI, which also takes backup calls for the Trevor Project, an organization that helps LGBTQ people in crisis.\u003c/p>\n\u003cp>Sometimes, on those calls, Jansen tells callers what it was like for him to come out–the fear he felt and the unexpected acceptance he found.\u003c/p>\n\u003cp>“I think when somebody needs to hear that you can actually come to the other side of it, hearing that somebody has done that can be powerful,” he said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>If you are having thoughts of suicide, go to SpeakingOfSuicide.com/resources or call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK).\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "What Makes A Leader?",
"title": "What Makes A Leader?",
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"content": "\u003cp>Leaders can have many different styles — just compare President Donald Trump to \u003ca href=\"https://www.malala.org/malalas-story\" target=\"_blank\" rel=\"noopener\">Malala Yousafzai\u003c/a> to your boss or the coach of your kid's soccer team.\u003c/p>\n\u003cp>But a \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aat0036\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Thursday suggests that people who end up in leadership roles of various sorts all share one key trait: Leaders make decisions for a group in the same way that they make decisions for themselves. They don't change their decision-making behavior, even when other people's welfare is at stake.\u003c/p>\n\u003cp>That may come as a bit of surprise, given that most lists of key leadership qualities focus on things like charisma and communication skills.\u003c/p>\n\u003cp>\"Previous research has mostly focused on these kinds of either personality characteristics of a leader, or situations where individuals are likely to lead,\" says \u003ca href=\"https://www.econ.uzh.ch/en/people/researchers/edelson.html\" target=\"_blank\" rel=\"noopener\">Micah Edelson\u003c/a>, a neuroscientist at the University of Zurich in Switzerland. \"But we don't know much about the cognitive or neurobiological process that is happening when you are choosing to lead or follow — when you're faced with this choice to lead or follow.\"\u003c/p>\n\u003cp>He notes that the decisions of leaders can affect the lives of many others. \"It's not always that easy to make such a choice, and it's something that could be even a little bit aversive to you, to make a choice that impacts other people,\" says Edelson. \"And there are some people that seem to be able to do it; some people don't. So we were interested in looking at that.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>He and his colleagues had volunteers come to the lab, and gave them questionnaires that are widely used to predict whether someone is likely to be in a position of leadership. They also collected information about people's real-world leadership experience, such as what rank they'd achieved in the military (which is compulsory for men in Switzerland) or in the popular Swiss Scouts organization.\u003c/p>\n\u003cp>Then they put the participants into small groups and had them play a series of games in which individuals had to make choices about whether to take a risky action to get a reward.\u003c/p>\n\u003cp>\"These are choices about uncertain gambles that have some probability of success and potential gains and losses,\" Edelson explains.\u003c/p>\n\u003cp>The player could choose to either make the choice alone, or defer the decision to a majority vote.\u003c/p>\n\u003cp>The games were played under two conditions: Sometimes the decision affected only the individual player's winnings and other times the decision affected what the entire group received.\u003c/p>\n\u003cp>What the researchers found is that people in general tended to avoid taking responsibility for what happens to others; deferral rates were the highest when decisions affected other people's pocketbooks.\u003c/p>\n\u003cp>But the people who changed their decision-making behavior the least were the ones who generally served as leaders in the real-world and scored high on leadership questionnaires. Unlike others, they did not require more certainty before being ready to personally make a decision that would affect the whole group.\u003c/p>\n\u003cp>\"On average, people tend to increase the certainty threshold when the choices affect the entire group. But higher-scoring leaders just keep their thresholds almost constant,\" says Edelson, who says preliminary work using MRI brain scanning supports the idea that leaders and followers differ in how their brains process information about gains, losses, and risk in the context of thinking about others.\u003c/p>\n\u003cp>Other neuroscientists say the work, published in the journal \u003cem>Science\u003c/em>, is fascinating.\u003c/p>\n\u003cp>\"It seems a very reasonable finding,\" says \u003ca href=\"http://affectivebrain.com/?page_id=161\" target=\"_blank\" rel=\"noopener\">Tali Sharot\u003c/a>, a cognitive neuroscientist at University College London. \"It works with our intuition, but in the same way it's not something that you'd necessarily think about that distinguishes leadership.\"\u003c/p>\n\u003cp>Sharot cautions that it's not clear whether this decision-making behavior is what led people to their leadership position, or if they've developed it as a result of real-world leadership experience.\u003c/p>\n\u003cp>And this study doesn't say anything about who ends up being a \"good\" leader, either.\u003c/p>\n\u003cp>But Sharot says the researchers have identified something about leadership that can hold true regardless of a leader's style.\u003c/p>\n\u003cp>\"You can have authoritarian leaders who like to have the ultimate control,\" she says. \"You can have democratic leaders who want to lead according to the will of the people. You have leaders who are risk-takers, leaders who are risk-adverse and conservative and so on.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But what's really interesting about this work, she says, is that these different types of leaders' decision-making behavior stays the same regardless of whether the outcome affects only themselves or other people. \"What this paper shows is that all these types of individuals, all these types of leaders, have something in common.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What+Makes+A+Leader%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Leaders can have many different styles — just compare President Donald Trump to \u003ca href=\"https://www.malala.org/malalas-story\" target=\"_blank\" rel=\"noopener\">Malala Yousafzai\u003c/a> to your boss or the coach of your kid's soccer team.\u003c/p>\n\u003cp>But a \u003ca href=\"http://science.sciencemag.org/cgi/doi/10.1126/science.aat0036\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Thursday suggests that people who end up in leadership roles of various sorts all share one key trait: Leaders make decisions for a group in the same way that they make decisions for themselves. They don't change their decision-making behavior, even when other people's welfare is at stake.\u003c/p>\n\u003cp>That may come as a bit of surprise, given that most lists of key leadership qualities focus on things like charisma and communication skills.\u003c/p>\n\u003cp>\"Previous research has mostly focused on these kinds of either personality characteristics of a leader, or situations where individuals are likely to lead,\" says \u003ca href=\"https://www.econ.uzh.ch/en/people/researchers/edelson.html\" target=\"_blank\" rel=\"noopener\">Micah Edelson\u003c/a>, a neuroscientist at the University of Zurich in Switzerland. \"But we don't know much about the cognitive or neurobiological process that is happening when you are choosing to lead or follow — when you're faced with this choice to lead or follow.\"\u003c/p>\n\u003cp>He notes that the decisions of leaders can affect the lives of many others. \"It's not always that easy to make such a choice, and it's something that could be even a little bit aversive to you, to make a choice that impacts other people,\" says Edelson. \"And there are some people that seem to be able to do it; some people don't. So we were interested in looking at that.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>He and his colleagues had volunteers come to the lab, and gave them questionnaires that are widely used to predict whether someone is likely to be in a position of leadership. They also collected information about people's real-world leadership experience, such as what rank they'd achieved in the military (which is compulsory for men in Switzerland) or in the popular Swiss Scouts organization.\u003c/p>\n\u003cp>Then they put the participants into small groups and had them play a series of games in which individuals had to make choices about whether to take a risky action to get a reward.\u003c/p>\n\u003cp>\"These are choices about uncertain gambles that have some probability of success and potential gains and losses,\" Edelson explains.\u003c/p>\n\u003cp>The player could choose to either make the choice alone, or defer the decision to a majority vote.\u003c/p>\n\u003cp>The games were played under two conditions: Sometimes the decision affected only the individual player's winnings and other times the decision affected what the entire group received.\u003c/p>\n\u003cp>What the researchers found is that people in general tended to avoid taking responsibility for what happens to others; deferral rates were the highest when decisions affected other people's pocketbooks.\u003c/p>\n\u003cp>But the people who changed their decision-making behavior the least were the ones who generally served as leaders in the real-world and scored high on leadership questionnaires. Unlike others, they did not require more certainty before being ready to personally make a decision that would affect the whole group.\u003c/p>\n\u003cp>\"On average, people tend to increase the certainty threshold when the choices affect the entire group. But higher-scoring leaders just keep their thresholds almost constant,\" says Edelson, who says preliminary work using MRI brain scanning supports the idea that leaders and followers differ in how their brains process information about gains, losses, and risk in the context of thinking about others.\u003c/p>\n\u003cp>Other neuroscientists say the work, published in the journal \u003cem>Science\u003c/em>, is fascinating.\u003c/p>\n\u003cp>\"It seems a very reasonable finding,\" says \u003ca href=\"http://affectivebrain.com/?page_id=161\" target=\"_blank\" rel=\"noopener\">Tali Sharot\u003c/a>, a cognitive neuroscientist at University College London. \"It works with our intuition, but in the same way it's not something that you'd necessarily think about that distinguishes leadership.\"\u003c/p>\n\u003cp>Sharot cautions that it's not clear whether this decision-making behavior is what led people to their leadership position, or if they've developed it as a result of real-world leadership experience.\u003c/p>\n\u003cp>And this study doesn't say anything about who ends up being a \"good\" leader, either.\u003c/p>\n\u003cp>But Sharot says the researchers have identified something about leadership that can hold true regardless of a leader's style.\u003c/p>\n\u003cp>\"You can have authoritarian leaders who like to have the ultimate control,\" she says. \"You can have democratic leaders who want to lead according to the will of the people. You have leaders who are risk-takers, leaders who are risk-adverse and conservative and so on.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But what's really interesting about this work, she says, is that these different types of leaders' decision-making behavior stays the same regardless of whether the outcome affects only themselves or other people. \"What this paper shows is that all these types of individuals, all these types of leaders, have something in common.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=What+Makes+A+Leader%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Hundreds Claim Anti-Depressant Drug Triggered Compulsive Behavior",
"title": "Hundreds Claim Anti-Depressant Drug Triggered Compulsive Behavior",
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"content": "\u003cp>The casino didn’t always call out to Denise Miley.\u003c/p>\n\u003cp>At most, she and her husband, Brad, would drive over to the Mystic Lake Casino Hotel, just outside Minneapolis, a few times a year.[contextly_sidebar id=\"9sShWsOplz0H3vVUV8sySSc7G2bI7ViQ\"]\u003c/p>\n\u003cp>Then, in the fall of 2014, she got an itch to go more often. She’d ride her bike the 35 miles down to the casino and ask her husband to pick her up. It was just exercise, she’d tell him. Sometimes she would start driving to the office where she worked as an accountant. But when the freeway split off, she’d peel south and head to the slots.\u003c/p>\n\u003cp>“I didn’t have a word for it back then, but I was starting to feel compulsed,” she said. “I wanted to stay longer, and longer, and longer.”\u003c/p>\n\u003cp>She also had no idea her compulsion might be linked to a drug she began taking for depression and anxiety a few weeks before she began seriously gambling. By the time she stopped taking aripiprazole — an antipsychotic sold under the brand name Abilify — she’d stayed in the casino long enough to lose more than $150,000.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Miley, 41, filed a lawsuit in January 2016 against the drug makers Bristol-Myers Squibb and Otsuka, alleging the drug — one of the best-selling in the world — caused compulsive behavior. The suit contends that the companies knew or should have known it could create such urges, and didn’t adequately warn the thousands of people in the U.S. who use the medication each year.\u003c/p>\n\u003cp>Hundreds more people have since sued the companies, claiming that the drug caused them to gamble, eat, or have sex compulsively. And the Food and Drug Administration signaled its own concern in a 2016 \u003ca href=\"https://www.fda.gov/Drugs/DrugSafety/ucm498662.htm\" target=\"_blank\" rel=\"noopener\">safety warning\u003c/a>, saying that uncontrollable urges to gamble, binge eat, shop, and have sex \u003ca href=\"https://www.statnews.com/2016/05/03/abilify-gambling-sex-urges/\">had been reported\u003c/a> with use of the antipsychotic.\u003c/p>\n\u003cp>“We have people who have lost their retirement accounts, spent their children’s college funds, blown through a lifetime of savings,” said Gary Wilson, an attorney with Robins Kaplan, a firm representing some of the plaintiffs, including Miley.[contextly_sidebar id=\"WUrxs3xRbhUp0ARmCKpI7XmIsP1oVJc8\"]\u003c/p>\n\u003cp>Scientists haven’t figured out how, exactly, a drug might trigger compulsive behavior. Psychiatrists say that even if Abilify does have a role, it’s probably just part of the explanation, since millions of people take the drug without experiencing such problems.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Otsuka, which developed the drug, and Bristol-Myers Squibb, which marketed it jointly with Otsuka in the U.S., have denied the allegations. Bristol-Myers Squibb referred questions about Abilify to Otsuka, which said it could not comment on pending litigation.\u003c/p>\n\u003cp>The lawsuits have all been lumped together, and the case is presided over by Judge M. Casey Rodgers in the Northern District Court of Florida. The judge picked three bellwether lawsuits to go to trial in a bid to spur a resolution for the other cases, but those three were settled out of court earlier this year for an undisclosed amount.\u003c/p>\n\u003cp>Now, Rodgers has ordered the thousands of other plaintiffs and the drug makers to work out a framework for a global settlement by Sept. 1. At the same time, the court is working to pick a new group of cases to move to trial if a settlement can’t be reached.\u003c/p>\n\u003cp>\u003cstrong>Blockbuster Drug Spurs Safety Warning\u003c/strong>\u003c/p>\n\u003cp>The lawsuits are the latest chapter in the roller-coaster history of Abilify. It was approved by the FDA for schizophrenia in 2002. It’s since been approved for treating bipolar disorder, irritability associated with autistic disorder, Tourette’s syndrome, and major depressive disorder.\u003c/p>\n\u003cp>In 2007, Bristol-Myers Squibb agreed to pay more than $500 million to settle federal charges that it illegally marketed the drug to pediatric physicians and nursing homes. And in 2016, the company reached a $19.5 million settlement with 42 states and Washington, D.C., which accused the drug maker of illegally promoting Abilify to people with Alzheimer’s disease and other forms of dementia.[contextly_sidebar id=\"LnZfdPbBiZTyzqKBvnLrSW8u5Uoeh4mS\"]\u003c/p>\n\u003cp>But it hasn’t all been bad news. Aripiprazole remains one of the most-prescribed drugs on the market. And though it went generic in the U.S. in 2015, it continues to generate big sales. The brand-name version of the drug has raked in more than $51 billion worldwide since it was approved, according to \u003ca href=\"https://www.fiercepharma.com/pharma/from-old-behemoth-lipitor-to-new-king-humira-u-s-best-selling-drugs-over-25-years\" target=\"_blank\" rel=\"noopener\">IQVIA\u003c/a>, a health care analytics company.\u003c/p>\n\u003cp>And in 2017, the \u003ca href=\"https://www.statnews.com/2017/11/13/pill-sensor-fda-approval/\">FDA approved Abilify MyCite\u003c/a>, a version of the drug embedded with a sensor that can alert a patient’s physician or caregiver when its been ingested. It was the first approval of a so-called smart pill.