20 Episode results for "clinical associate professor"

Robin Austin

HIT Like a Girl

41:45 min | 1 year ago

Robin Austin

"To season two of the hit like a girl podcast where with each episode. We hear from different women experts in the health IT industry, we like to hear about what makes them tick how over come challenges work there. Especially proud of advice that would give to other women following in their footsteps and much more. I'm joined Rios and I'm Robin Roberts today. We're joined by Robin Austin who's and clinical associate professor the university of Minnesota school of nursing and a registered nurse with the background in informatics. She's focused on patient engagement mobile health, apps and patient access to health records and her most recent work relates to the use of consumer generated data, and how to leverage it for a whole person or Listrik approach to care. Let's hear more. My name is Robyn Austin. And I am currently a clinical associate professor at the university of Minnesota school of nursing. This is my fifth year there and all jump in and give a little bit of background on my road or pathway up into being at the university of Minnesota. And so I'm a registered nurse and right out of nursing school. I went to work as an owners are upgrading room nurse. And I thought that was great fascinating area of nursing to be in. It's fast paced. It's you get to see a lot of different things. But in that time period, we started using a lot of newer technology in our uprating rooms. And so I thought that was really fascinating again, one more area of being able to work across disciplines. But then also engaging the the families and patients as well. So that kind of led me into more healthy t field within healthcare, and and so in working within that for a few years, our one of our facility, I did work at their owners completely, paperless. Is. Far as documentation and charting, and so that was very newer concept at the time. And again, it was another area. I thought I could just dive right into inside became a super user on our systems and really tried to get to know more of the technology that I could be a go to person to help troubleshoot some of our own teams. And I thought that was really fascinating get into that more knowing about what was going on. And how are all these systems connected or interconnected, so to speak and then in that process? I ended up taking a couple years off a work, and I was at home with my kids, but I decided to go back and get my master's in nursing education, and at that time as well, I did a health certificate and healthcare informatics. And so I was able to really look at how can we combine nursing education and this new world of technology into our curriculum as educating some of those brand new nurses coming out. And so that was another way for me to really get into the health IT world of how are we educating our upcoming, nurses? How are we educating our current workforce? And really getting everybody up. Speed so to speak on using technology at the bedside, and as part of care management or whatever field of particularly healthcare nursing that you were in and then shortly after my masters, I realize I did a teaching opportunity as part of my master's degree, and our student teaching is really what it was called. And I realize I liked academe a lot. And I thought if I'm going to stay in this world of Kadena, I better go back and get my doctorate. And so I did a doctorate of nursing practice in specializing again in nursing informatics and part of my doctorate, I really was focusing on some of the elements of technology that I thought were fascinating. But then also maybe potentially causing made it could be having some harm meaning that I was really interested in health literacy, and how are individuals are consumers patients caregivers. How do they have access to health information? But yet now in this new world or new medium technology. What is online what is out there as far as what level of literacy that we're looking at online or is this causing people? Maybe not have access to health information. That's now so rapid on the internet. And so that led me down into the my doctorate scholarly project was focusing on how to especially particularly for older adults. How do we have them safely? Find health information online that's reliable safe and easy to use as well. So that kind of led me down that pass. And then shortly after finishing my doctorate. I moved to the university of Minnesota as a clinical faculty, and I've been there now for again, this is my fifth year being at the university of Minnesota. And actually, I'm finishing my PHD this coming fall. So adding that element of now being able to do research in this field is really quite fascinating for me. So that's a short answer to my background and how I got to wear. I am well, I think your commitment to ongoing education and your passion for just not only learning yourself. But wanting that to transcend into other clinical users future clinical users and people that are sharing that passion. About informatics patient safety is just really remarkable. Let me ask you a question looking retrospectively before we dive into kind of the here. And now, you know, we're in an age where lot of people are using electronic medical records trying to gain more option patient gauge backs of information. But it wasn't always like that. And it sounds like you started in a day in time where an implementing that it was quite new was there some people that maybe were not as thrilled or passionate about the implementation that technology back then. Yeah. Three question. And I think even now fast forwarding today, and I'll go back into a moment. But even think there are still some hesitation, even though with now, we have more research to show that patients that are more engaged have better health outcomes patients that can read medical records or their notes feel more engaged in their own care. But when I first started our was very interested in this area. It was more or less people aren't gonna want to do that. Or it was only a certain few may wanna do that. Or it was very, you know, it was it's going to cost more time and effort, and I don't have time to do that, you know, being the clinical bedside, and I agree with that. But argument is well being a nurse myself that was in a very fast paced environment. Sometimes adding one more thing to my plate was just so overwhelming. And how are we going to fit this in to make it work for providers, and nurses that are at the bedside making more seamless and at the same time engaging patients making them feel welcome and inclusive. And I think too part of the. Movement of patient engagement was better understanding better outcomes. But then also realizing that there was a piece in safety factor to it as well that Asians could read their medical records or notes and say, no, I don't think this part. Here is correct. Or I missing this piece. That was another big component that I think people are waking up to the fact of oh, this could really be, you know, a true partnership. And I think the movement also of really being very patient centered. We have to include the patient, and so that was the other part. I think that you know, there's many I think national initiatives that were going on at the same time. But I agree. It wasn't always like that. And it's been slow to get going. But I think the more we the more we know in the more patients are really getting involved. And also, the providers Sandpoint is well of understanding the value of it is becoming much more much more apparent I think much more on welcome in the health system. So to speak. So if he were a judge from a patient engagement aspect, you know, and kind of the crawl walk run of adopting and implementing and embracing that technology from where you sit where would you say that you think, you know, society in general or the majority of our that's a great question. So I think we're at the walk phase almost and I know there are some that are that early adopters that are already out there running out in front, but I think as you know, and then there are some people that are maybe don't want to engage at all. Our don't wanna use technology or can't use technology to the extent that we would think potentially. I think as a general, you know, I think of it as big bell curve. Right. So I think most of the population probably are at that walk phase. But some are certainly getting ready to launch in being in that run. And so that's where I would think a majority would be although in, you know, I love everybody to be at the run phase and everybody up to speed and gathering all their information. But at the same time, I. I appreciate the the sensitivity in the intention moving forward. Whereas sometimes I jump into little bit too quickly because it's new technology, and it's great and cool. But at the same time, we need to be very mindful of what is our intention, and do we have everything that, you know, privacy and security are huge issues. We know from the media we hear so much about the hacking going on or you know, a accounts getting infiltrated all of that. And that's very personal health data is I think a big concern for a lot of individuals. So I think it's being at that walk phase is a great spot that we're in because we still have time to adjust and we have time to adapt and be a little bit more nimble versus having to be way out in front, and then go back and change some things. So that'd be my guess is ready where people are right now. I have a question, and it's something really begin to the healthcare literacy and physically electronic health literacy, we know how however language can be and how important it is to. Be intentionally inclusive with our language. How have you seen either different patient engagement strategies or potentially mobile health apps are the engagement of patients, and are they actually understanding the information that is out there? And what is be what are being made improve that? So that more people can understand, you know, this larger healthcare conversation. Yeah. Great question. So that was a big concern of mine as well that were implementing all these great technology, you know, patient portals and all the information's online. But yet are we further creating a digital divide for versus those that can access, and maybe those that have difficulty accessing. And so I think some of the strategies that I've seen to help narrow that gap are either if they have a mobile health that maybe having that happen multiple languages would be one. I think having if patients have access to their records or and