Science Vs: How a Nation Got Hooked

Science Vs. a podcast produced by Gimlet media, highlighted the making of the opioid epidemic in their March 22nd cast.  They feature the perspectives of a chemist/professor from Wisconsin (whoot!), a pain specialist from Washington as well as an emergency physician from Philadelphia. The podcast largely echos the sentiment from our most recent read, so consider adding it to your commute or work out play list.  Lastly a quick shout out to the podcast show notes with EXTENSIVE use of citations to call out scientific literature. Don’t miss this entertaining format delivering you the evidence right to your ear buds!

More people in the U.S. died from opioids in 2016 than the peak year of the AIDS epidemic. So how did we get here? We speak to Prof. June Dahl, pain specialist Dr. David Tauben, and emergency physician Dr. Jeanmarie Perrone.” (1)

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https://gimletmedia.com/shows/science-vs/6nh3lg/opioids-how-america-got-hooked?utm_source=gimletPlayer&utm_medium=copyShare&utm_campaign=gimletPlayer

  1. Science Vs. Opioids: How America Got Hooked | Science Vs. Gimlet. https://gimletmedia.com/shows/science-vs/6nh3lg. Published April 15, 2019. Accessed June 13, 2019.
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Featured Book: Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference

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Consider adding this book to your reading list!  Featured in a post by the Gold Humanism Honor society, a most recent review suggest that compassion, may be the fix for healthier patients and more resilient doctors.

“Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference,” written by physician-scientist team Stephen Trzeciak and Anthony Mazzarelli, provides overwhelming evidence for the healing power of compassion. Kindness brings longer, healthier lives not only for patients, the book argues, but also for health-care professionals. When a physician is compassionate, patients heal better and faster, and the doctors are happier and less burned out.” (1)

Now available on Amazon, it promises to be a read promising for both it’s base in evidenced based medicine but also in its power to ground practitioners in a simple practice, compassion.

 

  1. Seppälä E. Doctors who are kind have healthier patients who heal faster, according to new book. The Washington Post. https://www.washingtonpost.com/lifestyle/2019/04/29/doctors-who-show-compassion-have-healthier-patients-who-heal-faster-according-new-book/?utm_term=.ee113361d615. Published April 29, 2019. Accessed May 22, 2019.

The hardship of methadone clinics in rural Arizona

Learning more and more about heroin addiction as well as the rise of synthetic medications developed to treat addiction through the narrative of Dreamland, I wondered what it might be like for our patients in Arizona.  I came across this recent article highlighting the struggle to fight addiction in rural Arizona and the long journey, both literally and figuratively, that patient’s travel to access methadone.

“I never wake up and go, ‘I can’t wait to take my methadone.’ It’s just part of the day, like drinking a cup of coffee,” says Maggie Phillips, who credits methadone treatment for her sobriety. “I feel healthier and happier now than I ever have in my life.” (1)

“Phillips straps her younger sons into their car seats and pulls out of the driveway for their once-a-month trip to Safford. The round trip is long for kids, but it’s half as long as it once was – Phillips used to travel all the way to Tucson, every day, for months, until Community Medical Services opened a year ago.

She has to get there before the clinic closes at 11:30 a.m. If she misses her appointment, she has to make the same trip the next day, or suffer drug withdrawals and miss another chance to beat her addiction.

“I have kids. I want to be sober for them,” said Phillips, 29, a homemaker whose husband stays behind to work. “The treatment helps me stay sober. It’s helped me be where I’m at today.”

Fighting opioid addiction always is tough, but it’s even tougher for rural residents who live miles from treatment clinics. Most clinics in the U.S., built in response to the heroin epidemic of the 1970s, are in big cities. These days, drug abuse has expanded to the suburbs and rural areas but the facilities to treat it have lagged because of funding shortages and the stigma around drug-treatment facilities.

In Arizona, 12 clinics treat addiction with methadone – a synthetic opioid used for decades to stabilize users and minimize withdrawal symptoms – but most are in the Phoenix area.” (1)

Check out the full length story at: https://cronkitenews.azpbs.org/2019/04/03/rural-methadone/

  1. Carbajal L. Methadone clinics centered in Phoenix. Cronkite News – Arizona PBS. https://cronkitenews.azpbs.org/2019/04/03/rural-methadone/. Published April 4, 2019. Accessed May 22, 2019.