\u003c/p>\n\u003cp>As the drug grew increasingly popular, reports kept cropping up that a small number of patients taking the drug had started gambling uncontrollably and experiencing other compulsive behaviors. Between November 2002 and May 2016 when the FDA issued its warning, there were 184 case reports linking the drug to impulse control problems in the medical literature and the FDA’s adverse event database, according to the agency.\u003c/p>\n\u003cp>The European Medicines Agency was the first regulator to issue a warning, in 2012, that Abilify had been linked to compulsive behavior. In 2015, Canadian drug regulators followed suit. Both required the drug makers to change the labeling, but “pathological gambling” wasn’t added as a potential adverse event to Abilify’s labeling information until January 2016. The FDA didn’t issue a warning to the public until May 2016.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>When asked about the reasons for the delay compared with warnings issued in other countries, an FDA spokesperson said, “Our safety signal folks are always reviewing the research.”[contextly_sidebar id=\"bXGbCmsnub7uybQC8z1CP2S7Wf4LFA0O\"]\u003c/p>\n\u003cp>Otsuka maintains that there weren’t any signs the drug might be linked to pathological gambling in its initial clinical trials. In one large study — testing Abilify paired with the antidepressant bupropion, the exact combination that Miley was prescribed — the drug makers reported there weren’t any unexpected adverse events.\u003c/p>\n\u003cp>But Miley said that wasn’t her experience.\u003c/p>\n\u003cp>\u003cstrong>The Itch to Gamble Grows\u003c/strong>\u003c/p>\n\u003cp>It never occurred to Miley that the drug might be to blame for her growing urge to gamble. She started taking the drug in September 2014, two years before the FDA went public with its warning.\u003c/p>\n\u003cp>Nor did it raise a red flag for her psychiatrist when Miley mentioned offhand at an appointment that fall that she’d been gambling more. She pitched it almost as a good thing.\u003c/p>\n\u003cp>“I remember saying, ‘We’re going to the casino a lot more. We’re doing it for an excursion — we’re getting out of the house,’” Miley said.\u003c/p>\n\u003cp>Miley went back to work, but only part time and with the option to work remotely from her home in Maple Grove, Minn. That meant she could go to the casino without anyone realizing where she’d gone. Some days, she told herself she didn’t have that much work to do. Other days, she just ended up there. Miley’s husband knew she sometimes went to the casino alone — but he had no idea how often. She didn’t always tell him. She hated how she felt: alone and ashamed.\u003c/p>\n\u003cp>“This whole thing snowballed extremely fast,” she said. Looking back, she felt so distant from herself — a dedicated mom to four kids who calls herself her family’s “rock.”\u003c/p>\n\u003cfigure id=\"attachment_356302\">\n\u003cfigure class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.statnews.com/wp-content/uploads/2018/08/IMG_4991.jpg\">\u003cimg src=\"https://www.statnews.com/wp-content/uploads/2018/08/IMG_4991-640x853.jpg\" alt=\"A photo of Denise Miley and her family.\" width=\"640\" height=\"853\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Denise Miley, her husband, Brad, and her four sons in 2017. Courtesy Denise Miley\u003c/figcaption>\u003c/figure>\n\u003c/figure>\n\u003cp>That fall, if her oldest son’s high school basketball games were anywhere near the casino, she’d dash over during halftime. She told her family she was popping out to do some quick Christmas shopping.\u003c/p>\n\u003cp>“I had the full intention of going back to his games,” she said. “But I’d sit there and keep gambling and gambling.”\u003c/p>\n\u003cp>More than once, she didn’t make it back and had to ask someone else to drive her son home. She was losing money, and growing more and more concerned. She finally told her husband she’d lost $10,000.[contextly_sidebar id=\"sRT777cXIzknFQmC7YTj1Ql8vPHYroHO\"]\u003c/p>\n\u003cp>She grew increasingly desperate to win the money back. “That was the first time I had considered or threatened suicide,” she said.\u003c/p>\n\u003cp>She found herself in the same brutal spiral that many of the other plaintiffs say they’ve found themselves in: They started taking Abilify to grapple with depression and other serious psychiatric conditions, but then started experiencing compulsions that crushed them with guilt and damaged their relationships — feeding their depression.\u003c/p>\n\u003cp>Miley’s husband convinced her to talk to a physician who specialized in gambling addiction and who recommended she enter inpatient treatment. But there weren’t any openings. So her husband took her car away, hoping to cut off her ability to get to the casino. She was supposed to take the bus to work.\u003c/p>\n\u003cp>“That’s what he thought I would do,” she said. She did take the bus to work. Then, she’d wait for the bank to open so she could take money out of their account and hop on the lightrail to the Mall of America, where she caught another bus to the casino. Sometimes she made it back to work, but other times she’d miss the bus. Once, she took a taxi and had it drop her off at the bus station, so it looked like she took the bus home from work.\u003c/p>\n\u003cp>“It wasn’t me. It just wasn’t me at all during those times,” she said.\u003c/p>\n\u003cp>That early interaction with her psychiatrist still haunts her. What if he had known about the possible link to Abilify? What if he had taken her off the drug, right then and there? Before the compulsion had stripped her of her savings. Before it had harmed her relationships with her family and friends. Before it had threatened her career. Before it had made her think about suicide.\u003c/p>\n\u003cp>“I just look back a lot and go, ‘How this could have been different,’” she said. “That’s where I get angry.”\u003c/p>\n\u003cp>\u003cstrong>Scientists stumped by a rare link\u003c/strong>\u003c/p>\n\u003cp>The science on the potential link between Abilify and impulse control problems is far from settled.\u003c/p>\n\u003cp>A quick biology lesson: Abilify is a partial dopamine agonist, which means it acts on dopamine, a neurotransmitter that ferries signals between neurons in the brain. It’s involved in multiple pathways, including one that regulates reward processing, pleasure, and motivation.\u003c/p>\n\u003cp>Both sides battled it out in court over the question of whether Abilify is capable of causing uncontrollable impulses, roping in a slew of experts to testify on either side. In March, Rodgers ruled “there’s a genuine dispute of material fact.” That is, it’s not clear what might be happening, but there isn’t enough evidence to prove it’s impossible.\u003c/p>\n\u003cp>Experts say the more critical question — and the bigger mystery — is why impulse-control problems might show up in just a small slice of the millions of patients who take Abilify each year.\u003c/p>\n\u003cp>“If it were as simple as it causing [the behavior], then the streets would be filled with impulsive people,” said Dr. Jon Grant, a psychiatrist who studies impulsive-compulsive disorders at University of Chicago.\u003c/p>\n\u003cp>Answering that question would take a significant amount of time and money, experts said. It would require a randomized trial and a ton of baseline data from brain scans, blood tests, and detailed patient histories to tease out what factors might be at play.\u003c/p>\n\u003cp>“If we stick to science, we have to say there’s a very interesting signal there that’s worth investigating,” said Dr. Timothy Fong, a psychiatrist who serves as the co-director of the University of California, Los Angeles, gambling studies program. “But to do that investigation will take a massive amount of resources,” he added.\u003c/p>\n\u003cp>There’s also a looming question of how responsible the drug might be for impulse control issues in some patients, if at all, Grant said. If it were shown that the drug causes impulse control problems in people with a certain genetic makeup, or people who were exposed to certain environmental factors, what percent of the blame could be placed on the drug?\u003c/p>\n\u003cp>“The legal system looks at it very differently,” Grant said.\u003c/p>\n\u003cp>One piece of evidence cited by the plaintiffs: When some patients started taking the drug, they experienced compulsive behavior. When they stopped the drug, it stopped. In some cases, when a patient started taking Abilify again, the impulses reportedly picked right back up where they’d left off. In its 2016 warning, the FDA noted that in the majority of case reports, the compulsions happened in people with no prior history of impulse control problems.\u003c/p>\n\u003cp>It’s also not the first drug linked to such problems. Similar issues have been seen with certain Parkinson’s drugs that also work on the dopamine system.\u003c/p>\n\u003cp>“The story [about Abilify] is not a story that’s unusual or surprising,” said Fong.\u003c/p>\n\u003cp>\u003cstrong>A promise to get help\u003c/strong>\u003c/p>\n\u003cp>One night in February 2015, Miley was supposed to be celebrating a close friend’s 60th birthday. It was the kind of neighborhood get-together she ordinarily gets excited about. But that morning, she took a familiar trip — down to work and on to the casino.\u003c/p>\n\u003cp>A week earlier, Miley had tried to take $50,000 out of her retirement account, but was told it was going to take several days to get the money. With the casino clawing at her brain, she instead took out a $50,000 loan. She was winning the day of the party — up so much that she thought she’d be able to pay off the debt.\u003c/p>\n\u003cp>She called her friend and told her she was working late. It was smack in the middle of tax season, so she thought it would be believable.\u003c/p>\n\u003cp>“I knew I shouldn’t be lying to people,” Miley said. “But the power that I felt like I needed to gamble was so much more than any of that.”\u003c/p>\n\u003cp>Her friend knew better. Miley was still ahead when the girlfriend showed up with a second friend at the casino at nearly 1 a.m. By that point, Miley had moved to high-stakes poker. One friend told Miley she looked like “a shell of [herself].”\u003c/p>\n\u003cp>She was embarrassed and distraught. She felt out of control, suicidal. They wanted to drive her to the nearest treatment facility, but Miley wanted to see her kids. So with a promise to return in the morning, they drove her home.\u003c/p>\n\u003cp>Miley’s husband, meanwhile, had realized she was gone and checked their bank accounts. To his shock, he realized she had been withdrawing their savings. He moved most of their money to an account Miley couldn’t access. When she arrived home, she made him the same promise: “In the morning, we’ll go.”\u003c/p>\n\u003cp>The next morning, Miley wrote her husband a note saying she was going to work to get everything in order before they went to the treatment facility. She did go to her office. Then she drained the little bit of money her husband had left in their bank account for making their house payment and paying other bills, and made a beeline for the casino.\u003c/p>\n\u003cp>Her husband was so desperate he considered calling the police, since she’d taken his car. He begged her to come home, and, eventually, Miley agreed. They sped straight toward the treatment facility, more than 100 miles from home.\u003c/p>\n\u003cp>“Shame. That’s all I felt, this whole time,” Miley recalled. “Shame at what I was putting my family through. Shame at what I was doing. Shame that I couldn’t control this.”\u003c/p>\n\u003cp>Shortly after she arrived, a provider pulled her off of Abilify and Xanax, which she had been prescribed in December for her growing anxiety, Miley said. She felt the urge to gamble vanish. It happened so fast, in fact, that she felt out of place in treatment.\u003c/p>\n\u003cp>“I could relate to the [other patients’] feelings of shame and embarrassment,” she said. “But I couldn’t relate to always struggling with wanting to go gambling.”\u003c/p>\n\u003cp>After 30 days in the inpatient facility, Miley went to a few Gamblers Anonymous meetings and saw a psychologist who specialized in treating gambling addiction, but ultimately stopped going. She just wasn’t experiencing the same urges anymore.\u003c/p>\n\u003cp>\u003cstrong>‘I could finally start healing’\u003c/strong>\u003c/p>\n\u003cp>In the 3 1/2 years since she stopped taking Abilify, Miley has settled back into a routine. She and her husband love watching their kids play sports and spending time at the lake with her parents and in-laws.\u003c/p>\n\u003cp>They’re trying to rebuild their lives. While she believes her compulsions were out of her control, that doesn’t change what she went through, or what she put her family through, she said. And it doesn’t return the money she gambled away. She took money out of her retirement account after treatment to pay off the bank loan.\u003c/p>\n\u003cp>She felt a little bit of the shame lift when the FDA warning came out in 2016. It no longer was just her pointing to Abilify, or even a law firm. Now, federal regulators were saying there might be a link.\u003c/p>\n\u003cp>“I could finally start healing,” she said. But it still feels raw. She still gets emotional talking about the toll it took on her family.\u003c/p>\n\u003cp>In late 2016, Miley had to go to the Hard Rock Hotel & Casino in Las Vegas for a work trip. She was absolutely dreading it. It dredged up old feelings that she’d tried to stuff away. She had to walk through the casino floor to get from her hotel room to the meeting rooms.\u003c/p>\n\u003cp>Not once, Miley said, did she feel like gambling.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/02/abilify-lawsuits-claim-drug-triggered-compulsive-gambling/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\u003csection>\u003c/section>\n\n",
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"excerpt": "Hundreds have sued drug makers, claiming that antipsychotic Ablify caused them to gamble, eat, or have sex compulsively.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The casino didn’t always call out to Denise Miley.\u003c/p>\n\u003cp>At most, she and her husband, Brad, would drive over to the Mystic Lake Casino Hotel, just outside Minneapolis, a few times a year.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Then, in the fall of 2014, she got an itch to go more often. She’d ride her bike the 35 miles down to the casino and ask her husband to pick her up. It was just exercise, she’d tell him. Sometimes she would start driving to the office where she worked as an accountant. But when the freeway split off, she’d peel south and head to the slots.\u003c/p>\n\u003cp>“I didn’t have a word for it back then, but I was starting to feel compulsed,” she said. “I wanted to stay longer, and longer, and longer.”\u003c/p>\n\u003cp>She also had no idea her compulsion might be linked to a drug she began taking for depression and anxiety a few weeks before she began seriously gambling. By the time she stopped taking aripiprazole — an antipsychotic sold under the brand name Abilify — she’d stayed in the casino long enough to lose more than $150,000.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Miley, 41, filed a lawsuit in January 2016 against the drug makers Bristol-Myers Squibb and Otsuka, alleging the drug — one of the best-selling in the world — caused compulsive behavior. The suit contends that the companies knew or should have known it could create such urges, and didn’t adequately warn the thousands of people in the U.S. who use the medication each year.\u003c/p>\n\u003cp>Hundreds more people have since sued the companies, claiming that the drug caused them to gamble, eat, or have sex compulsively. And the Food and Drug Administration signaled its own concern in a 2016 \u003ca href=\"https://www.fda.gov/Drugs/DrugSafety/ucm498662.htm\" target=\"_blank\" rel=\"noopener\">safety warning\u003c/a>, saying that uncontrollable urges to gamble, binge eat, shop, and have sex \u003ca href=\"https://www.statnews.com/2016/05/03/abilify-gambling-sex-urges/\">had been reported\u003c/a> with use of the antipsychotic.\u003c/p>\n\u003cp>“We have people who have lost their retirement accounts, spent their children’s college funds, blown through a lifetime of savings,” said Gary Wilson, an attorney with Robins Kaplan, a firm representing some of the plaintiffs, including Miley.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Scientists haven’t figured out how, exactly, a drug might trigger compulsive behavior. Psychiatrists say that even if Abilify does have a role, it’s probably just part of the explanation, since millions of people take the drug without experiencing such problems.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Otsuka, which developed the drug, and Bristol-Myers Squibb, which marketed it jointly with Otsuka in the U.S., have denied the allegations. Bristol-Myers Squibb referred questions about Abilify to Otsuka, which said it could not comment on pending litigation.\u003c/p>\n\u003cp>The lawsuits have all been lumped together, and the case is presided over by Judge M. Casey Rodgers in the Northern District Court of Florida. The judge picked three bellwether lawsuits to go to trial in a bid to spur a resolution for the other cases, but those three were settled out of court earlier this year for an undisclosed amount.