having that conversation with their provider or the nurse about. Do you understand? Maybe some of these components that are in your health record. I think having a patient portal has been helpful as well. And I know that somehow systems have what they call, you know, patient navigator that can help individuals navigate that patient portal. But even having reading it once is one thing, but then having the ability to go back to it multiple times. I think is very very beneficial. And that has served as a reference, I know for myself if I've given a prescription or instructions sometimes I may be listening. But then it's always helpful to be able to go back and reference it again to say, what did they say? Again, was that wants to times a day was at two times a day or when was it again? And so having the ability to go back and reference multiple times, and I think in very intentional about whether it's in multiple languages or having a patient navigator and showing individuals how to log in when I got my link to log into the portal, it was here's a link, and then they kinda give you a brief description of how to go in and do it. And so. Oh, that was very helpful. But I think having more conversation for individuals or having a very dedicated call line to to call and talk about that patient portal and increasing engagement around that piece of when I go in for my appointments now, I they'll they'll tell me your results will be available on the import all about however long, it will take and just that they are constantly referencing that that that I can go to that as a communication tool. Nets now part of our conversation. When I go in for an appointment. So I think that there are things that people are are systems that are doing although I think it could be maybe more intentional. But again, I know sometimes resources are very scarce in this area. I think it hit the nail on the head. When you talk about that exactly when you say, it's sometimes scarce because let's talk about the way the most people in America, get information, probably the most pervasive way which happens away from the system, Robin, which is people accessing information on their own. So we'll. Call it out the major search engines, right? And we all know them. You know, I wanna know what's going on. You know, I'm not necessarily going to the portal, even and understanding I'm the proxy for my kids, these sorts of things to gather information sent to the nurse. I'm at WWW dot what have you what are your thoughts around people accessing information that way and kind of what's going on in how we could do to me the better guide patients or their caregivers. Yeah. That's a great question and kind of an ongoing effort, and you you hit the nail to exactly that people are going. There's online for health information, and we jokingly call it Dr Google because we that's the first thing I go to Google, whatever, I think, I might be having or my kids may be having what have you? But I think that there are ways that we as consumers or patients and caregivers can safely surf and internet, and as we know kind of the internet is a little bit of the wild wild west when it comes to health information and people kind of made the some. Action that if it's on the internet. It must be true, which we know is not correct at all far from it in. So I think some of the things that I've I've kind of us pointed people to as far as making sure that you are what they used to call safe surfing or making sure that what website that you do land on there are certain checks and balances that you can do with that website, and these are somewhat applicable to a mobile health app as well. But we'll talk about online health resources at the moment. But so I always tell individuals that if you're looking for health information online, making sure that your website. You are added that GIO V or that gove or dot org or even a dot EDU, which is more for educational academic institutions, maybe maybe more reliable than dot com 'cause as dot coms may be more apt to be selling information or selling things, not always. But sometimes, and I think just being you know, what they call us iber skeptic and being making sure that you are you're. Eating. What is is? This really true is too. Good to be true. Then it might it probably is or might be and just making sure that you understand that the website is when was it last updated? I always check that part two was it in two thousand thirteen I'll though it doesn't seem that far away. But it is kinda far away. And who's updating that website? Do they have a name is there that health website that have a list of reviewers? And are they are they medical personnel are professionals it by physician nurse is it by a physical therapist, or what have you kind of website you're looking at. But making sure that it might be reviewed or put out there by someone that has a credential or licensed to be giving that information the other thing, I think to be thinking about would be in the website in general, do they have evidence to support it like is there do they reference a research article or do they reference another, you know, National Institute of health kind of website, some of our more, national, esteemed institutions that are known for their reliability. And they're good information that they put. Out and the other thing to look for is their bias within that website or health information? Meaning that are they trying to sell something in where do they get their funding funded by pharmaceutical institution, and I'm not saying they're bad. But I'm just saying just be mindful of who in might be putting out there is that, you know, acidic remedy, and they're selling something is there is there kind of in in bias in that website as well. In the last thing, I think to look for is what is the privacy statement? And this really is starting to move into the idea of mobile health at world to you know, is the website asking you put in your information. Is it asking you for your name your Email address and a phone number maybe or things that they can push back out at you as far as advertisement. So that's the other thing. I think to really understand is. Whereas my information or any data I put in here, where's it going? And so that's I think when we moved to the idea of mobile health apps, and you know, I've signed up for apps before in the past as well. But. Then I I don't really understand the privacy component is whereas data going and who owns that data. We're now getting into the idea of data ownership, and but I going back, and we'll maybe we can touch on that a little bit as well. But I think going back to the health information online is just doing some of those very simple checks of whatever resource you're on to make sure that you've comfortable with what it is. And what you're reading that is a lot of really solid advice that you're giving, and I think he made a really good transition over into the mobile health app conversation, because we all know, there's, you know, thousands if not hundreds of thousands of health apps, I believe it's one of the most popular type of app in existence. So do you have any similar or other advice for folks that are trying to narrow down? Hey, which is the best mobile health app for me. Yeah. Absolutely. And so what we talked about with online health information, you can kind of use with the mobile health app as well. I would just go more into the privacy component of that. And where's your data going and who owns that data so to speak, and I know that my fitness pal. I'll put in you know, you have to send you can put as much details you want? I think if you by the by the app itself or use the free version, I know there's different versions out there. And I'm okay with that. I was I'm fine if they track my Ron, my bike or whatever. But it's really even you're doing more of the apps that are more intense more in depth. Maybe they're tracking your blood glucose, or you're monitoring, your weight or your blood pressure things like that that might be something to be a little bit more mindful of is whereas data going who owns that data. And so also going back to making sure that is this app, even save. So we know that the ratings system that they have for apps right now is basically you can look at that five star rating. And so look at this has five stars. But we don't really know who actually has rating those apps, and I know in the past they've tried to have some rating scales or rating classic. Nations and those have not always stuck around so to speak. There was one in the past on my can't remember the name of that right now. But I know it's no longer in existence. I don't know if they're funding ran out or what happened. But I think keeping those just straight up simple checks and balances that we had talked about with online health information can be applied to a mobile health apps. But also knowing that on the F forgot to mention with a online health information is they have some websites have what's called a hone code or H O N, which is jammed for health on the internet code, and that's an independent review that that you can you can apply to your own website, and they have credential license individuals that will go and review your health website, making sure that it matches their criteria for the hone code. And then you can if it if it does you can get a little symbol at the bottom. That says this this website is certified hone code. And unfortunately, they do not have something like that right now for mobile health apps. I know that there's. Been talk of wanting to do that. But again, I think just keeping some very, you know, you as a consumer understanding what this what this mobile health app. Does doesn't do where my data may be going is something that you can do for yourself? Just because we don't have that checks and balances we don't have anything beyond a five star rating system yet to really understand. No the piece of advice. I would give is that when you view are looking for a specific app managing chronic disease, diabetes, or maybe heart disease. In blood pressure is go to some of the national organizations such as the American Association or the American Heart Association, and they themselves recommend apps as well. And so what is your professional that national kind of organization and governing body of some of those professionals, what would they recommend? And I think that's a really good place to start to say, oh, look at the American diabetic association recommends I don't know if it's my glucose buddy or something one of those names. Are diabetes pal. I think is another one and checking with that. And then also asking your