American College of Emergency Physicians: Opioid Update

ACEP highlights the latest updates in Emergency Medicine regarding the opioid crisis. Upcoming next week is a conversation with Dan Quinones, author of Dreamland. (1)

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https://soundcloud.com/acep-frontline/ryan-stanton-md-facep-opioid-update-state-of-the-union?fbclid=IwAR0hvLz09bHZHfOtuNMvjg4Baa-R3wK5jF7Jdnt3MjQjJAYC_Fxlv_OJbUI

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https://www.acep.org/globalassets/new-pdfs/education/opioids/acep-opioid-flyer.pdf

  1. ACEP. American College of Emergency Physicians – ACEP. Opioids: Get an update on the crisis via… – American College of Emergency Physicians – ACEP. https://www.facebook.com/ACEPFan/photos/a.109462266177/10157624301806178/?type=3&theater. Accessed May 18, 2019.

Unique Business Model

Dan Quinones tells of the dreams of Xalisco boys and how their plans to support their families and return heroic to their small communities in Mexico spurred a public health crisis.

“Avila was part of a migration of impoverished Mexican sugar cane farm workers that has had profound repercussions for cities and towns across America. Over the last decade and a half, immigrants from the county of Xalisco (population 44,000), in the Pacific Coast state of Nayarit, have developed a vast and highly profitable business selling black-tar heroin, a cheap, potent, semi-processed form of the drug.” (1)

In Dream Land, Quinones talks with former junkies, gleaning the from them the unique relationship the Xalisco boys chartered with their customers. The were overall, nonviolent, usually polite and their customers forging a therapeutic relationship, dealers would service their needs, at competitively low prices in customer friendly, human way.

It is curious that in the quest to dull pain, addicts promoted a responsive, almost thoughtful delivery model and a gentile workforce as the ideal business plan to spark a heroin epidemic. Maybe this in a world of hurt a human touch was what people need, something that both heroin users and dealers yearned for?

  1. Quinones S. The good life in Xalisco can mean death in the United States. Los Angeles Times. https://www.latimes.com/archives/la-xpm-2010-feb-16-la-me-blacktar16-2010feb16-story.html. Published February 16, 2010. Accessed May 18, 2019.
  2. Quinones S. Serving All Your Heroin Needs. The New York Times. https://www.nytimes.com/2015/04/19/opinion/sunday/serving-all-your-heroin-needs.html. Published April 17, 2015. Accessed May 18, 2019.

How medical professionals talk about disease matters                       

Language is powerful. What we say about disease and how we communicate about illness frame how the public sees, approaches and supports patients.   From cancer to HIV to tuberculosis, the way in which civilians have taken ownership of the promotion and conversation of chronic diseases has greatly changed the disease outlook for common conditions.

Natalie Holt poses, “So cancer, TB and HIV, they are all connected by this cycle of lies and stigma often perpetuated by medical professionals and then something unexpected happens, someone emerges who is not necessarily a clinician, that changes the way a disease is perceived.”

Take a gander at her TEDx talk. Take a second to think about how your actions, often bourn out of thoughts and words, affect stigma of a given illness or disease state.

 

Summer Book Selection: Dreamland

Coming to a discussion near you, the week fo June 17th is Dreamland by Sam Quinones!

Below is a highlighted review of the book from NY Magazine’s the Strategist.  The page has a wonderful selection of similar books on the topic if you’re already familiar with Dreamland or interested on the topic! (http://nymag.com/strategist/article/essential-books-about-the-opioid-crisis.html)

Quinones tackles two stories of capitalism in Dreamland, a book recommended by four of our experts: (1) Purdue’s relentless marketing of OxyContin and (2) the simultaneous inundation of black tar heroin from Mexico’s west coast. The book contains interviews with pharmaceutical pioneers, Mexican entrepreneurs, narcotics investigators, as well as addicts and their families, and it shows how the collision of these two events led to an unmitigated disaster that has devastated communities across the country. Eve Marson, the director of Dr. Feelgood, says the book paints “a devastating picture of Americans whose lives have been destroyed by both prescription opiates and street heroin. [Quinones] carefully reveals how these two epidemics are intrinsically linked.” “The writing is taut and meticulous,” says Peltz. “And the portraits he paints of the humans affected are powerful and painful. Quinones documents in this book how America’s two powerful addictions — opioids and greed — combined to create one of the most devastating epidemics in the country’s history.” (1)

  1. Schneider K. The Most Essential Books for Wrapping Your Head Around the Opioid Crisis. The Strategist. http://nymag.com/strategist/article/essential-books-about-the-opioid-crisis.html. Published September 10, 2018. Accessed April 15, 2019.