\u003c/p>\n\u003cp>Now, Rodgers has ordered the thousands of other plaintiffs and the drug makers to work out a framework for a global settlement by Sept. 1. At the same time, the court is working to pick a new group of cases to move to trial if a settlement can’t be reached.\u003c/p>\n\u003cp>\u003cstrong>Blockbuster Drug Spurs Safety Warning\u003c/strong>\u003c/p>\n\u003cp>The lawsuits are the latest chapter in the roller-coaster history of Abilify. It was approved by the FDA for schizophrenia in 2002. It’s since been approved for treating bipolar disorder, irritability associated with autistic disorder, Tourette’s syndrome, and major depressive disorder.\u003c/p>\n\u003cp>In 2007, Bristol-Myers Squibb agreed to pay more than $500 million to settle federal charges that it illegally marketed the drug to pediatric physicians and nursing homes. And in 2016, the company reached a $19.5 million settlement with 42 states and Washington, D.C., which accused the drug maker of illegally promoting Abilify to people with Alzheimer’s disease and other forms of dementia.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But it hasn’t all been bad news. Aripiprazole remains one of the most-prescribed drugs on the market. And though it went generic in the U.S. in 2015, it continues to generate big sales. The brand-name version of the drug has raked in more than $51 billion worldwide since it was approved, according to \u003ca href=\"https://www.fiercepharma.com/pharma/from-old-behemoth-lipitor-to-new-king-humira-u-s-best-selling-drugs-over-25-years\" target=\"_blank\" rel=\"noopener\">IQVIA\u003c/a>, a health care analytics company.\u003c/p>\n\u003cp>And in 2017, the \u003ca href=\"https://www.statnews.com/2017/11/13/pill-sensor-fda-approval/\">FDA approved Abilify MyCite\u003c/a>, a version of the drug embedded with a sensor that can alert a patient’s physician or caregiver when its been ingested. It was the first approval of a so-called smart pill.\u003c/p>\n\u003cp>As the drug grew increasingly popular, reports kept cropping up that a small number of patients taking the drug had started gambling uncontrollably and experiencing other compulsive behaviors. Between November 2002 and May 2016 when the FDA issued its warning, there were 184 case reports linking the drug to impulse control problems in the medical literature and the FDA’s adverse event database, according to the agency.\u003c/p>\n\u003cp>The European Medicines Agency was the first regulator to issue a warning, in 2012, that Abilify had been linked to compulsive behavior. In 2015, Canadian drug regulators followed suit. Both required the drug makers to change the labeling, but “pathological gambling” wasn’t added as a potential adverse event to Abilify’s labeling information until January 2016. The FDA didn’t issue a warning to the public until May 2016.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>When asked about the reasons for the delay compared with warnings issued in other countries, an FDA spokesperson said, “Our safety signal folks are always reviewing the research.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Otsuka maintains that there weren’t any signs the drug might be linked to pathological gambling in its initial clinical trials. In one large study — testing Abilify paired with the antidepressant bupropion, the exact combination that Miley was prescribed — the drug makers reported there weren’t any unexpected adverse events.\u003c/p>\n\u003cp>But Miley said that wasn’t her experience.\u003c/p>\n\u003cp>\u003cstrong>The Itch to Gamble Grows\u003c/strong>\u003c/p>\n\u003cp>It never occurred to Miley that the drug might be to blame for her growing urge to gamble. She started taking the drug in September 2014, two years before the FDA went public with its warning.\u003c/p>\n\u003cp>Nor did it raise a red flag for her psychiatrist when Miley mentioned offhand at an appointment that fall that she’d been gambling more. She pitched it almost as a good thing.\u003c/p>\n\u003cp>“I remember saying, ‘We’re going to the casino a lot more. We’re doing it for an excursion — we’re getting out of the house,’” Miley said.\u003c/p>\n\u003cp>Miley went back to work, but only part time and with the option to work remotely from her home in Maple Grove, Minn. That meant she could go to the casino without anyone realizing where she’d gone. Some days, she told herself she didn’t have that much work to do. Other days, she just ended up there. Miley’s husband knew she sometimes went to the casino alone — but he had no idea how often. She didn’t always tell him. She hated how she felt: alone and ashamed.\u003c/p>\n\u003cp>“This whole thing snowballed extremely fast,” she said. Looking back, she felt so distant from herself — a dedicated mom to four kids who calls herself her family’s “rock.”\u003c/p>\n\u003cfigure id=\"attachment_356302\">\n\u003cfigure class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"https://www.statnews.com/wp-content/uploads/2018/08/IMG_4991.jpg\">\u003cimg src=\"https://www.statnews.com/wp-content/uploads/2018/08/IMG_4991-640x853.jpg\" alt=\"A photo of Denise Miley and her family.\" width=\"640\" height=\"853\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Denise Miley, her husband, Brad, and her four sons in 2017. Courtesy Denise Miley\u003c/figcaption>\u003c/figure>\n\u003c/figure>\n\u003cp>That fall, if her oldest son’s high school basketball games were anywhere near the casino, she’d dash over during halftime. She told her family she was popping out to do some quick Christmas shopping.\u003c/p>\n\u003cp>“I had the full intention of going back to his games,” she said. “But I’d sit there and keep gambling and gambling.”\u003c/p>\n\u003cp>More than once, she didn’t make it back and had to ask someone else to drive her son home. She was losing money, and growing more and more concerned. She finally told her husband she’d lost $10,000.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>She grew increasingly desperate to win the money back. “That was the first time I had considered or threatened suicide,” she said.\u003c/p>\n\u003cp>She found herself in the same brutal spiral that many of the other plaintiffs say they’ve found themselves in: They started taking Abilify to grapple with depression and other serious psychiatric conditions, but then started experiencing compulsions that crushed them with guilt and damaged their relationships — feeding their depression.\u003c/p>\n\u003cp>Miley’s husband convinced her to talk to a physician who specialized in gambling addiction and who recommended she enter inpatient treatment. But there weren’t any openings. So her husband took her car away, hoping to cut off her ability to get to the casino. She was supposed to take the bus to work.\u003c/p>\n\u003cp>“That’s what he thought I would do,” she said. She did take the bus to work. Then, she’d wait for the bank to open so she could take money out of their account and hop on the lightrail to the Mall of America, where she caught another bus to the casino. Sometimes she made it back to work, but other times she’d miss the bus. Once, she took a taxi and had it drop her off at the bus station, so it looked like she took the bus home from work.\u003c/p>\n\u003cp>“It wasn’t me. It just wasn’t me at all during those times,” she said.\u003c/p>\n\u003cp>That early interaction with her psychiatrist still haunts her. What if he had known about the possible link to Abilify? What if he had taken her off the drug, right then and there? Before the compulsion had stripped her of her savings. Before it had harmed her relationships with her family and friends. Before it had threatened her career. Before it had made her think about suicide.\u003c/p>\n\u003cp>“I just look back a lot and go, ‘How this could have been different,’” she said. “That’s where I get angry.”\u003c/p>\n\u003cp>\u003cstrong>Scientists stumped by a rare link\u003c/strong>\u003c/p>\n\u003cp>The science on the potential link between Abilify and impulse control problems is far from settled.\u003c/p>\n\u003cp>A quick biology lesson: Abilify is a partial dopamine agonist, which means it acts on dopamine, a neurotransmitter that ferries signals between neurons in the brain. It’s involved in multiple pathways, including one that regulates reward processing, pleasure, and motivation.\u003c/p>\n\u003cp>Both sides battled it out in court over the question of whether Abilify is capable of causing uncontrollable impulses, roping in a slew of experts to testify on either side. In March, Rodgers ruled “there’s a genuine dispute of material fact.” That is, it’s not clear what might be happening, but there isn’t enough evidence to prove it’s impossible.\u003c/p>\n\u003cp>Experts say the more critical question — and the bigger mystery — is why impulse-control problems might show up in just a small slice of the millions of patients who take Abilify each year.\u003c/p>\n\u003cp>“If it were as simple as it causing [the behavior], then the streets would be filled with impulsive people,” said Dr. Jon Grant, a psychiatrist who studies impulsive-compulsive disorders at University of Chicago.\u003c/p>\n\u003cp>Answering that question would take a significant amount of time and money, experts said. It would require a randomized trial and a ton of baseline data from brain scans, blood tests, and detailed patient histories to tease out what factors might be at play.\u003c/p>\n\u003cp>“If we stick to science, we have to say there’s a very interesting signal there that’s worth investigating,” said Dr. Timothy Fong, a psychiatrist who serves as the co-director of the University of California, Los Angeles, gambling studies program. “But to do that investigation will take a massive amount of resources,” he added.\u003c/p>\n\u003cp>There’s also a looming question of how responsible the drug might be for impulse control issues in some patients, if at all, Grant said. If it were shown that the drug causes impulse control problems in people with a certain genetic makeup, or people who were exposed to certain environmental factors, what percent of the blame could be placed on the drug?\u003c/p>\n\u003cp>“The legal system looks at it very differently,” Grant said.\u003c/p>\n\u003cp>One piece of evidence cited by the plaintiffs: When some patients started taking the drug, they experienced compulsive behavior. When they stopped the drug, it stopped. In some cases, when a patient started taking Abilify again, the impulses reportedly picked right back up where they’d left off. In its 2016 warning, the FDA noted that in the majority of case reports, the compulsions happened in people with no prior history of impulse control problems.\u003c/p>\n\u003cp>It’s also not the first drug linked to such problems. Similar issues have been seen with certain Parkinson’s drugs that also work on the dopamine system.\u003c/p>\n\u003cp>“The story [about Abilify] is not a story that’s unusual or surprising,” said Fong.\u003c/p>\n\u003cp>\u003cstrong>A promise to get help\u003c/strong>\u003c/p>\n\u003cp>One night in February 2015, Miley was supposed to be celebrating a close friend’s 60th birthday. It was the kind of neighborhood get-together she ordinarily gets excited about. But that morning, she took a familiar trip — down to work and on to the casino.\u003c/p>\n\u003cp>A week earlier, Miley had tried to take $50,000 out of her retirement account, but was told it was going to take several days to get the money. With the casino clawing at her brain, she instead took out a $50,000 loan. She was winning the day of the party — up so much that she thought she’d be able to pay off the debt.\u003c/p>\n\u003cp>She called her friend and told her she was working late. It was smack in the middle of tax season, so she thought it would be believable.\u003c/p>\n\u003cp>“I knew I shouldn’t be lying to people,” Miley said. “But the power that I felt like I needed to gamble was so much more than any of that.”\u003c/p>\n\u003cp>Her friend knew better. Miley was still ahead when the girlfriend showed up with a second friend at the casino at nearly 1 a.m. By that point, Miley had moved to high-stakes poker. One friend told Miley she looked like “a shell of [herself].”\u003c/p>\n\u003cp>She was embarrassed and distraught. She felt out of control, suicidal. They wanted to drive her to the nearest treatment facility, but Miley wanted to see her kids. So with a promise to return in the morning, they drove her home.\u003c/p>\n\u003cp>Miley’s husband, meanwhile, had realized she was gone and checked their bank accounts. To his shock, he realized she had been withdrawing their savings. He moved most of their money to an account Miley couldn’t access. When she arrived home, she made him the same promise: “In the morning, we’ll go.”\u003c/p>\n\u003cp>The next morning, Miley wrote her husband a note saying she was going to work to get everything in order before they went to the treatment facility. She did go to her office. Then she drained the little bit of money her husband had left in their bank account for making their house payment and paying other bills, and made a beeline for the casino.\u003c/p>\n\u003cp>Her husband was so desperate he considered calling the police, since she’d taken his car. He begged her to come home, and, eventually, Miley agreed. They sped straight toward the treatment facility, more than 100 miles from home.\u003c/p>\n\u003cp>“Shame. That’s all I felt, this whole time,” Miley recalled. “Shame at what I was putting my family through. Shame at what I was doing. Shame that I couldn’t control this.”\u003c/p>\n\u003cp>Shortly after she arrived, a provider pulled her off of Abilify and Xanax, which she had been prescribed in December for her growing anxiety, Miley said. She felt the urge to gamble vanish. It happened so fast, in fact, that she felt out of place in treatment.\u003c/p>\n\u003cp>“I could relate to the [other patients’] feelings of shame and embarrassment,” she said. “But I couldn’t relate to always struggling with wanting to go gambling.”\u003c/p>\n\u003cp>After 30 days in the inpatient facility, Miley went to a few Gamblers Anonymous meetings and saw a psychologist who specialized in treating gambling addiction, but ultimately stopped going. She just wasn’t experiencing the same urges anymore.\u003c/p>\n\u003cp>\u003cstrong>‘I could finally start healing’\u003c/strong>\u003c/p>\n\u003cp>In the 3 1/2 years since she stopped taking Abilify, Miley has settled back into a routine. She and her husband love watching their kids play sports and spending time at the lake with her parents and in-laws.\u003c/p>\n\u003cp>They’re trying to rebuild their lives. While she believes her compulsions were out of her control, that doesn’t change what she went through, or what she put her family through, she said. And it doesn’t return the money she gambled away. She took money out of her retirement account after treatment to pay off the bank loan.\u003c/p>\n\u003cp>She felt a little bit of the shame lift when the FDA warning came out in 2016. It no longer was just her pointing to Abilify, or even a law firm. Now, federal regulators were saying there might be a link.\u003c/p>\n\u003cp>“I could finally start healing,” she said. But it still feels raw. She still gets emotional talking about the toll it took on her family.\u003c/p>\n\u003cp>In late 2016, Miley had to go to the Hard Rock Hotel & Casino in Las Vegas for a work trip. She was absolutely dreading it. It dredged up old feelings that she’d tried to stuff away. She had to walk through the casino floor to get from her hotel room to the meeting rooms.\u003c/p>\n\u003cp>Not once, Miley said, did she feel like gambling.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This\u003ca href=\"https://www.statnews.com/2018/08/02/abilify-lawsuits-claim-drug-triggered-compulsive-gambling/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\u003csection>\u003c/section>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mom, Desperate to Help Her Son, Drove the First Cannabis Pharmaceutical to Market",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">The first prescription medication extracted from the marijuana plant is poised to land on pharmacists' shelves this fall. Epidiolex, made from purified cannabidiol, or CBD, a compound found in the cannabis plant,\u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2018/06/25/623236189/fda-green-lights-marijuana-based-pharmaceutical-drug\">\u003cspan style=\"font-weight: 400\"> is approved for two rare types of epilepsy.\u003c/span>\u003c/a>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Its journey to market was driven forward by one family's quest to find a treatment for their son's epilepsy.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'\"I thought, 'My son needs access to that. \"'\u003c/aside>\n\u003cp>Scientific and public interest in CBD had been percolating for several years before the Food and Drug Administration finally approved Epidiolex in June. But researching CBD — which doesn't cause the mind-altering high that comes from THC, the primary psychoactive component of marijuana — is hard, because of tight restrictions on using cannabis in research.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam Vogelstein's family and his doctors found ways to work around those restrictions in their fight to control his seizures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam’s seizures started in 2005 when he was four years old. It's a moment his mother, Evelyn Nussenbaum, will never forget. The family was saying goodbye to a dinner guest when Sam's face suddenly slackened and he fell forward at the waist.