provider, I think that's the other checks and balances you can do to say, hey, I'm I just saw this. It's recommended by the you know, they endorse. This should I be using this. And what would they say about it? So there's some simple things and consumers can do for themselves to be protective. I think what really talking about here is getting information in Safeway right in a responsible way. And so when we think about safety, you know, kinda wanna switch gears here for a minute. What you think about all the learning you've done all the teach teach you do. Let's talk about patient safety in informatics kind of in general, not just information seeking 'cause there's so many facets to that. What has been, you know, some of the experience or insight, you can share about just kind of the information of informatics, implementation growing and utilization, and adoption, and how that can impact, you know, patientsafety really clinical sense. And I'm sure you've seen that firsthand. Cases. Yeah. Great question. So a couple of samples I can think of that really impact patient safety is one of if patients themselves can go back in and check their own records or medication list, for example, to something this that medication reconciliation lists and have a conversation with the provider or the nurse to and both of them at the same time having it it's open up for dual conversation. Does. This is what I'm seeing is. Do you agree with this? And if there's are discrepancies. What are they? And then they may go in and kind of fix that or make some notes in there to say, I'm no longer taking this medication or I've never taken that in the past or I'm actually taking one and it's not on this list. So that I think is being able to have that conversation to have a checks and balances and to have another set of is on record as well. As always, I think, always helpful piece. I've noticed it as well. As even thinking of an I'm speaking from a nurse perspective is because that's what I know. And that's. Kinda my my my role is that being at the bedside with patients and being able to use the barcode administration for medications, and then that's tied directly to their electric health record and right away. It will come up and have an alert warning. If there's an allergy and just that I think alone has been very tremendously impactful and at the one more check and balance that we can we may read it in the in the electric health record. But able to scan it and it it's an air. Warning that comes up about the patient has as you know, civic sofa allergy, for example, another way to have that era. Warning pop up is another great example, I think of patient safety and really being able to have again, not only the patients say it, then the electron health record era warning that's coming up. So there's multiple stop points to make sure that we are doing absolutely the best possible care that we can at that point of dispension of that medication. I was just gonna say, wow. I'm really impressed Robin with everything that you're saying. And I am actually learning quite a bit through this conversation. You've mentioned in your profile shines can you share with us? What is citizen science? Yeah. Great. That's a great question. It's really I think another really exciting field that starting to really emerge out of all this piece in a gauge -ment patience taking control of their own hate health data so to speak and some of this. I think in in my opinion, and others may have other disagreements or may have other thoughts on it as well. But I think it also kind of came out of the fact that we now have access to so much data and individuals have the ability to track kind of entrenched their own health information, I can look back on my fitness pal. And look at all my past exercises that I've done, and you know, I could graph that out if I wanted to and so that was a, you know, a movement kind of called the internet of things or the quantified self so to speak that you're able to track. Pretty much anything bio physiologically that you want to that you could track and trend, but the idea of citizen science also kind of emerged out of I think individuals themselves that maybe aren't quote unquote trained scientists doing some science on their own. Maybe looking at nature patterns weather patterns, and now we've translated that idea from more of earth science, you know, environmental science world into health and some of that has started to emerge by people that are just super curious about their own health. Maybe they were diagnosed with something. And now I wanna be able to monitor it myself and not have to rely on my health provider all of the time, but have it as an opportunity for a conversation or other individuals have emerged as kind of being able to monitor their own health out of crisis. Maybe that they've needed to do this because of necessity or the fact that they were it was brand new to them, and they didn't know anything about it. And the best way they knew how to really monitor their lab results over. The time. And so the emergence of the citizen science. It's really I think quite exciting. Again, another way an opportunity for I think in individual who is maybe a patient tracking their own health, data and health trends over time and having a conversation with their provider about it from the research standpoint of of citizen science is that it gives a Napa -tunities for real patient advocates dissipation in general to partner with a researcher and someone that is that they could apply for funding. And really where the patient is asking the research in developing those research questions is not coming from the researcher. And so that to me is really exciting, as, you know, evolving kind of researcher in this world that I'm really excited to say, what are what how can we help you and eating the patience or the family members our communities to say, I can't come up with the research question, it has to come from the individual and we together. Can help to come up with a solution or research something that needs to be done. Like right now versus waiting, you know, ten twelve years and the idea of science and research takes you know, what they say from bench bedside. So to speak is like seventeen years, it's a tremendously long from when some of actually doing research to win it can even be implemented at the clinical bedside. So this is a way to really not fast track. But really get to our research question right away and to really ask and partner with those individuals that have those questions now. And so we can kind of get to the meat is things so to speak right away. Does that help answer that question? Yes. That's a fantastic answer to a really great question. So I have to tell you personally, I met with a group of rare disease patients in Capitol Hill yesterday and got the opportunity to cross the table from the deputy director of the CDC to explain that the parent evidence of this rare disease is something I would almost the FAI as impure data. At this point in time because of the lack of action research etcetera, and the very few physicians that are there, and what could we do to accelerate partnering with them to have their support? And they had recently formed a task force the last week. And so I actually had the opportunity to use the term you just talked about that incients and share some of the formal surveys. We had done as a patient group. And honestly to see that in action in really what is a little bit of a health crisis. And to have that collaboration. I think the thing that got most excited about is the opportunity to partner with them, and helping better align the research questions that needed to be asked of the scientific experts of the clinical experts of the disease detectives at the CDC and all of these individuals that are now starting to collaborate. But that our information was going to be meaningful and do something because we've tried in very formal way. As you know in this case to find a commonality or a common denominator for causation epidemiology. But I love your perspective on this. And I think that something we're disease affects so many people, and that's just a niche that I happen to live in. I love what you said about that. And I think there's so much opportunity for that to explore d-. But in knowing that there's large clinical, and even government agencies that are willing to have that kind of collaboration was a very new and unique cutting. And so I'm really excited to hear you say citizen science because I honestly found it doing something. I should probably be more careful of and be cyber skeptic of myself more often in Google, so Robin. Let me ask you a question. You have a great deal of, you know, experience not just on the clinical side, the academic side, the informatics I, but I'm sure as a consumer like most of us as well. What is one thing you would like to see evolve or exceleron eight faster in the world and the arena, you're living in what is something that you're either looking for. Looking forward to I would say a couple of things to it. Carson. I you know, I tend to dream early big. But one thing for sure I think is the citizen science movement really moving forward with intention and being able to align what I get excited about being able to align. My knowledge and skill with individuals that need help that they can I say, they meeting patience, consumers, family members or caregivers. What have you can really ask the questions, and that how can we align? Our efforts to apply for funding and to get to the to kind of move that forward like you said at a at a much faster pace. I think is really really exciting. And what are some of the resources that you know, that we talked about today about being a cyber skeptic and understanding mobile health, apps and data ownership, and how can we get that out to individuals in citizen science, and what are the additional skills that we can provide and to help accelerate that world and provide information, you know, from an informatics scam point are there specific skills that individuals are really looking. For and what are they hoping? We are me as a profession or professionals help that component. 