Summer 2019 Book Selection

Check out the list of top picks for the 2019 Copa Book Club summer selection:

 

Pete Farley’s Crazy

Recommended to our state senator on ED Doc Day at the Capitol, a evocative look into the interaction between mental health and our justice system. 9780425213896.jpeg

“Former Washington Post reporter Pete Earley had written extensively about the criminal justice system. But it was only when his own son- in the throes of a manic episode-broke into a neighbor’s house that he learned what happens to mentally ill people who break a law.

This is the Earley family’s compelling story, a troubling look at bureaucratic apathy and the countless thousands who suffer confinement instead of care, brutal conditions instead of treatment, in the “revolving doors” between hospital and jail. With mass deinstitutionalization, large numbers of state mental patients are homeless or in jail-an experience little better than the horrors of a century ago. Earley takes us directly into that experience-and into that of a father and award-winning journalist trying to fight for a better way” (1)

Books with similar topics include: The Center Cannot Hold and Brain on Fire

Sam Quinoes’ Dream Land

An ongoing recommendation throughout research regarding opioid use and misuse, an honest look at one man’s perspective on the makings of our opioid crisis.

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“With a great reporter’s narrative skill and the storytelling ability of a novelist, acclaimed journalist Sam Quinones weaves together two classic tales of capitalism run amok whose unintentional collision has been catastrophic. The unfettered prescribing of pain medications during the 1990s reached its peak in Purdue Pharma’s campaign to market OxyContin, its new, expensive—and extremely addictive—miracle painkiller. Meanwhile a massive influx of black tar heroin—cheap, potent, and originating from one small county on Mexico’s west coast, independent of any drug cartel—assaulted small towns and midsized cities across the country, driven by a brilliant, almost unbeatable marketing and distribution system. Together these phenomena continue to lay waste to communities from Tennessee to Oregon, Indiana to New Mexico.” (2)

 

David Eagleman’s Sum- Tales from the Afterlife (Short Stories!)

My current read and an international best seller, Eagleman takes a look at what lies beyond.

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“SUM shows us forty wonderfully imagined possibilities of life beyond death. In one afterlife you may find that God is the size of a microbe and is unaware of your existence. In another, your creators are a species of dim-witted creatures who built us to figure out what they could not. In a different version of the afterlife you work as a background character in other people’s dreams. Or you may find that the afterlife contains only people whom you remember, or that the hereafter includes the thousands of previous gods who no longer attract followers. In some afterlives you are split into your different ages; in some you are forced to live with annoying versions of yourself that represent what you could have been; in others you are re-created from your credit card records and Internet history. Many versions of our purpose here are proposed; we are mobile robots for cosmic mapmakers, we are reunions for a scattered confederacy of atoms, we are experimental subjects for gods trying to understand what makes couples stick together. These tales—at once witty, wistful and unsettling—are rooted in science and romance and awe at our mysterious existence while asking the key questions about death, hope, technology, immortality, love, biology and desire that expose radiant new facets of our humanity.” (3)

Target dates for our Summer 2019 discussion include the week of June 17th!

1. Early P. Crazy . Amazon. https://www.amazon.com/Crazy-BYEarley-Earley/dp/B006RU0MKK/ref=sr_1_1?keywords=crazy book&qid=1554768709&s=books&sr=1-1. Published January 1, 1970. Accessed April 9, 2019.

2. Quinones S. Dreamland: The True Tale of America’s Opiate Epidemic. Amazon. https://www.amazon.com/Dreamland-True-Americas-Opiate-Epidemic/dp/1511336404. Accessed April 9, 2019.

3. Eagleman D. Sum: Tales from the Afterlives. Amazon. https://www.amazon.com/Sum-Tales-Afterlives-David-Eagleman/dp/1491503629. Accessed April 9, 2019.

 

Spring Book Discussion: Cutting for Stone

Please see our weekly digest for the most up to date information on our Spring Meal and Discussion on Wednesday, March 27th 630p at Casa De McElhinny

Below is a quick summary of the book courtesy of Penguin Random House books if you’re shy, otherwise just come for the food, stay for the conversation on life and medicine!

“An epic novel that spans continents and generations, Cutting for Stone is an unforgettable story of love and betrayal, compassion and redemption, exile and home that unfolds across five decades in India, Ethiopia, and America.