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"He did something that looked like a judo bow after a match,\" says Nussenbaum.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Two months passed before Sam had another seizure, but then he started having them every week. Eventually he was suffering through 100 seizures a day.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"When they were bad, they were once every three minutes,\" Nussenbaum says.\u003c/span>\u003c/p>\n\u003cp>\u003cb>A Roller-Coaster Ride\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam was diagnosed with \u003c/span>\u003ca href=\"https://www.epilepsy.com/learn/types-epilepsy-syndromes/epilepsy-myoclonic-absences\">\u003cspan style=\"font-weight: 400\">epilepsy with myoclonic-absences\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which is characterized by an abrupt unresponsiveness and then sudden body jerks. The episodes were quick, but dangerous.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_443389\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-443389 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/07/IMG_5817-e1531785628384.jpg\" alt=\"\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Dr. Roberta Cilio, neurologist at UCSF, proudly tells her patient Sam Vogelstein he is cleared to drive a car. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">The electricity in Sam's brain would misfire for about five to 20 seconds, enough time to fall down stairs, plunge face first into a dinner plate, or crack his head on a window.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"I don't remember a lot of it really,\" says Sam.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He does remember the barrage of medications his doctors put him on. Some helped briefly. Others triggered hallucinations, full body rashes and uncontrolled anger.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Sam is a pretty gentle person,\" his mother says. \"We put him on one medication and it made him angry, and he started punching kids. And it was like, 'Oh my God, this is not my kid.' \"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than 3.4 million Americans have epilepsy, according to the \u003c/span>\u003ca href=\"https://www.cdc.gov/epilepsy/about/fast-facts.htm\">\u003cspan style=\"font-weight: 400\">Centers for Disease Control and Prevention,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> but treating the disease is often a riddle doctors find difficult to solve.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam struggled to read, to write, to solve math problems, and Nussenbaum watched her son fall further and further behind in school.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Life for Sam was like a bad cell phone connection: Every few moments the signal dropped out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"It was scary,\" Nussenbaum says.\u003c/span> \u003cspan style=\"font-weight: 400\">\"I would often cry in my shower or I would drive up to the top of Grizzly Peak [in Berkeley] and sit in my car and scream.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Joining the Underground\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2011, Nussenbaum came across an article in a British medical journal about a small seizure study on rats. The researchers successfully treated the rodents with CBD.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"I thought, 'My son needs access to that,' \" says Nussenbaum.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But seven years ago, pure CBD was not easy to get. Many states have since legalized medical marijuana and CBD is widely available at dispensaries and on the internet, but it is still classified as a \u003c/span>\u003ca href=\"https://www.dea.gov/druginfo/ds.shtml\">\u003cspan style=\"font-weight: 400\">Schedule 1 \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">drug by the U.S. Drug Enforcement Administration, which means it's illegal under federal law.\u003c/span>\u003c/p>\n\u003cp>Nussembaum joined an underground epilepsy collective. The group worked with an herbalist to cook up their own CBD. Sam responded well to the first recipe, but his seizures returned while he was medicating with the second batch.\u003c/p>\n\u003cp>\"When we had it tested, there was no CBD,\" says Nussembaum.\u003c/p>\n\u003cp>Next, Sam's family and another member of the collective tried to make their own CBD. The process produced a rank odor that wafted out into the neighborhood.\u003c/p>\n\u003cp>\"We talked about what would happen if we get arrested\u003cdel>,\u003c/del>\" said Nussembaum. \"And I thought, you know what, arrest me.\"\u003c/p>\n\u003cp>\u003cstrong>Pushing for Access\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Finally, Nussenbaum learned about a British pharmaceutical company, \u003c/span>\u003ca href=\"https://www.gwpharm.com/about-us\">\u003cspan style=\"font-weight: 400\">GW Pharmaceuticals, \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">that was making a medicine derived from highly concentrated CBD to treat multiple sclerosis patients. After months of phone calls and emails from Sam’s parents, the company agreed to let Sam try the drug, in the U.K. and under a doctor's supervision for two weeks. The family flew to London shortly after.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"After one day his seizures were down to 30,\" says Nussenbaum. \"After two days they were down to 10. After three days he had one seizure.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam didn't suffer any side effects.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Back in the U.S., Sam’s parents needed to find a way to keep getting the drug. They collaborated with \u003c/span>\u003ca href=\"https://pediatrics.ucsf.edu/faculty/roberta-cilio\">\u003cspan style=\"font-weight: 400\">Dr. Roberta Cilio\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a neurologist at UC San Francisco. They petitioned the FDA to allow Sam to use the drug under a \u003c/span>\u003ca href=\"https://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.htm\">\u003cspan style=\"font-weight: 400\">compassionate use\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003cspan style=\"font-weight: 400\">Four months and hundreds of pages of documents later, the FDA allowed Sam to enroll in his own one-person trial at UCSF. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The DEA was a little more cautious. One day two agents knocked on Cilio's office door. After hours of questioning, the two men requested she store the medication in a giant safe weighing close to 1,000 pounds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">According to GW Pharmaceuticals, Sam was the first patient in the world to receive Epidiolex, the brand name of the purified CBD strain.\u003c/span>\u003c/p>\n\u003cp>\u003cb>An Expanded Trial and Varying Results\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Inspired by Sam’s success, Cilio, and other clinicians, started trying Epidiolex on other patients. In 2015, she and several co-authors published a study \u003c/span>\u003ca href=\"https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)00379-8/abstract\">\u003cspan style=\"font-weight: 400\">in \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">Lancet Neurology\u003c/span>\u003c/i>\u003c/a>\u003cspan style=\"font-weight: 400\"> that included 214 patients with treatment-resistant epilepsy, all children and young adults\u003c/span>\u003cb>. \u003c/b>\u003cspan style=\"font-weight: 400\">(The trial was partly funded by GW Pharmaceuticals.) \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_443390\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-443390\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/07/DSC-7492-800x1253.jpg\" alt=\"\" width=\"800\" height=\"1253\">\u003cfigcaption class=\"wp-caption-text\">Sam Vogelstein at fencing lessons in Berkeley, CA. \u003ccite>(Fred Vogelstein)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">For most patients the results were not as dramatic as they had been for Sam. Seizures dropped in 36.5 percent of patients, which is about the same success rate as other seizure medications, Cilio says. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And some patients experienced side effects like fatigue, diarrhea and convulsions. Cilio doesn't know why CBD transforms some lives and other patients don't respond at all.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"The studies that are out are mostly short term,\" says Cilio. \"We need to learn who the best responders are. Of course, we know this is not a miracle drug.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There have been \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2015/12/07/458818829/marijuana-extract-may-help-some-children-with-epilepsy-study-finds\">\u003cspan style=\"font-weight: 400\">other trials of CBD oil\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for intractable epilepsy, which have shown that the substance is helpful for a portion of patients, and several states have legalized \u003c/span>\u003ca href=\"http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx\">\u003cspan style=\"font-weight: 400\">CBD oil\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> specifically for the treatment of intractable epilepsy or seizure disorders. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">CBD has gained popularity with consumers as a remedy for a variety of other ailments. But the products that are available over the counter or in medical cannabis dispensaries aren't regulated the way pharmaceutical drugs are, so the consistency and dose can vary widely.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The FDA's decision to approve Epidiolex means that epilepsy patients will have access to a pharmaceutical-grade drug, which delivers a high-quality, consistent dose of CBD, \u003c/span>\u003ca href=\"https://medschool.vanderbilt.edu/brain-institute/person/robert-carson-md-phd\">\u003cspan style=\"font-weight: 400\">says Robert Carson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> a pediatric neurologist at Vanderbilt University who treats patients with epilepsy.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Unanswered Questions\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Epidiolex still has to get over one regulatory hurdle. The DEA needs to reclassify CBD so it is no longer considered a\u003c/span>\u003ca href=\"https://www.dea.gov/druginfo/ds.shtml\">\u003cspan style=\"font-weight: 400\"> Schedule 1 \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">substance. Drugs in this category are considered to have no medical use and a high potential for abuse. The FDA's approval of Epidiolex means CBD no longer fits that category, and the reclassification is expected sometime in the fall.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Patients will need a prescription to get the drug. \u003c/span>\u003ca href=\"https://www.epilepsy.com/learn/types-epilepsy-syndromes/epilepsy-myoclonic-absences\">\u003cspan style=\"font-weight: 400\">GW Pharmaceuticals\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has not released a price yet. And Sam's mom, Evelyn Nussenbaum, worries that some insurance companies might not cover it.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In the meantime, Sam still gets his drugs from the investigational pharmacy at UCSF. One day he hopes he'll be prescribing the medication to patients like him.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"I want to be an epilepsy doctor,\" Sam says.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">First he's working on his driving license. Dr. Cilio just cleared Sam to get behind the wheel. He's 17 now and hasn't had a seizure in more than two years.\u003c/span>\u003c/p>\n\n",
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"excerpt": "The inspiring story of how one family was instrumental in bringing Epidiolex to market and what hurdles may still lie ahead. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">The first prescription medication extracted from the marijuana plant is poised to land on pharmacists' shelves this fall. Epidiolex, made from purified cannabidiol, or CBD, a compound found in the cannabis plant,\u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2018/06/25/623236189/fda-green-lights-marijuana-based-pharmaceutical-drug\">\u003cspan style=\"font-weight: 400\"> is approved for two rare types of epilepsy.\u003c/span>\u003c/a>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Its journey to market was driven forward by one family's quest to find a treatment for their son's epilepsy.\u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'\"I thought, 'My son needs access to that. \"'\u003c/aside>\n\u003cp>Scientific and public interest in CBD had been percolating for several years before the Food and Drug Administration finally approved Epidiolex in June. But researching CBD — which doesn't cause the mind-altering high that comes from THC, the primary psychoactive component of marijuana — is hard, because of tight restrictions on using cannabis in research.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam Vogelstein's family and his doctors found ways to work around those restrictions in their fight to control his seizures.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam’s seizures started in 2005 when he was four years old. It's a moment his mother, Evelyn Nussenbaum, will never forget. The family was saying goodbye to a dinner guest when Sam's face suddenly slackened and he fell forward at the waist.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"He did something that looked like a judo bow after a match,\" says Nussenbaum.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Two months passed before Sam had another seizure, but then he started having them every week. Eventually he was suffering through 100 seizures a day.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"When they were bad, they were once every three minutes,\" Nussenbaum says.\u003c/span>\u003c/p>\n\u003cp>\u003cb>A Roller-Coaster Ride\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam was diagnosed with \u003c/span>\u003ca href=\"https://www.epilepsy.com/learn/types-epilepsy-syndromes/epilepsy-myoclonic-absences\">\u003cspan style=\"font-weight: 400\">epilepsy with myoclonic-absences\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which is characterized by an abrupt unresponsiveness and then sudden body jerks. The episodes were quick, but dangerous.\u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_443389\" class=\"wp-caption aligncenter\" style=\"max-width: 1920px\">\u003cimg class=\"wp-image-443389 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/07/IMG_5817-e1531785628384.jpg\" alt=\"\" width=\"1920\" height=\"1440\">\u003cfigcaption class=\"wp-caption-text\">Dr. Roberta Cilio, neurologist at UCSF, proudly tells her patient Sam Vogelstein he is cleared to drive a car. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">The electricity in Sam's brain would misfire for about five to 20 seconds, enough time to fall down stairs, plunge face first into a dinner plate, or crack his head on a window.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"I don't remember a lot of it really,\" says Sam.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He does remember the barrage of medications his doctors put him on. Some helped briefly. Others triggered hallucinations, full body rashes and uncontrolled anger.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Sam is a pretty gentle person,\" his mother says. \"We put him on one medication and it made him angry, and he started punching kids. And it was like, 'Oh my God, this is not my kid.' \"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">More than 3.4 million Americans have epilepsy, according to the \u003c/span>\u003ca href=\"https://www.cdc.gov/epilepsy/about/fast-facts.htm\">\u003cspan style=\"font-weight: 400\">Centers for Disease Control and Prevention,\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> but treating the disease is often a riddle doctors find difficult to solve.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam struggled to read, to write, to solve math problems, and Nussenbaum watched her son fall further and further behind in school.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Life for Sam was like a bad cell phone connection: Every few moments the signal dropped out.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"It was scary,\" Nussenbaum says.\u003c/span> \u003cspan style=\"font-weight: 400\">\"I would often cry in my shower or I would drive up to the top of Grizzly Peak [in Berkeley] and sit in my car and scream.”\u003c/span>\u003c/p>\n\u003cp>\u003cb>Joining the Underground\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In 2011, Nussenbaum came across an article in a British medical journal about a small seizure study on rats. The researchers successfully treated the rodents with CBD.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"I thought, 'My son needs access to that,' \" says Nussenbaum.