'cause I think the more we give individual skills and knowledge of the better weak and be as well. And so I think that's one area. That's really really exciting to me is moving that component forward. Another thing that I'm really interested in kind of going back to the mobile health app world, and I getting more and more curious about data ownership and who owns that data far as in a mobile health app and do consumers and myself, a DWI even understand what that means. And it came up from a perspective of if an individual is using your data you put into a mobile health app to better their product. And then they sell that product for millions or billions of dollars, but that was part of my data. And so do I get a profit of that in the answer's probably no. But I think like if what is do we understand that consumerism aspect of what has happening with data? And I had heard them say once before that. Data's kind of the new currency. And but yet if they're using my data unknowingly or I gave it away. Unknowingly what are the implications for that? And so I think in the world of mobile health apps is that not only do we have to have a symbol or some sort of criteria say that this is a you know, evidence based app, which we didn't really get into the science of evidence. Are you know, what is the science in an app itself? But is is there a symbol or co that we have the signify that this is evidence based product. How is it rated? But then what is the level of data ownership? And so could could we somehow tear it where I would agree with this app. I don't they can use my data. I don't care. They can look at my running app or how far I Ron. I don't care. But in this apple here. I don't wanna share my weight. I don't wanna share. My blood pressure scores was their way, we can tear that leveling of giving access to data. And I know that we're not there yet. Although we're starting to have the conversations and so. Say those are two big areas that are exciting. But yet wanting to be mindful of and making sure that we are getting the correct information out there again as well. So that'd be my two my two areas. Do you haven't canot? So with e jars and other players that are within a medical facility, they have to go through the certified health, I t product list or chapel, even the apps that integrate I believe have to be certified to mobile mobile apps. Just get to bypass that altogether. That's a great question. I'm not sure about that. Because you know, they're looking at it has to be built on a specific platform in order to be integrated in. So I I don't know in. I'm not sure how and I'm not in a big help in their IT departments. I'm not actually able to understand how that would all work. I know there are some houses Dems that are working to integrate them mobile health up data into their each are. But as far as certification of that app. I don't know. That's a great question. It'd be. Way to start segue into say, these would be useful in health the stem, these if their personal use you can use them outside the health system. That'd be a great next step. I think things like we do have a a platform to start that conversation. I'm sure that the mobile health apps don't have the same certification requirements, but, you know, something similar subset of them. Probably would make a lot of sense. Right. Absolutely. And I know that there is even conversation of depending on what the app can. Or can't do might have to be certified or go through the process of FDA approval. And there's people had a lot of conversations around mad as well or opinions. So that again, I think it just depends on what the app does. Or what they who developers? What they want the app to do whether it needs FDA approval or another subset of certification. I think that would be really helpful to help understand the credibility is you know, what people are accessing and making use of to your point about. Information safely, let's veer off in a little bit different direction. This is the hit like a girl podcast. You have worked as a female for a long time in the clinical side in the HI piece. I'd in the academic side. What is your how is your experience been shaped in being and probably what is often time classified as a male dominated field or fields Pearl? Yeah. Great question. And so I think I took a couple of things one I took I had a good role model my mom lives in health IT or just I health I t sorry IT and general back in the day. And I saw her modeling the way as far as how she behaved how for role and she moved up the ladder and became executive leadership as well in organizations, and so I think I had a great role model, and I remember her telling stories about specific meetings that she was in behavior that was exhibited towards her just because she was a female, and how did you handle that? I would ask questions about what did you do? Do in my mom is really good about not overreacting or letting it show that maybe something bothered her. And so I think he met even though it it did bother her. But being able to see that. And how do you handle that? But two I had really good role models and as far as out in the field as well. So I think in all the positions I've been, and I've always kind of sought out a female leader that I looked up to and I've had some great mentors along the way and even some of the mentors from afar, but just watching their behavior. How did they act asking questions? I had one great. She was a director of our surgery center, and she just had such a great way of being a leader. And she would always we're not waiting to blame game. We are. You know, this is what we need to do as a team. And I think just being able to see that. And I just applauded from the tough decisions that people had to make but made them with such confidence in thority, and but at the same time compassion, and so I think being able to see those. Those and then apply some of that to myself as well. And I remember I have meetings with some mentors along the way and one in particular, we'd meet every, you know, year every other year, and she's okay now you need to work on that. And then I would run and go do whatever she had talked about. And then like a year later. I'd follow up and say, okay now, I've done this how about and I remember having a conversation with her about physicians, and I said, well, I didn't really go to this meeting. Because I I don't think I you know, it was for other faculty or I didn't think I was there. She said stop. She said, wait a minute. If not you who. And I was like, well, what do you mean? And she said, well, it's not you who's going to do it. So you need to step up, and you need to stop think of yourself as a junior person or you don't belong. And so some of those moments where someone had to kind of have a little bit of tough love to say, you do belong there you need to step up and you need to get out from behind the chair so to speak. But I think those things for me without my. In my career of seeking out. Some of those highlights not to say that there haven't been moments where you're super frustrated or maybe an unfair situation came up. But it tell you handle that and your resilience coming back or coming back better. They don't I learn from that situation. It was not great at all super uncomfortable. But I think I would do this in this next time or I would I would first of all start out by doing something different on the forefront. But being able to reflect on some of those experiences, good or bad. And how are you going to move forward and have a better foot forward? I think would be great. So having a good role model at home being able to find great mentors along the way knowing you're going to have some hiccups. And that's okay. But how do you learn from those little bit of hiccups and have some passion to move forward. That's all really great advice, and what you're sparking in me is an idea that I learned, you know, basically, we all experienced fear. We all experience being intimidated by something, but it really. Is important to acknowledge you know, that we're actually a an a lot of ways bigger than those fears and bigger than those intimidation. So moving forward are stepping up our taking action, even if you do have feelings of, you know, not being good enough or just being insecure in general about going forward with something and living with that discomfort and growing past it. So thank you for all of that advice. Yeah. One more thing. I had to say to that. I always laugh at his remember, I had a mentor advisor of mine, and she was single, you know, you're you're growing when you're feeling uncomfortable. If it well, then it must be working because I am uncomfortable. All of the time. It's kind of a joke. But it's true. It's and when you do have those moments of growth, it's maybe not the most comfortable, but being able to move into that area, you know, being comfortable with the uncomfortable. So to speak as good way to put it to. Absolutely. I agree hundred percent. Well, robin. Thank you for taking the time to speak with us today. If somebody wanted to find you on line where would they look? Yeah. Thank you. So they could go to Lincoln. I'm linked in. And it's Lincoln slash Robin are Austin DNP DC. If you just probably searched out Robin are Austin that would come up as well. And I'm also on Twitter at at Robin are Austin excellent and Robin. Is there anything else you wanted to talk about today that we didn't get to or anything else? You wanna mention us? You know, this is been such a great conversation. We touched on so many topics. I think it's just, you know, from a health IT professional standpoint is that you know, we all have insecurities and fears, but to move ahead anyway is I think the best best way to go about it and far as citizens science movement is I think if we're just hit the iceberg right now, it's gonna be really exciting in the next few years. Somebody running to get involved in it, isn't what recommendation would you have for them? Yeah. That's a great question. And so actually the National Institute of health just started. I think they have a few resources are tool kits out there. And if you just if you Google National Institute of health citizen science, and I think it's called sit side bio meetings set CIT side S the I. And then Beilby I oh, they have some great resources out there as well. That can and then links to other things that can get you out for more information or just finding in general what what is it that they're trying to do. And I think coming from the National Institute of health, and they're taking notice of this as well as a really big step in a really great opportunity. Thank you so much. Yeah. Absolutely. Thank you again. I really appreciate it. It was fun. And thank you for listening to the hit like a girl podcast. If you wanna know more about us or this guest checkout her website at hit like a girl pod dot com. While you're at it. If you found value in this episode, we'd appreciate to ratings on I two or simply Telefe rent. You can also connect with us on Twitter or Instagram at the handle hit like a girl pod. Thanks again. See soon.