Narrated by Marion Stone, the story begins even before Marion and his twin brother, Shiva, are born in Addis Ababa’s Missing Hospital (a mispronunciation of “Mission Hospital”), with the illicit, years-in-the-making romance between their parents, Sister Mary Joseph Praise, a beautiful Indian nun, and Thomas Stone, a brash, brilliant British surgeon. Mary and Thomas meet on a boat out of Madras in 1947; she follows him to Ethiopia and to Missing, where they work side by side for seven years as nurse and doctor. After Mary dies while giving birth to the twins—a harrowing, traumatic scene on the operating table—Thomas vanishes, and Marion and Shiva grow up with only a dim sense of who he was, and with a deep hostility toward him for what they see as an act of betrayal and cowardice.

The twins are raised by Hema and Ghosh, two Indian doctors who also work at Missing, and who shower Marion and Shiva with love and nurture their interest in medicine—part of the deep, almost preternatural connection the brothers share. They are so close that Marion, as a boy, thinks of them as a single entity: ShivaMarion.

Marion and Shiva come of age as Ethiopia hovers on the brink of revolution, and their lives become intertwined with the nation’s politics. Addis Ababa is a colorful, cosmopolitan city: the Italians have left behind cappuccino machines, Campari umbrellas, and a vibrant expat community. But they’ve also left a nation crippled by poverty, hunger, and authoritarian rule: Ethiopia in the 1960s and 1970s is both bolstered and trapped by its notorious emperor, Haile Selassie, and rocked by violence and civil war.

Yet it is not politics but love that tears the brothers apart: Shiva sleeps with Genet—the daughter of their housekeeper and the girl Marion has always loved. This second betrayal, now by the two people this sensitive young man loves most, sends Marion into a deep depression. And when Genet joins a radical political group fighting for the independence of Eritrea, Marion’s connection to her forces him into exile: he sneaks out of Ethiopia and makes his way to America.

Marion interns at a hospital in the Bronx, an underfunded, chaotic place where the patients are nearly as poor and desperate as those he had seen at Missing. It is here that Marion comes to maturity as a doctor and as a man. It is here, too, that he meets his father and takes his first steps toward reconciling with him. But when the past catches up to Marion—nearly destroying him—he must entrust his life to the two men he thought he trusted least in the world: the father who abandoned him and the brother who betrayed him. The surprising, stunning denouement both arises from and reenacts the major themes of Cutting for Stone: love and betrayal, forgiveness and self-sacrifice, and the inextricable union of life and death.” (1)

 

  1. Penguin Random House Books. “Cutting for Stone by Abraham Verghese – Reading Guide – PenguinRandomHouse.com: Books.” PenguinRandomhouse.com, http://www.penguinrandomhouse.com/books/183598/cutting-for-stone-by-abraham-verghese/9780375714368/readers-guide/.

Prescription for reading?

Can reading really make you happier?  Check out this piece from the New Yorker, it takes a look into to bibliotherapy. Never heard of bibliotherapy? Check out the whole article! (https://www.newyorker.com/culture/cultural-comment/can-reading-make-you-happier?platform=hootsuite)  I’ve included a few of my favorite quotes below:

“bibliotherapist at the London headquarters of the School of Life, which offers innovative courses to help people deal with the daily emotional challenges of existence.”

“The insights themselves are still nebulous, as learning gained through reading fiction often is—but therein lies its power. In a secular age, I suspect that reading fiction is one of the few remaining paths to transcendence, that elusive state in which the distance between the self and the universe shrinks. Reading fiction makes me lose all sense of self, but at the same time makes me feel most uniquely myself. ”

“A 2011 study published in the Annual Review of Psychology, based on analysis of fMRI brain scans of participants, showed that, when people read about an experience, they display stimulation within the same neurological regions as when they go through that experience themselves. We draw on the same brain networks when we’re reading stories and when we’re trying to guess at another person’s feelings.”

“So even if you don’t agree that reading fiction makes us treat others better, it is a way of treating ourselves better. ”

Check out this website from the Carnegie Library of Pittsburg, featuring The Novel Cure by Ella Berthould and Susan Elderkin:

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https://www.carnegielibrary.org/bibliotherapy-and-me/

 

Dovey, Ceridwen, and Ceridwen Dovey. “Can Reading Make You Happier?” The New Yorker, The New Yorker, 17 July 2018, http://www.newyorker.com/culture/cultural-comment/can-reading-make-you-happier?platform=hootsuite.