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But seven years ago, pure CBD was not easy to get. Many states have since legalized medical marijuana and CBD is widely available at dispensaries and on the internet, but it is still classified as a \u003c/span>\u003ca href=\"https://www.dea.gov/druginfo/ds.shtml\">\u003cspan style=\"font-weight: 400\">Schedule 1 \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">drug by the U.S. Drug Enforcement Administration, which means it's illegal under federal law.\u003c/span>\u003c/p>\n\u003cp>Nussembaum joined an underground epilepsy collective. The group worked with an herbalist to cook up their own CBD. Sam responded well to the first recipe, but his seizures returned while he was medicating with the second batch.\u003c/p>\n\u003cp>\"When we had it tested, there was no CBD,\" says Nussembaum.\u003c/p>\n\u003cp>Next, Sam's family and another member of the collective tried to make their own CBD. The process produced a rank odor that wafted out into the neighborhood.\u003c/p>\n\u003cp>\"We talked about what would happen if we get arrested\u003cdel>,\u003c/del>\" said Nussembaum. \"And I thought, you know what, arrest me.\"\u003c/p>\n\u003cp>\u003cstrong>Pushing for Access\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Finally, Nussenbaum learned about a British pharmaceutical company, \u003c/span>\u003ca href=\"https://www.gwpharm.com/about-us\">\u003cspan style=\"font-weight: 400\">GW Pharmaceuticals, \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">that was making a medicine derived from highly concentrated CBD to treat multiple sclerosis patients. After months of phone calls and emails from Sam’s parents, the company agreed to let Sam try the drug, in the U.K. and under a doctor's supervision for two weeks. The family flew to London shortly after.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"After one day his seizures were down to 30,\" says Nussenbaum. \"After two days they were down to 10. After three days he had one seizure.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Sam didn't suffer any side effects.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Back in the U.S., Sam’s parents needed to find a way to keep getting the drug. They collaborated with \u003c/span>\u003ca href=\"https://pediatrics.ucsf.edu/faculty/roberta-cilio\">\u003cspan style=\"font-weight: 400\">Dr. Roberta Cilio\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, a neurologist at UC San Francisco. They petitioned the FDA to allow Sam to use the drug under a \u003c/span>\u003ca href=\"https://www.fda.gov/NewsEvents/PublicHealthFocus/ExpandedAccessCompassionateUse/default.htm\">\u003cspan style=\"font-weight: 400\">compassionate use\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003cspan style=\"font-weight: 400\">Four months and hundreds of pages of documents later, the FDA allowed Sam to enroll in his own one-person trial at UCSF. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The DEA was a little more cautious. One day two agents knocked on Cilio's office door. After hours of questioning, the two men requested she store the medication in a giant safe weighing close to 1,000 pounds.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">According to GW Pharmaceuticals, Sam was the first patient in the world to receive Epidiolex, the brand name of the purified CBD strain.\u003c/span>\u003c/p>\n\u003cp>\u003cb>An Expanded Trial and Varying Results\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Inspired by Sam’s success, Cilio, and other clinicians, started trying Epidiolex on other patients. In 2015, she and several co-authors published a study \u003c/span>\u003ca href=\"https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)00379-8/abstract\">\u003cspan style=\"font-weight: 400\">in \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">Lancet Neurology\u003c/span>\u003c/i>\u003c/a>\u003cspan style=\"font-weight: 400\"> that included 214 patients with treatment-resistant epilepsy, all children and young adults\u003c/span>\u003cb>. \u003c/b>\u003cspan style=\"font-weight: 400\">(The trial was partly funded by GW Pharmaceuticals.) \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_443390\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-443390\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/07/DSC-7492-800x1253.jpg\" alt=\"\" width=\"800\" height=\"1253\">\u003cfigcaption class=\"wp-caption-text\">Sam Vogelstein at fencing lessons in Berkeley, CA. \u003ccite>(Fred Vogelstein)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">For most patients the results were not as dramatic as they had been for Sam. Seizures dropped in 36.5 percent of patients, which is about the same success rate as other seizure medications, Cilio says. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And some patients experienced side effects like fatigue, diarrhea and convulsions. Cilio doesn't know why CBD transforms some lives and other patients don't respond at all.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"The studies that are out are mostly short term,\" says Cilio. \"We need to learn who the best responders are. Of course, we know this is not a miracle drug.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There have been \u003c/span>\u003ca href=\"https://www.npr.org/sections/health-shots/2015/12/07/458818829/marijuana-extract-may-help-some-children-with-epilepsy-study-finds\">\u003cspan style=\"font-weight: 400\">other trials of CBD oil\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for intractable epilepsy, which have shown that the substance is helpful for a portion of patients, and several states have legalized \u003c/span>\u003ca href=\"http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx\">\u003cspan style=\"font-weight: 400\">CBD oil\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> specifically for the treatment of intractable epilepsy or seizure disorders. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">CBD has gained popularity with consumers as a remedy for a variety of other ailments. But the products that are available over the counter or in medical cannabis dispensaries aren't regulated the way pharmaceutical drugs are, so the consistency and dose can vary widely.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The FDA's decision to approve Epidiolex means that epilepsy patients will have access to a pharmaceutical-grade drug, which delivers a high-quality, consistent dose of CBD, \u003c/span>\u003ca href=\"https://medschool.vanderbilt.edu/brain-institute/person/robert-carson-md-phd\">\u003cspan style=\"font-weight: 400\">says Robert Carson\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> a pediatric neurologist at Vanderbilt University who treats patients with epilepsy.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Unanswered Questions\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Epidiolex still has to get over one regulatory hurdle. The DEA needs to reclassify CBD so it is no longer considered a\u003c/span>\u003ca href=\"https://www.dea.gov/druginfo/ds.shtml\">\u003cspan style=\"font-weight: 400\"> Schedule 1 \u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">substance. Drugs in this category are considered to have no medical use and a high potential for abuse. The FDA's approval of Epidiolex means CBD no longer fits that category, and the reclassification is expected sometime in the fall.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Patients will need a prescription to get the drug. \u003c/span>\u003ca href=\"https://www.epilepsy.com/learn/types-epilepsy-syndromes/epilepsy-myoclonic-absences\">\u003cspan style=\"font-weight: 400\">GW Pharmaceuticals\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> has not released a price yet. And Sam's mom, Evelyn Nussenbaum, worries that some insurance companies might not cover it.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In the meantime, Sam still gets his drugs from the investigational pharmacy at UCSF. One day he hopes he'll be prescribing the medication to patients like him.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"I want to be an epilepsy doctor,\" Sam says.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>https://youtu.be/UzXsjMDpNq4\u003c/p>\n\u003cp>Each year, more than 100,000 Americans \u003ca href=\"http://www.bradycampaign.org/key-gun-violence-statistics\" target=\"_blank\" rel=\"noopener\">are shot\u003c/a>. And the wounds to bone and tissue caused by specially designed bullets also are getting \u003ca href=\"https://tsaco.bmj.com/content/3/1/e000139\" target=\"_blank\" rel=\"noopener\">more severe\u003c/a>, according to surgeons.\u003c/p>\n\u003cp>Not all bullets are created equal. The energy of a bullet is determined by its mass and speed, and its wounding potential hinges on its ability to transfer its energy to a target; even rounds that are similar in size, or look similar, can cause dramatically different damage.\u003c/p>\n\u003cp>In this latest \"Let's Talk\" \u003ca href=\"https://www.youtube.com/watch?v=UzXsjMDpNq4\" target=\"_blank\" rel=\"noopener\">video\u003c/a>, we examine four of the most common bullets in America. We explain the physics behind their differences in design, and show why the destruction caused by one round in an AR-15-style weapon can be so much greater than a typical bullet used in target practice or hunting.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=WATCH%3A+The+Science+Behind+Why+Some+Bullets+Are+More+Destructive+Than+Others&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"content": "\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://content.jwplatform.com/players/FN1FYn4y-jEuQjxp9.html\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>What we see often determines how we act: We hit the brakes if a car is stopped ahead of us. We duck to avoid a low-hanging tree branch. We bend down to tie our shoe when the laces come undone.We rarely give these actions a second thought. But Mriganka Sur, a professor at the Massachusetts Institute of Technology’s Picower Institute for Learning and Memory, is obsessed with them.“How is vision, which we do effortlessly, transformed into action, which requires volition, which requires attention and engagement?” Sur asked. “How this transformation takes place is a fundamental question that is at the heart of brain function and behavior.”\u003c/p>\n\u003cp>In a recent \u003ca href=\"https://www.nature.com/articles/s41467-018-05012-y\" target=\"_blank\" rel=\"noopener\">mouse study\u003c/a> published in Nature Communications, Sur and his team took a step toward answering that question\u003cem>.\u003c/em> Their experimental data suggest that the posterior parietal cortex, or PPC, may help us make decisions based on what we see.\u003c/p>\n\u003cp>First author Gerald Pho, formerly a Ph.D. student in Sur’s lab and now a postdoctoral fellow at Harvard, was exhilarated to see mice’s PPCs light up under a microscope when they made choices based on visual stimuli.\u003c/p>\n\u003cp>“It’s quite magical,” he said. “It’s almost like fireworks.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pho said he’s excited to see how our understanding of visual decision-making will develop as imaging technology becomes more advanced.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I just think we’re in an exciting time in neuroscience,” he said. “And I think the advance of these technologies can only improve our ability to understand how the brain works in a normal animal, and extending to humans, but also how it goes awry in neurological disease.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://content.jwplatform.com/players/FN1FYn4y-jEuQjxp9.html\" width=\"640\" height=\"360\" frameborder=\"0\" scrolling=\"yes\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>What we see often determines how we act: We hit the brakes if a car is stopped ahead of us. We duck to avoid a low-hanging tree branch. We bend down to tie our shoe when the laces come undone.We rarely give these actions a second thought. But Mriganka Sur, a professor at the Massachusetts Institute of Technology’s Picower Institute for Learning and Memory, is obsessed with them.“How is vision, which we do effortlessly, transformed into action, which requires volition, which requires attention and engagement?” Sur asked. “How this transformation takes place is a fundamental question that is at the heart of brain function and behavior.”\u003c/p>\n\u003cp>In a recent \u003ca href=\"https://www.nature.com/articles/s41467-018-05012-y\" target=\"_blank\" rel=\"noopener\">mouse study\u003c/a> published in Nature Communications, Sur and his team took a step toward answering that question\u003cem>.\u003c/em> Their experimental data suggest that the posterior parietal cortex, or PPC, may help us make decisions based on what we see.\u003c/p>\n\u003cp>First author Gerald Pho, formerly a Ph.D. student in Sur’s lab and now a postdoctoral fellow at Harvard, was exhilarated to see mice’s PPCs light up under a microscope when they made choices based on visual stimuli.\u003c/p>\n\u003cp>“It’s quite magical,” he said. “It’s almost like fireworks.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The first rule of soccer is pretty obvious: don't use your hands. But soccer's signature move, heading the ball, can cause a detectable impact on players' brains. And according to a study \u003ca href=\"https://pubs.rsna.org/doi/10.1148/radiol.2018180217\" target=\"_blank\" rel=\"noopener\">published Tuesday in Radiology\u003c/a>, female players are more sensitive to the impact than males.\u003c/p>\n\u003cp>The study authors found that female amateur soccer players who frequently head balls showed more white matter brain alterations than their male counterparts. The study included 49 women and 49 men, ages 18 to 50, and examined MRI imaging of players' brains. Each female player was compared to a male player of a similar age and with other similar characteristics including frequency of heading exposure.\u003c/p>\n\u003cp>Lead author \u003ca href=\"http://www.einstein.yu.edu/faculty/148/michael-lipton/\" target=\"_blank\" rel=\"noopener\">Michael Lipton\u003c/a>, a neuroradiologist and neuroscientist at Albert Einstein College of Medicine, says white matter in the brain can be compared to fiber optic cable, which connects a network of computer. White matter is made up thread-like axon nerve fibers that connect neurons to each other, and their protective covering, myelin.\u003c/p>\n\u003cp>Heading causes these brain tissues to become disorganized, Lipton says. His previous research found that these abnormalities accompany \u003ca href=\"https://www.einstein.yu.edu/docs/labs/michael-lipton/Soccer_heading_is_associated_with_WM.pdf\" target=\"_blank\" rel=\"noopener\">poorer cognitive function\u003c/a> associated with memory or attention issues when associated with heading.\u003c/p>\n\u003cp>\"The most important finding here is that we see that in women's brains, actually looking at brain tissue, there seems to be a greater sensitivity to repetitive, very low-level injury relative to men,\" he says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>An important note about this research, Lipton says, is that it isn't about concussions. Instead, it's measuring \"sub-concussive injuries,\" or repeated impacts that don't cause any immediate, acknowledged problem for the player, but could be problematic in the long-term.\u003c/p>\n\u003cp>\"It's actually more important to define what's happening in people that are not yet symptomatic, because that's where there's still an opportunity to head off long-term problems,\" he says.\u003c/p>\n\u003cp>It's already known that female soccer players are at a higher risk of concussion than males. Wellington Hsu, a professor of orthopedic surgery at Northwestern University, \u003ca href=\"http://aaos-annualmeeting-presskit.org/2017/research-news/concussions_hsu/\" target=\"_blank\" rel=\"noopener\">led a decade-long study\u003c/a> of injuries among high school athletes that found this.\u003c/p>\n\u003cp>But the current study gives additional evidence that women are more susceptible to the impact of heading, and shows more areas of women's brains are susceptible to potential injury than men's.\u003c/p>\n\u003cp>Hsu, who was not involved in the current study, says while it's not possible to draw firm conclusions from the study alone, it suggests a path forward for making the sport safer.\u003c/p>\n\u003cp>\"What I think this paper may lead to is further research in the preventative mechanisms of concussions, whether or not it's a brace or a helmet or heading technique or a different way we think about this in men and women,\" Hsu says.\u003c/p>\n\u003cp>Women \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC233178/\" target=\"_blank\" rel=\"noopener\">are more likely to report concussion-related symptoms\u003c/a> than men, but Lipton says there has been debate over whether women actually are more sensitive or just more likely to speak up.\u003c/p>\n\u003cp>This study confirms that there are changes in the tissue of women's brains after these repetitive hits from the soccer ball that are different from men in a similar situation.\u003c/p>\n\u003cp>\"This is the first time anybody has put a definitive piece of information behind what has been a contentious dispute as to whether women's brains are intrinsically more sensitive, or whether it's an artifact of reporting of symptoms,\" Lipton says.