Robin National Institute of health university of Minnesota Google Robin Austin partner clinical associate professor university of Minnesota school Google National Institute of h CDC Robyn Austin Listrik uprating Twitter Sandpoint diabetes FDA Rios
How to Scientifically Make Your Brain Perform Noticeably Better & How to Effectively Hold a Grudge

Something You Should Know

49:51 min | 1 year ago

How to Scientifically Make Your Brain Perform Noticeably Better & How to Effectively Hold a Grudge

"Today on something, you should know. You know, you should be grateful for what you have. And when you actually are grateful amazing things can happen. I'll explain that. Then there's a good chance your brain is not performing at its best. And there are five reasons why when you think about what are the five things that caused memory loss. No mortar the five things there would clearly improve brain performance. It shouldn't be surprising. It's worse today than ever been before. And it's happening to younger and younger people. Plus, why is it that some people never seen began sick? I'll reveal what those people do differently and how to hold a grudge a real grudge in a positive way. Trust to think, you know, I'm not holding onto any bitterness. I forgive emotionally. But I'm going to remember this person is liable to behave in this way. So that if they do it again, I'm not going to be nearly shocked by all this today on something, you should know. Somethingyoushouldknow fascinating Intel, the world's top experts and practically and find you can use in your life today. Something should now. Mike carruthers? I welcome. Or one of the things I've learned from doing this podcast over the last. Couple of years is how listening habits can change particularly around the holidays each time for the last few years between thanksgiving and New Year's listening dips a little bit presumably because people are busy their their routine is disrupted. They have a lot of things to do Christmas shopping and all and then right after new years it goes back up and in the case of this year. It's going back up not only do wear it was before but even higher, but the point of all this is if during the holidays, you were unable to hear all the shows that we continue to produce as we do every week two episodes a week, you might want to go back in two or three ago and listen because we did have some really good episodes in December first up today. You know, a lot of pop psychology tells you to look on the bright side, keep a positive attitude or be thankful for what you. Have. And while there may be wisdom in there somewhere that last one be thankful for what you have seems to have some real power to it time and time again studies have shown that performing simple gratitude exercises, like keeping a gratitude diary or writing letters of thanks or acts of generosity can bring a range of benefits such as feelings of increased well-being, reduced depression, and these feelings will linger well after the exercises are finished. Now. A brain scanning study is helping scientists understand why these exercises have these profound effects the results suggest that even months after a simple short gratitude. Writing task people's brains are still wired to feel extra thankful the -plication is that gratitude tasks work at least in part because they have this self perpetuating nature. The more you practice. Gratitude. The more attuned you are to it and the more you enjoy the. The benefits from it. The results of the study suggests that the more practice, you give your brain at feeling and expressing gratitude, the more it adapts to this mindset. You can even think of it as your brain having sort of a gratitude muscle when you exercise it makes you feel better for a long time. And that is something you should know. When you hear terms like cognitive function or brain health. Maybe you think that's something you worry about when you get older memory loss mental decline, those are problems for older people. Well, no, it turns out those are problems for all of us. There are a lot of younger people today walking around in kind of a brain fog more today than ever before. And for the most part it is preventable and fixable. Dr Stephen Mosley is an MD and fellow of the American Heart Association and the American Academy of family physicians. He's an affiliate clinical associate professor at the university of south Florida. And he's author of a book called the better brain solution. Dr Mosley is about to explain the fascinating science of how your brain works, and what you can do to make it work better at any age by Dr Mosley. Welcome. I'm delighted to be with you. So let's start by addressing this issue of mental decline and poor mental performance as it relates to young people because I think that people think this is an older person problem, and you say, no more and more often today. Young adults even are having brain fog. They're not as sharp. They're not as productive. They don't focus as well. They forget names have to reread passages in books they walk into a room. And they forget why they're there. I mean, brain fog is increasingly common, and it's really strongly related to our lifestyle choices, especially the food we eat. And so what's different is is it because we've changed our diet is it because why why would now younger people beginning brain fog, when they didn't forty fifty years ago well fruits, as you know, it's a lot more processed. There's more sugar. There's more refined carbs than ever. Before and we're also less active. So I mean, if I think about the five steps in the better brain solution that help improve brain performance one is food. We're not getting the same quality food or eating the wrong foods to would be nutrients because we're not getting the food more people are nutrient deficient today. Number three is activity. We're not as active as we used to be four stress. And I think we're more stress today than we've ever been before. And last step five is toxins, and there's more toxins in our environment. So it should when you think about what are the five things that cause memory loss. And what are the five things? They would clearly improve brain performance. It shouldn't be surprising. It's worse today than it's ever been before. And it's happening to younger and younger people. So help me understand what it is about those things. Hopefully, there's a kind of a general answer rather than have to go through all of them. But what is it because of the toxins in the food and the whatever. For the stress. What is that do specifically to your brain to cause the problem? What's going on the probably the number one causes we call insulin resistance. It sounds complicated. But let me explain it. So it's simple insulin's, the hormone that pushes energy into yourself. So when you eat a meal, insulin goes up, and it pushes the energy way in stores it for later. So like, you don't have a famine, and that's when we eat healthy that works beautifully. But what if you had cereal or toast for breakfast? Even Hawaii toast, a sandwich or wrap a whole a whole grain wrap for lunch and you had a granola bar for a snack. And then you had rice potatoes or corn for dinner. You've overloaded your storage capacity. You can't store. We can't store that much refined carbs and your body becomes insulin resistant and the. For your brain. Here's the irony member in one hundred thousand years, humans have never really had an excess amount of process sugar in their lives that never happened till recently. But today with all the processed food, it's really common. So when the brain becomes resistant. It literally turns off it's like a power surge, and you blow the switch, you know to your light. So the brain turns off your foggy you don't function. Well, you're less productive. And they've actually showed that like if a young adult goes out, and has, you know, pancakes with syrup or, you know, a breakfast, cereal and drinks, orange juice for breakfast. They have less productivity less brain speed for the next six to eight hours. So that's clearly documented, but that's really common. And if it's just a choice then. Okay. You're let's say just your birthday. We'll who cares. You're less productivity. You're more forgetful. But if it's every day. Your brain doesn't function. You're not reaching your potential, you might lose your job for being, you know, kind of brain foggy. And you're shrinking your brain. You're killing your rain cells in your brain shrinking, and you're going to be at risk for memory loss earlier in life than ever should have been. But I like to think that in my experience is sometimes that even if I'm not feeling particularly on my game, I can override it with a lot of concentration and get closer to what I need to do and breakthrough that fog with sheer determination some degree. But eventually you're just stressing yourself out, and you can't keep up. And that's why the other parts come into it. That's a Suming you're physically fit, and you have that physical stamina, and you work out. That's assuming you manage your stress and your cortisol levels aren't high all the time and you're stressed out. Because then you won't have that reserve, and you won't have that Dr. And that assumes you meet your nutrient needs, and that you have some reserve to handle it there. And it also means you're not being poisoned. So that's how the five steps of this program all come into play. 