\u003c/p>\n\u003cp>It's unclear why women more biologically likely to be affected by repetitive heading. Lipton says it could have to do with sex hormones, or with the fact that women typically having less body and muscle mass than their male counterparts.\u003c/p>\n\u003cp>Thomas Kaminski, a professor of kinesiology and applied physiology at the University of Delaware, who was not involved in the study, says that the differences in these changes in the brain could have to do with neck strength. Women typically have weaker necks and smaller heads than men.\u003c/p>\n\u003cp>Does this research mean women should hang up their cleats forever? Probably not, says Lipton. There are a lot of \u003ca href=\"https://www.npr.org/sections/health-shots/2014/04/02/297910425/run-when-youre-25-for-a-sharper-brain-when-youre-45\" target=\"_blank\" rel=\"noopener\">brain health benefits to getting active\u003c/a>, and women are actually okay to head the ball up to a certain point.\u003c/p>\n\u003cp>\"We're not saying that you head the ball and then you're brain injured,\" Lipton says. \"The data consistently shows that there seems to be some level of exposure to these repeated impacts which is pretty well tolerated by most people. It's really a matter of figuring out how much is too much.\"\u003c/p>\n\u003cp>Lipton says he hopes to find out if there's a safe threshold on heading impact for women. The latest FIFA data shows \u003ca href=\"https://www.fifa.com/mm/document/fifafacts/bcoffsurv/emaga_9384_10704.pdf\" target=\"_blank\" rel=\"noopener\">265 million people play soccer\u003c/a> across the globe, and Lipton says, adverse effects when multiplied by that many people \"potentially [pose] a huge public health concern.\"\u003c/p>\n\u003cp>\"The problem isn't that [soccer is] creating all kinds of vegetative, brain damaged people,\" he says. \"But what's the potential benefit of athletics that's being given up by the effect of this kind of repeated head injury? And is there a way to strike a balance so that people can benefit maximally and not incur the adverse effects?\"\u003c/p>\n\u003cp>Kaminski says it would be interesting to take this research one step forward and explore this problem in youth. In the U.S., youth players can start heading the ball at age 11. He thinks it's worth questioning whether that age cutoff should be older. Parents are faced with the issue of wanting their kids to be active but safe at the same time, he says.\u003c/p>\n\u003cp>\"What happens if [children] head the ball ten times, or a hundred times?\" he says. \"Would you see these changes? Those are the big question marks I have.\"\u003c/p>\n\u003cp>Carla Garcia, a Brooklyn resident and participant in the study, has been playing soccer since she was five. Now 52, she says these results probably won't change the way she plays, but if she were younger, she would consider heading the ball a bit less. She joined the study as a way to give back to the sport she loves — and she even wants to donate her brain to science to help researchers understand brain injuries.\u003c/p>\n\u003cp>\"I think it probably over the long term will have an effect on the way that younger women and younger people play, and I got involved for that reason,\" she says. \"I thought that Dr. Lipton and his colleagues could find the way to make it safer for kids to play.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Sara Kiley Watson is NPR's Science desk intern.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heading+May+Be+Riskier+For+Female+Soccer+Players+Than+Males&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first rule of soccer is pretty obvious: don't use your hands. But soccer's signature move, heading the ball, can cause a detectable impact on players' brains. And according to a study \u003ca href=\"https://pubs.rsna.org/doi/10.1148/radiol.2018180217\" target=\"_blank\" rel=\"noopener\">published Tuesday in Radiology\u003c/a>, female players are more sensitive to the impact than males.\u003c/p>\n\u003cp>The study authors found that female amateur soccer players who frequently head balls showed more white matter brain alterations than their male counterparts. The study included 49 women and 49 men, ages 18 to 50, and examined MRI imaging of players' brains. Each female player was compared to a male player of a similar age and with other similar characteristics including frequency of heading exposure.\u003c/p>\n\u003cp>Lead author \u003ca href=\"http://www.einstein.yu.edu/faculty/148/michael-lipton/\" target=\"_blank\" rel=\"noopener\">Michael Lipton\u003c/a>, a neuroradiologist and neuroscientist at Albert Einstein College of Medicine, says white matter in the brain can be compared to fiber optic cable, which connects a network of computer. White matter is made up thread-like axon nerve fibers that connect neurons to each other, and their protective covering, myelin.\u003c/p>\n\u003cp>Heading causes these brain tissues to become disorganized, Lipton says. His previous research found that these abnormalities accompany \u003ca href=\"https://www.einstein.yu.edu/docs/labs/michael-lipton/Soccer_heading_is_associated_with_WM.pdf\" target=\"_blank\" rel=\"noopener\">poorer cognitive function\u003c/a> associated with memory or attention issues when associated with heading.\u003c/p>\n\u003cp>\"The most important finding here is that we see that in women's brains, actually looking at brain tissue, there seems to be a greater sensitivity to repetitive, very low-level injury relative to men,\" he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>An important note about this research, Lipton says, is that it isn't about concussions. Instead, it's measuring \"sub-concussive injuries,\" or repeated impacts that don't cause any immediate, acknowledged problem for the player, but could be problematic in the long-term.\u003c/p>\n\u003cp>\"It's actually more important to define what's happening in people that are not yet symptomatic, because that's where there's still an opportunity to head off long-term problems,\" he says.\u003c/p>\n\u003cp>It's already known that female soccer players are at a higher risk of concussion than males. Wellington Hsu, a professor of orthopedic surgery at Northwestern University, \u003ca href=\"http://aaos-annualmeeting-presskit.org/2017/research-news/concussions_hsu/\" target=\"_blank\" rel=\"noopener\">led a decade-long study\u003c/a> of injuries among high school athletes that found this.\u003c/p>\n\u003cp>But the current study gives additional evidence that women are more susceptible to the impact of heading, and shows more areas of women's brains are susceptible to potential injury than men's.\u003c/p>\n\u003cp>Hsu, who was not involved in the current study, says while it's not possible to draw firm conclusions from the study alone, it suggests a path forward for making the sport safer.\u003c/p>\n\u003cp>\"What I think this paper may lead to is further research in the preventative mechanisms of concussions, whether or not it's a brace or a helmet or heading technique or a different way we think about this in men and women,\" Hsu says.\u003c/p>\n\u003cp>Women \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC233178/\" target=\"_blank\" rel=\"noopener\">are more likely to report concussion-related symptoms\u003c/a> than men, but Lipton says there has been debate over whether women actually are more sensitive or just more likely to speak up.\u003c/p>\n\u003cp>This study confirms that there are changes in the tissue of women's brains after these repetitive hits from the soccer ball that are different from men in a similar situation.\u003c/p>\n\u003cp>\"This is the first time anybody has put a definitive piece of information behind what has been a contentious dispute as to whether women's brains are intrinsically more sensitive, or whether it's an artifact of reporting of symptoms,\" Lipton says.\u003c/p>\n\u003cp>It's unclear why women more biologically likely to be affected by repetitive heading. Lipton says it could have to do with sex hormones, or with the fact that women typically having less body and muscle mass than their male counterparts.\u003c/p>\n\u003cp>Thomas Kaminski, a professor of kinesiology and applied physiology at the University of Delaware, who was not involved in the study, says that the differences in these changes in the brain could have to do with neck strength. Women typically have weaker necks and smaller heads than men.\u003c/p>\n\u003cp>Does this research mean women should hang up their cleats forever? Probably not, says Lipton. There are a lot of \u003ca href=\"https://www.npr.org/sections/health-shots/2014/04/02/297910425/run-when-youre-25-for-a-sharper-brain-when-youre-45\" target=\"_blank\" rel=\"noopener\">brain health benefits to getting active\u003c/a>, and women are actually okay to head the ball up to a certain point.\u003c/p>\n\u003cp>\"We're not saying that you head the ball and then you're brain injured,\" Lipton says. \"The data consistently shows that there seems to be some level of exposure to these repeated impacts which is pretty well tolerated by most people. It's really a matter of figuring out how much is too much.\"\u003c/p>\n\u003cp>Lipton says he hopes to find out if there's a safe threshold on heading impact for women. The latest FIFA data shows \u003ca href=\"https://www.fifa.com/mm/document/fifafacts/bcoffsurv/emaga_9384_10704.pdf\" target=\"_blank\" rel=\"noopener\">265 million people play soccer\u003c/a> across the globe, and Lipton says, adverse effects when multiplied by that many people \"potentially [pose] a huge public health concern.\"\u003c/p>\n\u003cp>\"The problem isn't that [soccer is] creating all kinds of vegetative, brain damaged people,\" he says. \"But what's the potential benefit of athletics that's being given up by the effect of this kind of repeated head injury? And is there a way to strike a balance so that people can benefit maximally and not incur the adverse effects?\"\u003c/p>\n\u003cp>Kaminski says it would be interesting to take this research one step forward and explore this problem in youth. In the U.S., youth players can start heading the ball at age 11. He thinks it's worth questioning whether that age cutoff should be older. Parents are faced with the issue of wanting their kids to be active but safe at the same time, he says.\u003c/p>\n\u003cp>\"What happens if [children] head the ball ten times, or a hundred times?\" he says. \"Would you see these changes? Those are the big question marks I have.\"\u003c/p>\n\u003cp>Carla Garcia, a Brooklyn resident and participant in the study, has been playing soccer since she was five. Now 52, she says these results probably won't change the way she plays, but if she were younger, she would consider heading the ball a bit less. 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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Sara Kiley Watson is NPR's Science desk intern.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heading+May+Be+Riskier+For+Female+Soccer+Players+Than+Males&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Marines Who Fired Rocket Launchers Now Worry About Their Brains",
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"content": "\u003cp>Chris Ferrari was just 18 the first time he balanced a rocket launcher on his right shoulder and aimed it at a practice target.\u003c/p>\n\u003cp>\"Your adrenaline's going and you're trying to focus on getting that round to hit, and then you go to squeeze that trigger and, you know.\"\u003c/p>\n\u003cp>Boom!\u003c/p>\n\u003cp>The report is loud enough to burst the eardrums of anyone not wearing military-grade hearing protection. And the blast wave from the weapon is so powerful it feels like a whole-body punch.\u003c/p>\n\u003cp>\"It's exhilarating,\" says Chris's buddy Daniel, a former gunner in the Marine Corps who asked that we not use his last name. \"When you feel a concussive wave, it's an awesome thing. It fills you with awe.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It also may do bad things to your brain.\u003c/p>\n\u003cp>Studies show that troops who repeatedly fire powerful, shoulder-launched weapons can \u003ca href=\"https://academic.oup.com/acn/article/31/6/622/2236746\" target=\"_blank\" rel=\"noopener\">experience short-term problems with memory and thinking\u003c/a>. They may also feel nauseated, fatigued and dizzy. In short, they have symptoms like \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24901327\" target=\"_blank\" rel=\"noopener\">those of a concussion\u003c/a>.\u003c/p>\n\u003cp>It's still not clear whether firing these weapons can lead to long-term brain damage. But Chris and Daniel suspect that, for them, it may have.\u003c/p>\n\u003cp>While in the Marines, Daniel and Chris spent two years in the late 1990s firing a rocket launcher called the shoulder-launched multipurpose assault weapon, or \u003ca href=\"https://www.globalsecurity.org/military/systems/ground/smaw.htm\" target=\"_blank\" rel=\"noopener\">SMAW\u003c/a>.\u003c/p>\n\u003cp>They were a team. Chris loaded the rockets. Daniel pulled the trigger. Then they would switch places.\u003c/p>\n\u003cp>And together, they fired hundreds of rounds in training exercises around the world.\u003c/p>\n\u003cp>\"That's me and Daniel at the base of Mount Fuji, posing for a picture with our SMAW,\" Chris says as he leafs through an album of photographs Daniel put together.\u003c/p>\n\u003cp>The SMAW is one of several modern weapons light enough for one person to carry but powerful enough to blow up a tank.\u003c/p>\n\u003cp>Daniel and Chris say they felt like their brains had been rattled every time they fired the SMAW. And they fired it a lot.\u003c/p>\n\u003cp>\"Chris and I were incredibly good shots,\" Daniel says.\u003c/p>\n\u003cp>\"We never missed,\" Chris adds. \"We were always selected by our sergeant and our leaders to do the firing because they wanted to see the explosion, you know, they wanted to see the target get hit.\"\u003c/p>\n\u003cp>But as the two men fired the SMAW again and again, some of the thrill began to fade.\u003c/p>\n\u003cp>Every shot \"felt like the world was caving in on you,\" Chris says.\u003c/p>\n\u003cp>The U.S. military limits the number of times troops can fire heavy weapons like the SMAW in a single day. But the limits are based on concern about hearing loss, not brain damage.\u003c/p>\n\u003cp>And 20 years ago, safety wasn't taken very seriously, Daniel says.\u003c/p>\n\u003cp>\"I remember they were saying you're only allowed to shoot three of these things a day because it's, like, really bad for you,\" he says. \"And then I would shoot three and then you [Chris] would shoot three. And then the guys 10 feet from us would shoot six and then the other team would shoot six.\"\u003c/p>\n\u003cp>Chris had a lot of headaches, and sometimes couldn't think straight after a day on the range. \"You feel odd and you feel out of place and you feel exhausted and tired,\" he says. \"But, you know, you're a Marine and you learn to put it away.\"\u003c/p>\n\u003cp>Until you can't.\u003c/p>\n\u003cp>For Daniel, that happened during a joint training exercise in Malaysia. Their platoon was still setting up, Chris says, \"and all of sudden out of nowhere: Boom!\"\u003c/p>\n\u003cp>Malaysian troops just a few feet away had fired an antitank weapon called the \u003ca href=\"https://saab.com/land/weapon-systems/support-weapons/at4/\" target=\"_blank\" rel=\"noopener\">AT4\u003c/a>. The blast wave hit Daniel hard.\u003c/p>\n\u003cp>\"I was, like, absolutely dizzy,\" Daniel says. \"I was absolutely disjointed. I felt nauseous, like I really felt like I needed to throw up.\"\u003c/p>\n\u003cp>So Daniel told his sergeant. \"And it was just: 'Shut your face. Are you complaining? Why is everyone else OK and you're not?' \"\u003c/p>\n\u003cp>\u003cstrong>Blast Injuries Overlooked\u003c/strong>\u003c/p>\n\u003cp>Back then, in the 1990s, the military pretty much assumed a fighter's brain was fine unless there was some external sign of injury.\u003c/p>\n\u003cp>That was because, at the time, no one really understood how an invisible blast wave could damage the brain without leaving a mark, says Tracie Lattimore, who directs the Army's traumatic brain injury program.\u003c/p>\n\u003cp>\"The science wasn't up to speed,\" she says. \"It just didn't exist.\"\u003c/p>\n\u003cp>But since 2007, Lattimore says, the Department of Defense has spent about a billion dollars studying traumatic brain injuries, including those caused by blast exposure.\u003c/p>\n\u003cp>At first, the research focused on bomb blasts, especially those from the improvised explosive devices that had become common in Iraq and Afghanistan.\u003c/p>\n\u003cp>But over time, Lattimore says, the military's research has expanded beyond IEDs to include the effects of blasts from weapons like the one Chris and Daniel shot.\u003c/p>\n\u003cp>\"If you talk to us in a year from now, I think we're going to have exponential growth in our knowledge coming out of these current studies and our future studies,\" Lattimore says.\u003c/p>\n\u003cp>Eventually, that could help the hundreds of thousands of veterans who have fired these weapons in the past couple of decades.\u003c/p>\n\u003cp>But right now, people like Daniel and Chris have no way to know whether firing heavy weapons could have affected their brains.\u003c/p>\n\u003cp>Chris wonders whether all those blasts might be the reason he once landed in a military hospital for two weeks.\u003c/p>\n\u003cp>It happened after a weeklong training exercise in the California desert near Twentynine Palms. Thousands of troops took part and Daniel and Chris fired lots and lots of rockets. They also set off lots of explosives.\u003c/p>\n\u003cp>Several days after the exercise ended, Daniel noticed that Chris was awake in the middle of the night.\u003c/p>\n\u003cp>\"He just got up and started walking out of the room in his stinking underwear,\" Daniel says. \"And I was like, 'Hey Chris, what's going on?' And he was just kind of like looking through me.\"\u003c/p>\n\u003cp>\"I don't remember it,\" Chris says. \"But I know that they put me in the hospital and thought I had spinal meningitis or something.\"\u003c/p>\n\u003cp>He didn't. And the doctors never pinpointed another cause. They clearly thought something was wrong with his brain. But at the time, no one would have thought to ask whether the problem was caused by the weapons Chris had fired.\u003c/p>\n\u003cp>Chris's military career ended one morning when his platoon left on a bus and he didn't get on it. Ultimately, he got a bad conduct discharge.\u003c/p>\n\u003cp>It's been nearly two decades since Chris and Daniel fired the SMAW.\u003c/p>\n\u003cp>They've both settled in Northern California, which is where they grew up. And they both have symptoms that could be from a brain injury — or something else.\u003c/p>\n\u003cp>Chris has lots of questions.\u003c/p>\n\u003cp>\"Why does this hurt on my body? Why do I feel lost? Why can't I concentrate on stuff as long [as I used to]?\"\u003c/p>\n\u003cp>Chris also has trouble controlling his emotions, something he says wasn't a problem before his military service.\u003c/p>\n\u003cp>For Daniel, it's his memory that's the problem.\u003c/p>\n\u003cp>\"I used to be photographic. Now I'm forgetful,\" he says. \"I'm 40, that's ... I don't know, man. Maybe I'm getting old.\"\u003c/p>\n\u003cp>Both Chris and Daniel have problems with balance and orientation. For Daniel it can happen when he turns his head quickly or stumbles.\u003c/p>\n\u003cp>\"I lose my spatial orientation,\" he says. \"I don't know where I am. Vision gets blurrier. Even sound is kind of muffled.\"\u003c/p>\n\u003cp>These are common symptoms of damage to the brain's \u003ca href=\"https://vestibular.org/understanding-vestibular-disorder/human-balance-system\" target=\"_blank\" rel=\"noopener\">vestibular system\u003c/a>, something that affects many people who have experienced a traumatic brain injury from a bomb blast or blow to the head.\u003c/p>\n\u003cp>\u003cstrong>Uncertain Coverage \u003c/strong>\u003c/p>\n\u003cp>But Daniel and Chris were never in combat and never were injured in any obvious way during training. That means it's not clear whether they are entitled to care from doctors and hospitals run by the Department of Veterans Affairs.\u003c/p>\n\u003cp>Chris has never tried to get care from the VA. But Daniel has. And he learned that the VA doesn't have an obvious category for people like him.\u003c/p>\n\u003cp>Daniel had never connected his symptoms with his time as a Marine until he heard a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/20/506146595/pentagon-shelves-blast-gauges-meant-to-detect-battlefield-brain-injuries\" target=\"_blank\" rel=\"noopener\">radio story\u003c/a> on NPR suggesting that certain military weapons might be powerful enough to give the shooter a traumatic brain injury.\u003c/p>\n\u003cp>\"I went back to the VA and I said I want to be tested for TBI,\" he says. \"And they said great.\"\u003c/p>\n\u003cp>They handed him a questionnaire. The first question asked where he had been in combat. But he hadn't been.\u003c/p>\n\u003cp>The second question asked: \"Were you hit by an IED?\" Daniel says it went on: \"Was it a grenade explosion? Was a bomb dropped too close to you?\" So I couldn't actually answer the questionnaire.\"\u003c/p>\n\u003cp>All he'd done was fire a rocket launcher in training exercises, over and over and over.\u003c/p>\n\u003cp>VA doctors see quite a few veterans like Daniel, says \u003ca href=\"https://www.washingtondc.va.gov/management/index.asp?cx=1&key=15\" target=\"_blank\" rel=\"noopener\">Dr. Joel Scholten\u003c/a>, who's in charge of physical medicine and rehabilitation for the VA. He says the conversation usually goes like this:\u003c/p>\n\u003cp>\"While I was training we fired a certain type of weapon. I felt dizzy or had some ringing in my ears after that.\"\u003c/p>\n\u003cp>Then Scholten asks if the veteran was ever near a bomb blast or took a blow to the head. Many say yes. And for them, VA guidelines call for a full examination for traumatic brain injury.\u003c/p>\n\u003cp>But for veterans like Daniel, coverage is uncertain. That's because there still isn't clear evidence that training with heavy weapons can cause long-term problems with things like memory, thinking and balance.\u003c/p>\n\u003cp>\"These symptoms are what we call nonspecific,\" Scholten says. \"So they're not unique to traumatic brain injury, and in fact there is no symptom that happens only with traumatic brain injury or concussion.\"\u003c/p>\n\u003cp>From a medical perspective, the lack of a box to tick is not a big deal. Treatments usually focus on improving a patient's symptoms, regardless of the cause.\u003c/p>\n\u003cp>\"For instance, someone with cognitive or concentration impairments, we would focus our therapy on how to improve concentration,\" Scholten says.\u003c/p>\n\u003cp>But paying for therapy is another matter. The VA gives priority to veterans whose medical problems can be linked to their service.\u003c/p>\n\u003cp>And since military scientists still aren't sure whether firing a powerful weapon can have long-term effects, Daniel says the VA is sending him the bill. He's being asked to pay out of pocket for high-tech brain scans and other tests.\u003c/p>\n\u003cp>\"I love the VA,\" Daniel says. \"I have nothing bad to say about the VA. The individuals there get it. They really do. But their hands are typically tied by their process.\"\u003c/p>\n\u003cp>\u003ca href=\"https://blastinjuryresearch.amedd.army.mil/index.cfm/sos/neurological_effects_of_repeated_exposure\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> now underway should help clear up whether people like Daniel could have been harmed by the weapons they fired, Scholten says. And the results of those studies will be used to update the VA's guidelines on who gets checked out for a traumatic brain injury.\u003c/p>\n\u003cp>\"In the next iteration, will we or should we expand to include training exposures?\" Scholten says. \"Possibly so.\"\u003c/p>\n\u003cp>If they do, it could mean evaluating the brains of tens of thousands of veterans who trained with weapons like the one Daniel shot.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>You can contact Jon Hamilton at \u003c/em>\u003ca href=\"mailto:jhamilton@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>jhamilton@npr.org\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Marines+Who+Fired+Rocket+Launchers+Now+Worry+About+Their+Brains+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The military is trying to figure out whether troops can sustain brain injuries from firing certain powerful weapons. Two Marines who used to shoot these weapons think they already know.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Chris Ferrari was just 18 the first time he balanced a rocket launcher on his right shoulder and aimed it at a practice target.\u003c/p>\n\u003cp>\"Your adrenaline's going and you're trying to focus on getting that round to hit, and then you go to squeeze that trigger and, you know.\"\u003c/p>\n\u003cp>Boom!\u003c/p>\n\u003cp>The report is loud enough to burst the eardrums of anyone not wearing military-grade hearing protection. And the blast wave from the weapon is so powerful it feels like a whole-body punch.\u003c/p>\n\u003cp>\"It's exhilarating,\" says Chris's buddy Daniel, a former gunner in the Marine Corps who asked that we not use his last name. \"When you feel a concussive wave, it's an awesome thing. It fills you with awe.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It also may do bad things to your brain.\u003c/p>\n\u003cp>Studies show that troops who repeatedly fire powerful, shoulder-launched weapons can \u003ca href=\"https://academic.oup.com/acn/article/31/6/622/2236746\" target=\"_blank\" rel=\"noopener\">experience short-term problems with memory and thinking\u003c/a>. They may also feel nauseated, fatigued and dizzy. In short, they have symptoms like \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24901327\" target=\"_blank\" rel=\"noopener\">those of a concussion\u003c/a>.\u003c/p>\n\u003cp>It's still not clear whether firing these weapons can lead to long-term brain damage. But Chris and Daniel suspect that, for them, it may have.\u003c/p>\n\u003cp>While in the Marines, Daniel and Chris spent two years in the late 1990s firing a rocket launcher called the shoulder-launched multipurpose assault weapon, or \u003ca href=\"https://www.globalsecurity.org/military/systems/ground/smaw.htm\" target=\"_blank\" rel=\"noopener\">SMAW\u003c/a>.\u003c/p>\n\u003cp>They were a team. Chris loaded the rockets. Daniel pulled the trigger. Then they would switch places.\u003c/p>\n\u003cp>And together, they fired hundreds of rounds in training exercises around the world.\u003c/p>\n\u003cp>\"That's me and Daniel at the base of Mount Fuji, posing for a picture with our SMAW,\" Chris says as he leafs through an album of photographs Daniel put together.\u003c/p>\n\u003cp>The SMAW is one of several modern weapons light enough for one person to carry but powerful enough to blow up a tank.\u003c/p>\n\u003cp>Daniel and Chris say they felt like their brains had been rattled every time they fired the SMAW. And they fired it a lot.\u003c/p>\n\u003cp>\"Chris and I were incredibly good shots,\" Daniel says.\u003c/p>\n\u003cp>\"We never missed,\" Chris adds. \"We were always selected by our sergeant and our leaders to do the firing because they wanted to see the explosion, you know, they wanted to see the target get hit.\"\u003c/p>\n\u003cp>But as the two men fired the SMAW again and again, some of the thrill began to fade.\u003c/p>\n\u003cp>Every shot \"felt like the world was caving in on you,\" Chris says.\u003c/p>\n\u003cp>The U.S. military limits the number of times troops can fire heavy weapons like the SMAW in a single day. But the limits are based on concern about hearing loss, not brain damage.\u003c/p>\n\u003cp>And 20 years ago, safety wasn't taken very seriously, Daniel says.\u003c/p>\n\u003cp>\"I remember they were saying you're only allowed to shoot three of these things a day because it's, like, really bad for you,\" he says. \"And then I would shoot three and then you [Chris] would shoot three. And then the guys 10 feet from us would shoot six and then the other team would shoot six.\"\u003c/p>\n\u003cp>Chris had a lot of headaches, and sometimes couldn't think straight after a day on the range. \"You feel odd and you feel out of place and you feel exhausted and tired,\" he says. \"But, you know, you're a Marine and you learn to put it away.\"\u003c/p>\n\u003cp>Until you can't.\u003c/p>\n\u003cp>For Daniel, that happened during a joint training exercise in Malaysia. Their platoon was still setting up, Chris says, \"and all of sudden out of nowhere: Boom!\"\u003c/p>\n\u003cp>Malaysian troops just a few feet away had fired an antitank weapon called the \u003ca href=\"https://saab.com/land/weapon-systems/support-weapons/at4/\" target=\"_blank\" rel=\"noopener\">AT4\u003c/a>. The blast wave hit Daniel hard.\u003c/p>\n\u003cp>\"I was, like, absolutely dizzy,\" Daniel says. \"I was absolutely disjointed. I felt nauseous, like I really felt like I needed to throw up.\"\u003c/p>\n\u003cp>So Daniel told his sergeant. \"And it was just: 'Shut your face. Are you complaining? Why is everyone else OK and you're not?' \"\u003c/p>\n\u003cp>\u003cstrong>Blast Injuries Overlooked\u003c/strong>\u003c/p>\n\u003cp>Back then, in the 1990s, the military pretty much assumed a fighter's brain was fine unless there was some external sign of injury.\u003c/p>\n\u003cp>That was because, at the time, no one really understood how an invisible blast wave could damage the brain without leaving a mark, says Tracie Lattimore, who directs the Army's traumatic brain injury program.\u003c/p>\n\u003cp>\"The science wasn't up to speed,\" she says. \"It just didn't exist.\"\u003c/p>\n\u003cp>But since 2007, Lattimore says, the Department of Defense has spent about a billion dollars studying traumatic brain injuries, including those caused by blast exposure.\u003c/p>\n\u003cp>At first, the research focused on bomb blasts, especially those from the improvised explosive devices that had become common in Iraq and Afghanistan.\u003c/p>\n\u003cp>But over time, Lattimore says, the military's research has expanded beyond IEDs to include the effects of blasts from weapons like the one Chris and Daniel shot.\u003c/p>\n\u003cp>\"If you talk to us in a year from now, I think we're going to have exponential growth in our knowledge coming out of these current studies and our future studies,\" Lattimore says.\u003c/p>\n\u003cp>Eventually, that could help the hundreds of thousands of veterans who have fired these weapons in the past couple of decades.\u003c/p>\n\u003cp>But right now, people like Daniel and Chris have no way to know whether firing heavy weapons could have affected their brains.\u003c/p>\n\u003cp>Chris wonders whether all those blasts might be the reason he once landed in a military hospital for two weeks.\u003c/p>\n\u003cp>It happened after a weeklong training exercise in the California desert near Twentynine Palms. Thousands of troops took part and Daniel and Chris fired lots and lots of rockets. They also set off lots of explosives.\u003c/p>\n\u003cp>Several days after the exercise ended, Daniel noticed that Chris was awake in the middle of the night.\u003c/p>\n\u003cp>\"He just got up and started walking out of the room in his stinking underwear,\" Daniel says. \"And I was like, 'Hey Chris, what's going on?' And he was just kind of like looking through me.\"\u003c/p>\n\u003cp>\"I don't remember it,\" Chris says. \"But I know that they put me in the hospital and thought I had spinal meningitis or something.\"\u003c/p>\n\u003cp>He didn't. And the doctors never pinpointed another cause. They clearly thought something was wrong with his brain. But at the time, no one would have thought to ask whether the problem was caused by the weapons Chris had fired.\u003c/p>\n\u003cp>Chris's military career ended one morning when his platoon left on a bus and he didn't get on it. Ultimately, he got a bad conduct discharge.\u003c/p>\n\u003cp>It's been nearly two decades since Chris and Daniel fired the SMAW.\u003c/p>\n\u003cp>They've both settled in Northern California, which is where they grew up. And they both have symptoms that could be from a brain injury — or something else.\u003c/p>\n\u003cp>Chris has lots of questions.\u003c/p>\n\u003cp>\"Why does this hurt on my body? Why do I feel lost? Why can't I concentrate on stuff as long [as I used to]?\"\u003c/p>\n\u003cp>Chris also has trouble controlling his emotions, something he says wasn't a problem before his military service.\u003c/p>\n\u003cp>For Daniel, it's his memory that's the problem.\u003c/p>\n\u003cp>\"I used to be photographic. Now I'm forgetful,\" he says. \"I'm 40, that's ... I don't know, man. Maybe I'm getting old.\"\u003c/p>\n\u003cp>Both Chris and Daniel have problems with balance and orientation. For Daniel it can happen when he turns his head quickly or stumbles.\u003c/p>\n\u003cp>\"I lose my spatial orientation,\" he says. \"I don't know where I am. Vision gets blurrier. Even sound is kind of muffled.\"\u003c/p>\n\u003cp>These are common symptoms of damage to the brain's \u003ca href=\"https://vestibular.org/understanding-vestibular-disorder/human-balance-system\" target=\"_blank\" rel=\"noopener\">vestibular system\u003c/a>, something that affects many people who have experienced a traumatic brain injury from a bomb blast or blow to the head.\u003c/p>\n\u003cp>\u003cstrong>Uncertain Coverage \u003c/strong>\u003c/p>\n\u003cp>But Daniel and Chris were never in combat and never were injured in any obvious way during training. That means it's not clear whether they are entitled to care from doctors and hospitals run by the Department of Veterans Affairs.\u003c/p>\n\u003cp>Chris has never tried to get care from the VA. But Daniel has. And he learned that the VA doesn't have an obvious category for people like him.\u003c/p>\n\u003cp>Daniel had never connected his symptoms with his time as a Marine until he heard a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/20/506146595/pentagon-shelves-blast-gauges-meant-to-detect-battlefield-brain-injuries\" target=\"_blank\" rel=\"noopener\">radio story\u003c/a> on NPR suggesting that certain military weapons might be powerful enough to give the shooter a traumatic brain injury.\u003c/p>\n\u003cp>\"I went back to the VA and I said I want to be tested for TBI,\" he says. \"And they said great.\"\u003c/p>\n\u003cp>They handed him a questionnaire. The first question asked where he had been in combat. But he hadn't been.\u003c/p>\n\u003cp>The second question asked: \"Were you hit by an IED?\" Daniel says it went on: \"Was it a grenade explosion? Was a bomb dropped too close to you?\" So I couldn't actually answer the questionnaire.\"\u003c/p>\n\u003cp>All he'd done was fire a rocket launcher in training exercises, over and over and over.