'cause if you're you might be able to do one of those steps not so well and recover on the others. But there's really there's five pillars that hold you up. And when you when in most people today are falling apart on all five. So this insulin resistance that people have this is strictly a result of what they're eating. Yes. Yes. Well, no, it's the number one causes too much sugar and refined carbs, you know. But it also it's worse, if you don't exercise it's worse, if you're stressed, and it's worse, if you have toxins, so all of those factors and nutrient deficiencies caused it to so all five pillars impact, insulin resistance and insulin resistance is the number one cause for decrease brain productivity for memory loss and for heart disease. So what are the foods? We should be eating, and what are the foods, and you mentioned a couple, but what are the other foods? We should not be eating. There's twelve foods. You could irregularly they're really helping support your brain. And we shouldn't be eating so much sugar and flour and those two foodball and those twelve foods are. Well, like vegetables in particular, green Lisi's somebody you eat one Cup of green leafy today. Like broccoli, you know, kale spinach their brains eleven years younger than someone who doesn't eat them just one Cup, berries and cherries, those colorful pigments, and these fruits they're low in sugar and the those pigments protect brain cells in your arteries. There's super important that nuts. People go on low fat diets for weight loss, but a low fat diet and studies has been shown to deprive your brain of fat. You have decreased brain performance increase memory loss. I want people to Eat Smart, much more junk fat, but healthy fat things. I want them to eat more nuts olive oil, avocado cook with you know, extra virgin olive oil and avocado oil eats wild salmon have dark chocolate smart Fettes. You know, another category would be spices herbs. I'm a physician nutritionist. And chef I take food really seriously. I like food, and I think spices and herbs taste grade. And they improve the flavor food, but they're also any inflammatory and they protect their brain. Especially two of them Italian herbs like Rosemary. They will improve your brain functioning actually help you study and curcumin that's in to Merrick or curry spices curry spices. You can improve your brain function within just three hours of having curcumin and it lasts for a month. You mentioned earlier that you gave the example of, you know, if you had toast and a sandwich and all that people have been eating bread for thousands of years without a whole lot of problems. Why is bread so bad? Well, we actually have only had bred for like what three to four thousand years kind of tops and for and Abbas four thousand years except for maybe thirty or forty of them. We were farmers. We were out we were physically active six to eight hours a day. So the truth be told is if you're physically, you're you're like, a, you know, you have a physical job and you're out carrying heavy loads. You're a farmer and you work not with a tractor. But I shovel you need a lot more calories, and you can handle this stuff a lot better. But I don't know anybody, you know, maybe a few professional athletes. I've got a couple of athletes who are patients but short of bam. I don't have any patients. I mean, most people struggled to get an hour a day, and that's just not enough anymore. So we can't get by with not exercising all day and trying to eat. Bred three times a day like we could a hundred years ago. So let's talk about what is normal everyone. I think assumes that as you get older, your brain changes in ways that make you more forgetful. Is is that a safe assumption that you can say that shouldn't that's that's average? There's a difference. That's a really good point. And I'm so happy you're bringing it up. There's a difference between average aging your brain shrinks. And you're you lose your memory and your brain processing speed drops and normal aging with normal aging. You would lose a little bit of speed. It's like someone gives you a very slightly slower computer every couple years, but you're smarter. You have more experienced nobody notices, but you shouldn't be losing your memory your hip campus, the memory center shouldn't be shrinking the way it is today in an average person. And my seventy year olds are sharper now than they were when I met him at fifty five my forty five year olds are sharper now than when I met him at thirty. Well, why are you meeting them? Why are they coming to you in the first place? I mean, I have a clinic. I have an optimal health center. People come to see me to assess how their agent optimize their health and probably one of the more important things, we do is measure, brain processing, speed and memory. And when we realize, wow, your brain's kinda sluggish and to be honest half of them. Don't even notice it, it's, but you know, it's kind of been a slow insidious drop just gradually over time. They're more and more sluggish. They don't really notice in Whipple say to me is after they follow the better brain solution for a month. They'll go. Wow. I forgot how great I could feel. I forgot how sharp I could be thanks for giving my life back. I wanna ask you. What is a sluggish brain? I mean, what what does that look like what does that feel like to have a sluggish brain? But first here is a New Year's resolution. That's easy and pays big dividends. Better oral health by brushing, your teeth better and with a quick electric toothbrush. This is a resolution. In you'll stick with. I've been using quip for a long time every single day, and this is a very different electric toothbrush. It has sensitive sonic vibrations for ineffective clean that's gentle on your gums. Because the fact is a lot of people brush too, hard and some electric toothbrushes are too abrasive. But quip has a built in two minute timer that pulses every thirty seconds to remind you when to switch sides. So you clean your whole mouth evenly brush heads are automatically delivered to you on a dentist recommended schedule. Every three months for just five dollars because seventy five percent of people use old worn out bristles that are ineffective. Those are just a few reasons why I love quip and why over a million other happy healthy mouths due to quip starts at just twenty five dollars. And if you go to get quip dot com slash something right now, you can get your first refill pack for free that your I refill pack free at GE. T Q U I IP, get quip dot com slash something. So so doctor what does it mean to have a sluggish brain? I mean, would I know it can I see it can I can I sense it. What what is what's a sluggish brain? Well, someone calls out you attended phone number. Can you remember it or do you have trouble? And you have to write down part of that is we're so user these smartphones. We don't have friends remember phone numbers. So that's com. I'll admit that one's complicated. But you have to read a repass agenda book when you go to a meeting and someone assigns you for things to do. Do you walk out meeting? Go. Oh my gosh. I don't remember two of the four. I mean when you're doing work, can you just and people keep interrupting you can you just power through in despite you know, fifty interruptions day, you keep working at high speed and get it all done or I would say the average person needs an extra hour and an hour and a half every day just to get their work done because their brains processing speed is reduced. But there is an I guess I don't really know why there is. But there is a general acceptance that as you get older you're mental function will decline and that. That is normal. But I think we're too you're right. That's a really good point. We're too accepting of. Okay. I'm average. That's okay. But remember the average person today is overweight almost obese if you're normal weight, you're almost abnormal. So if you're mentally sharp. You're almost have normal so way too, many people are having decreased brain speed. So I don't want people to accept full. I'm average. That's okay. 'cause average isn't very good anymore. So help me understand though, that we'll hear that, you know, people get older and they become forgetful. But then there are some people who actually get a disease or a condition called dementia from which there is seldom I think any kind of big recovery. What's what's the difference between a sluggish brain and a demented brain? Okay. That's a good question. And it's so essentially you could be good brain performing speed. You can imagine you're sharp your quick you're alert or you can have some subject in say someone's going to get dementia in twenty years. We can actually kind of if we could go back twenty years for the guy diagnosed say you're gonna get diagnosed at sixty in your forty at forty you made probably don't notice yet. But if we were to do cognitive testing, we would see your testings dropped a bit for the first five years fifteen years before you get diagnosed with dementia. You're aware. Air that you're more forgetful than you were ten years ago, you're thinking I'm not as sharp. Okay. But this is just average aging, right? It's okay. But you're actually losing brain cells in your brain speeds, dropping down and over ten years, your, friends and coworkers notice it too, but they might accept that. Okay. Now instead of forty he's almost fifty or she's almost fifty. So it's okay. And then and then so that's subject of cog, you're aware of it. But you're still functioning the next they call it mild cognitive impairment. It's not a good description. It means you're mildly disabled, you can probably still do your job. Maybe not if it requires complex thinking, and you can still live on your own. You're not disabled that's a really bad sign net. Now, you're on the cusp the verge of dementia, and the definition of dementia is you're disabled from memory loss. You can no longer live on your own pay your Bill. Function you need request systems. And that's scary. And you can kind of reverse that a bit. But you're absolutely right by that point, your brain is basically shrunk from grape to a raisin, you've waited way too long. So my goal is if you do have mild cognitive impairment, you, you know, really your nearly disabled you could still get twenty to twenty five percent better in stop losing your brain function. Don't wait till you have dementia. I totally agree with you. But most important would be for the younger, folks. Go for optimal, brain performance, push. You know, why not be excellent? Let's stop accepting. I'm average 'cause that's not very good. Let's go for better brain performance in preventing memory loss. And then it's not just your rain the same things. Help your your brains like the canary in the coal mine. It's the first symptom for the whole body. But if you're hurting your memory, your probably, you know, hurting, your arteries. Is your worsening your romantic sexual function all that stuff falls apart? When you're hurting your memory. So why not feel fantastic and be more productive at the same time? So you're saying if I get you correctly in if I do I think this is a surprise to a lot of people that just because you're older doesn't necessarily mean you should forget things and and have a noticeable memory loss or cognitive decline. I well, mostly. Yes, I agree with most of that. I think you will have some drop in processing speed with normal aging. But but no one's gonna notice because we have life experience, and we can compensate for it. So it should be unnoticed. I really agree that there's no reason you can't be sharp alert and fully functional at seventy five eighty. I mean by a hundred okay, I'm getting I'm Marie listed. Sweet. We're not gonna be able to keep going. But I don't see any reason that someone should. Could be dwindling before eighty years of age. So just to be clear. Are you saying if someone were to do the things that you're talking about is it just to clear up, the brain fog and get you back to ground level? Or are you saying that doing these things will actually improve your mental function right now? So are in other words, are we preventing a negative or are we promoting a positive or both? Well, our average pitch I've had some exceptional responses. You know, like people who are on the verge of losing their jobs, and instead they got a raise 'cause their performance improved so much, but let me let's talk about average. I think that's more real. Let's be realistic. Let's be realistic. We've done randomized clinical trials where we randomized groups. We pick Jim members who didn't come to the gym. I did that because they were somewhat motivated, but they weren't doing anything about it. They didn't eat. Well, they didn't work out. But at least they were Jim members though. No in that group, and you can probably imagine many of them. We offer them to eat better. Eat healthy food made their nutrient needs at activity do ten minutes a day of stress management. Here's some toxins to avoid and we just tested them before. And afterwards the control group made no change. I mean, we said do the same and they obliged. They didn't change anything. They had no improvement and the average person in our intervention group who followed the better bring program improve their brain processing speed twenty five percent. That means their ability to process information went up twenty five dollars. They could finish eight hours of work in six hours of time. And their attention span there billion to focus when a forty percent briefly, you mentioned toxin, so what toxins am I getting that? I need to avoid three quick examples. Mercury. If you eat a lot of big mouth fish group or. Tuna. I'm swordfish grouper. You can have mercury. Toxicity ten percent of my patients have elevated mercury. And it's hurting their brain pesticides is the second. If your pesticide levels are high your three hundred and fifty percent more likely to get dementia than if they're low and there's a ton of pesticides. We need to be eating and most of it surprisingly doesn't come from fruit and vegetables that comes from animal products, dairy, meat and poultry. So when you're eating the dirty dozen fruit and vegetables, like, you know, apples, and strawberries and peppers and spinach. They should be organic you don't have to buy everything organic, and you're meeting dairy and poultry should be organic. Because that's where most pesticides and the last one briefly nitrosamines, those are nitrates in sandwich meats and hot dogs and bacon. We used to just think they cause cancer. But now, we know their neuro toxic. They've done studies on rats just really recently and showed that when we give them. Indeed them bacon and deli meats, they get Alzheimer's quickly. So if you eat meat or eat bacon, please make sure they're not they're organic, and I chose him in free. They don't have these toxins in them that are really common. We'll great. And and Dr Mosley also has more information and buying guide. The you can have for free at his website, which is Dr Mosley dot com. D R M A S L E Y dot com. Which is also in the show notes as his his book, the better brain solution. Thanks for joining me documentary. Thank you for having me for a long time. Now, I've been talking about and taking care of vitamins care of is a monthly subscription vitamin service that delivers completely personalized vitamin supplement packs right to your door. Look ninety percent of people fall short of the FDA recommended guidelines for at least one vitamin or nutrient. And the fact is it can be really hard to know what vitamins are sup. Laments. You should be taking but care of makes it really easy to find out. What you specifically need when you take their quick and easy online quiz. Then you're customized vitamins are shipped to you in these very convenient daily packets. So there's no more keeping track of all the bottles of supplements. And when are they going to run out, you just grab the daily packet and off you go take advantage of this month's special New Year's offer for fifty percent off your first month of personalized care of vitamins. Go to take care of dot com and enter the