\u003c/p>\n\u003cp>VA doctors see quite a few veterans like Daniel, says \u003ca href=\"https://www.washingtondc.va.gov/management/index.asp?cx=1&key=15\" target=\"_blank\" rel=\"noopener\">Dr. Joel Scholten\u003c/a>, who's in charge of physical medicine and rehabilitation for the VA. He says the conversation usually goes like this:\u003c/p>\n\u003cp>\"While I was training we fired a certain type of weapon. I felt dizzy or had some ringing in my ears after that.\"\u003c/p>\n\u003cp>Then Scholten asks if the veteran was ever near a bomb blast or took a blow to the head. Many say yes. And for them, VA guidelines call for a full examination for traumatic brain injury.\u003c/p>\n\u003cp>But for veterans like Daniel, coverage is uncertain. That's because there still isn't clear evidence that training with heavy weapons can cause long-term problems with things like memory, thinking and balance.\u003c/p>\n\u003cp>\"These symptoms are what we call nonspecific,\" Scholten says. \"So they're not unique to traumatic brain injury, and in fact there is no symptom that happens only with traumatic brain injury or concussion.\"\u003c/p>\n\u003cp>From a medical perspective, the lack of a box to tick is not a big deal. Treatments usually focus on improving a patient's symptoms, regardless of the cause.\u003c/p>\n\u003cp>\"For instance, someone with cognitive or concentration impairments, we would focus our therapy on how to improve concentration,\" Scholten says.\u003c/p>\n\u003cp>But paying for therapy is another matter. The VA gives priority to veterans whose medical problems can be linked to their service.\u003c/p>\n\u003cp>And since military scientists still aren't sure whether firing a powerful weapon can have long-term effects, Daniel says the VA is sending him the bill. He's being asked to pay out of pocket for high-tech brain scans and other tests.\u003c/p>\n\u003cp>\"I love the VA,\" Daniel says. \"I have nothing bad to say about the VA. The individuals there get it. They really do. But their hands are typically tied by their process.\"\u003c/p>\n\u003cp>\u003ca href=\"https://blastinjuryresearch.amedd.army.mil/index.cfm/sos/neurological_effects_of_repeated_exposure\" target=\"_blank\" rel=\"noopener\">Studies\u003c/a> now underway should help clear up whether people like Daniel could have been harmed by the weapons they fired, Scholten says. And the results of those studies will be used to update the VA's guidelines on who gets checked out for a traumatic brain injury.\u003c/p>\n\u003cp>\"In the next iteration, will we or should we expand to include training exposures?\" Scholten says. \"Possibly so.\"\u003c/p>\n\u003cp>If they do, it could mean evaluating the brains of tens of thousands of veterans who trained with weapons like the one Daniel shot.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>You can contact Jon Hamilton at \u003c/em>\u003ca href=\"mailto:jhamilton@npr.org\" target=\"_blank\" rel=\"noopener\">\u003cem>jhamilton@npr.org\u003c/em>\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Marines+Who+Fired+Rocket+Launchers+Now+Worry+About+Their+Brains+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Most People Think Pot's Totally Safe. But We Don't Actually Know",
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"content": "\u003cp>When it comes to pot, many Americans seem to think it is a magic cure-all despite the lack of scientific data to corroborate that view.[contextly_sidebar id=\"qbIMJ6HAj7B7PdjXyzZ3WGlgtNv4dD58\"]\u003c/p>\n\u003cp>Those are the findings of a new survey, published this week in the journal \u003ca href=\"http://annals.org/aim/article/doi/10.7326/M18-0810\">\u003cem>Annals of Internal Medicine\u003c/em>. \u003c/a>The online survey, conducted by researchers at UC San Francisco, found that many Americans believe marijuana has significant health benefits, despite a lack of scientific data to support that view.\u003c/p>\n\u003cp>That data lack is largely due to marijuana's restricted legal status in the U.S., which makes it difficult for scientists to study the drug's impact on human health, according to Timothy Fong, a professor of addiction psychiatry at UC Los Angeles.\u003c/p>\n\u003cp>[contextly_sidebar id=\"1hOtotjglJ20ftdvAgNx5fpFHerDNbOZ\"]Without actual data to go on, people fall back on personal or anecdotal evidence.\u003c/p>\n\u003cp>\"We want to do more studies, but we can’t do a darn thing if the federal government handcuffs us,” Fong told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “This is the kind of study that I think elevates the discussion. And it shows we have a long way to go.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers surveyed 16,280 people in the U.S. and found that 81 percent of respondents believe that smoking marijuana has at least one health benefit, with pain management being the most commonly cited one.\u003c/p>\n\u003cp>Yet a separate study \u003ca href=\"https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30110-5/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">spanning four years\u003c/a> found no evidence that marijuana use improves the symptoms of chronic pain.\u003c/p>\n\u003cp>The survey also found that 91 percent of respondents believe that marijuana has at least one risk, but the most commonly cited risk — legal trouble — wasn't health related, a finding researchers found troubling because it indicates that many people are downplaying potential harm, according to \u003ca href=\"http://chime.ucsf.edu/people/salomeh-keyhani-md\" target=\"_blank\" rel=\"noopener\">Dr. Salomeh Keyhani,\u003c/a> a professor of medicine at UC San Francisco.\u003c/p>\n\u003cp>“The American public has a much more favorable point of view than is warranted by the evidence,” Dr. Keyhani told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “Perhaps most concerning is that they think that it prevents health problems.”\u003c/p>\n\u003cp>The survey found that 18 percent of respondents believe that smoking marijuana is somewhat or completely safe for adults.\u003c/p>\n\u003cp>In addition, nearly half of those surveyed believe that marijuana can alleviate insomnia, anxiety and depression, none of which are scientifically established, says Dr. Keyhani.[contextly_sidebar id=\"llwIT8YXMfGYSqJGFFEv4ackgmMz0K5Q\"]\u003c/p>\n\u003cp>\"The bottom line is that there's no evidence for the vast majority of this,\" Dr. Keyhani told \u003ca href=\"https://www.livescience.com/63141-marijuana-assumed-beneficial.html\" target=\"_blank\" rel=\"noopener\">Livescience\u003c/a>. \"There's limited data on harm, and people think that means it's OK.\"\u003c/p>\n\u003cp>Researchers created the survey to examine the impact of marketing on the public's perception of marijuana. From \u003ca href=\"https://www.theguardian.com/society/2018/jul/23/cannabis-health-benefits-american-attitudes-study\" target=\"_blank\" rel=\"noopener\">the Guardian\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Mixed signals regarding marijuana’s potential dangers and benefits have enabled the commercial marijuana industry to promote a maximalist view of marijuana’s possible benefits. Since direct unproven claims of marijuana’s medical benefits, and assertions such as that a product cures cancer, can lead to unwanted attention from the FDA regulators, cannabis companies have learned to be much more subtle.\u003c/p>\u003c/blockquote>\n\u003cp>Despite the federal ban on marijuana, the Food and Drug Administration \u003ca href=\"https://www.kqed.org/futureofyou/443383/meet-sam-the-berkeley-kid-who-inspired-first-marijuana-based-drug\" target=\"_blank\" rel=\"noopener\">recently approved Epidiolex, an epilepsy drug\u003c/a> derived from marijuana. Medical marijuana is also legal in 31 states, a fact that only contributes to its rosy reputation.\u003c/p>\n\u003cp>Still, Keyhani says more research needs to be done. Until that happens, most of the health claims touted by the industry remain unproven.\u003c/p>\n\u003cp>“We need better data,” Keyhani told the Guardian. “We need any data.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When it comes to pot, many Americans seem to think it is a magic cure-all despite the lack of scientific data to corroborate that view.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Those are the findings of a new survey, published this week in the journal \u003ca href=\"http://annals.org/aim/article/doi/10.7326/M18-0810\">\u003cem>Annals of Internal Medicine\u003c/em>. \u003c/a>The online survey, conducted by researchers at UC San Francisco, found that many Americans believe marijuana has significant health benefits, despite a lack of scientific data to support that view.\u003c/p>\n\u003cp>That data lack is largely due to marijuana's restricted legal status in the U.S., which makes it difficult for scientists to study the drug's impact on human health, according to Timothy Fong, a professor of addiction psychiatry at UC Los Angeles.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Without actual data to go on, people fall back on personal or anecdotal evidence.\u003c/p>\n\u003cp>\"We want to do more studies, but we can’t do a darn thing if the federal government handcuffs us,” Fong told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “This is the kind of study that I think elevates the discussion. And it shows we have a long way to go.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Researchers surveyed 16,280 people in the U.S. and found that 81 percent of respondents believe that smoking marijuana has at least one health benefit, with pain management being the most commonly cited one.\u003c/p>\n\u003cp>Yet a separate study \u003ca href=\"https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30110-5/fulltext?code=lancet-site\" target=\"_blank\" rel=\"noopener\">spanning four years\u003c/a> found no evidence that marijuana use improves the symptoms of chronic pain.\u003c/p>\n\u003cp>The survey also found that 91 percent of respondents believe that marijuana has at least one risk, but the most commonly cited risk — legal trouble — wasn't health related, a finding researchers found troubling because it indicates that many people are downplaying potential harm, according to \u003ca href=\"http://chime.ucsf.edu/people/salomeh-keyhani-md\" target=\"_blank\" rel=\"noopener\">Dr. Salomeh Keyhani,\u003c/a> a professor of medicine at UC San Francisco.\u003c/p>\n\u003cp>“The American public has a much more favorable point of view than is warranted by the evidence,” Dr. Keyhani told \u003ca href=\"https://www.reuters.com/article/us-health-marijuana/americans-view-of-marijuana-is-rosy-and-unscientific-idUSKBN1KD2IR\" target=\"_blank\" rel=\"noopener\">Reuters.\u003c/a> “Perhaps most concerning is that they think that it prevents health problems.”\u003c/p>\n\u003cp>The survey found that 18 percent of respondents believe that smoking marijuana is somewhat or completely safe for adults.\u003c/p>\n\u003cp>In addition, nearly half of those surveyed believe that marijuana can alleviate insomnia, anxiety and depression, none of which are scientifically established, says Dr. Keyhani.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"The bottom line is that there's no evidence for the vast majority of this,\" Dr. Keyhani told \u003ca href=\"https://www.livescience.com/63141-marijuana-assumed-beneficial.html\" target=\"_blank\" rel=\"noopener\">Livescience\u003c/a>. \"There's limited data on harm, and people think that means it's OK.\"\u003c/p>\n\u003cp>Researchers created the survey to examine the impact of marketing on the public's perception of marijuana. From \u003ca href=\"https://www.theguardian.com/society/2018/jul/23/cannabis-health-benefits-american-attitudes-study\" target=\"_blank\" rel=\"noopener\">the Guardian\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>Mixed signals regarding marijuana’s potential dangers and benefits have enabled the commercial marijuana industry to promote a maximalist view of marijuana’s possible benefits. Since direct unproven claims of marijuana’s medical benefits, and assertions such as that a product cures cancer, can lead to unwanted attention from the FDA regulators, cannabis companies have learned to be much more subtle.\u003c/p>\u003c/blockquote>\n\u003cp>Despite the federal ban on marijuana, the Food and Drug Administration \u003ca href=\"https://www.kqed.org/futureofyou/443383/meet-sam-the-berkeley-kid-who-inspired-first-marijuana-based-drug\" target=\"_blank\" rel=\"noopener\">recently approved Epidiolex, an epilepsy drug\u003c/a> derived from marijuana. Medical marijuana is also legal in 31 states, a fact that only contributes to its rosy reputation.\u003c/p>\n\u003cp>Still, Keyhani says more research needs to be done. Until that happens, most of the health claims touted by the industry remain unproven.\u003c/p>\n\u003cp>“We need better data,” Keyhani told the Guardian. “We need any data.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Words Matter When Talking About Pain With Your Doctor",
"title": "Words Matter When Talking About Pain With Your Doctor",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.[contextly_sidebar id=\"PzT9DEOa22PlTyV4kUDRN8kM4A2CX5Tx\"]\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.[contextly_sidebar id=\"gNyBEO7kaaOOQQPLiTFHH1VcWAsQe2Bq\"]\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.[contextly_sidebar id=\"ClUbqCuoEqdLIyjzgS1I1irhMb4fhntn\"]\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.[contextly_sidebar id=\"jBdk15Gcdb1FQXh8PlzSvMvHZmeTdBu9\"]\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "When you go to the doctor in pain, you'll probably be asked to rate your discomfort on a scale of 0 to 10. But doctors say there may be a better way to assess pain.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
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"order": 10
},
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},
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"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
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"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
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"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"order": 1
},
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"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"meta": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
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"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
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"source": "kqed",
"order": 9
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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"id": "freakonomics-radio",
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"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
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"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
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},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
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"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
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"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
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},
"link": "/radio/program/latino-usa",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
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"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
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"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
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"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
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"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
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"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
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"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg",
"imageAlt": "On Our Watch from NPR and KQED",
"officialWebsiteLink": "/podcasts/onourwatch",
"meta": {
"site": "news",
"source": "kqed",
"order": 11
},
"link": "/podcasts/onourwatch",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw",
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}
},
"on-the-media": {
"id": "on-the-media",
"title": "On The Media",
"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
"airtime": "SUN 2pm-3pm, MON 12am-1am",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png",
"officialWebsiteLink": "https://www.wnycstudios.org/shows/otm",
"meta": {
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"source": "wnyc"
},
"link": "/radio/program/on-the-media",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2",
"tuneIn": "https://tunein.com/radio/On-the-Media-p69/",
"rss": "http://feeds.wnyc.org/onthemedia"
}
},
"pbs-newshour": {
"id": "pbs-newshour",
"title": "PBS NewsHour",
"info": "Analysis, background reports and updates from the PBS NewsHour putting today's news in context.",
"airtime": "MON-FRI 3pm-4pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.pbs.org/newshour/",
"meta": {
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"source": "pbs"
},
"link": "/radio/program/pbs-newshour",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2",
"tuneIn": "https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/",
"rss": "https://www.pbs.org/newshour/feeds/rss/podcasts/show"
}
},
"perspectives": {
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