promo code something. Fifty that's this month special New Year's offer fifty percent off your first month of personalized care of vitamins to take care of dot com and enter the promo code something fifty that's something five zero and that Lincoln promo code are also in the show notes. I'm sure if you stop and think about it you've held a grudge or two in your lifetime. And how many times have you been told that holding a grudge is not good forgive? And forget is what you should do holding grudges. Does you know good? Well, wait a second. Maybe that assumption is wrong. Maybe grudges can serve a valuable purpose. That's the claim of Sophie Hannah. Sophie is a writer mostly she's written crime fiction, but she's tackled. The topic of grudges in her new book how to hold a grudge from resentment to contentment the power of grudges to transform your life. And she thinks we need to take a closer look at grudges since we've all held one. Maybe we can put them to better use. Hi, Sophie, welcome. Thank you. Thanks for having nail. You bet. So first of all let's define what a grudge is. How do you? Fine it. Well, the crucial thing is I define it differently from how all the dictionaries define it. So the dictionaries all say, the grudges a feeling a dislike or resentment will bitterness some kind of negative feeling my new in different definition of grudge is the grudges no to feeling, but a story that still has relevance in your life. So give me an example. So the story will usually be about a negative experience that happened to you somebody did something that hit you all made you angry. And at the time, you might have felt upset or annoyed about it. But the grudge self is not lot feeling because that feeling whatever negative feeling you have it compacts, the grudge is the story about what happened that you remember, and you can remember that for years and even decades after the feelings from the incident have Pat on the crucial thing is that the the grudge story you can then use. To inspire you to motivate you to do all sorts of good things in your life. Now. So the prevailing wisdom is that. It's not a good idea to hold grudges that you should let them go that you're only hurting yourself that holding grudges hold you back and the person you're holding the grudge against couldn't care less. And so it does no one any harm except you exactly that is the prevailing wisdom, and that is what we've all been told to believe about grudge it. And if you think about the dictionary definitions of grudges, which most people just unquestioningly accept then that would be true, wouldn't it? So if we accept that a grudge is a negative bitter, unpleasant failing. Then of course, we don't want to hang onto those. Of course, those would us home if we kept them in clung onto them. But if I'm saying is true. And I know that it is from my own experience. Then we can remember grudge story and get only good things. From it. So when I think about some of migration stories that date back, maybe even ten years, I have no residue of negative feelings actual because those past long ago, what I do have though is a grudge story that has will I call a live relevance charge. The story still feels relevant an impulse because something about it makes me live and behave and think in a different way, which is good for me and good for the world. So let's say I have a grudge about somebody who was once very rude to me. I might still keep that grudge story now because it will always inspire me never to be rude to anybody, for example. But the feelings you have for the person who was rude to you have come and gone, the feelings have gone. So this is where it's important to draw distinction between thoughts on judgment, which is in one category. And feelings. Which is in another category. So I am absolutely willing emotionally to forgive anybody. I will happily go full would in my relationship with anybody. You know, give them any number of chances to behave. Well, and still like them and still love them. Even if I have a grudge about them what the grudge means is just the they did something or behaved in a way. The I won't to remember now because it has changed how I think about them. And the reason I called it a grudge because a lot of people have said to me, hang on a minute. What you're saying is all very is true. But I wouldn't call it a grudge. I'd just call it. You've learned a lesson from something that happened to you reason. Yeah. Yeah. Yeah. That's the most common criticism. I've had so fo but I have an answer for that criticism. Which is that the reason I call these things grudges is the if I have a grudge about somebody, then I might emotionally forgive them. An indeed I I always do emotionally forgive people. I don't dislike them, I don't resent them. But those people my grudge, jeez. As I call them. They do not have a completely clean slate in my mind. So, you know, most people I like love to have a completely clean slate. That's nothing. That's no kind of mock against them. There's nothing I think will I need to be this in mind. I'm protect myself from them in that way. All I need to have lower expectations of them. Because I know they have a tendency to behave in this not ideal way. So that's why I would call these things grudges because it's the it's the lack of a clean slate aspect that for me makes. Grudge? But you know, in a way all that means is that we don't, you know, when obliged to think about everybody in exactly the same way when when obliged to trust everybody in exactly the same way. So if somebody is homed us in a way that was really painful or really damaging then I think so K for that person not to have a clean slate in all minds, and for us to think, you know, I'm not holding onto any bitterness. I forgive emotionally, but I'm going to remember this person is liable to behave in this way. So that if they do it again, I'm not going to be nearly shocked and upset by that. Well, that's interesting because I think people do that we like to think that we forgive people, and we don't hold a grudge meaning that the person does have a clean slate. But in fact, they never do they you never think about the person the same way again after you've been upset by them. Because even even though you say. You forgive them. You always remember. Well, this is what's really interesting. So as well as having different definitions of grudges people also mean different things when they use the would forgive and we don't talk about this often enough. What does the word? Forgive main. Does it mean forgive emotionally amd forget and carry on as if the thing happened happened if that's what forgive means then yes, it's very hard to do. Because exactly as you say, none of us can forget anything that wounded us emotionally in a very deep way. If however we think of the would forgive a slightly different way. So, you know, maybe forgive can mean, we don't have any continuing Anga array JR. Or pain in relation to this person where willing to see them and give them every chance to behave well in future, and if they were to behave while in future, we would up -solutely appreciate that. You know, that is what forgive means to me. It doesn't mean that I'm going to forget those grudge stories I've got about people which still seemed to have a live relevance charge. And so to me the way I advocate holding grudges, which I have to say really works brilliantly in my life. What's good about that? Is it doesn't able you to forgive him ocean? Give that person every chance an even allow that. When they did the thing they did that hurt you. They might have been doing the best. They could you know, you you can even say, I don't blame them. They were in about place. They didn't realize what they do all of those things you can allow and you can forgive them, you know, in a in a sort of whole halted way, but you can still think, but they did do those things and that was not okay. And this is another big part of why I'm advocating holding grudges in the way, I am because human beings off Justice seeking creatures. We just we never won't be from the age of. To a child consi- note, fair his things bigger than mine. I won't Choi. He's had it for an hour. We get these instincts. We've got them from birth. And a lot of the reason why people have destructive grudges where they hate and they seek revenge, and it does leads of damage in the world. Is because we all have this idea that holding a grudge is bad, and we should all forgive. And what not often means is we end up trying to invalidate or repress our own perfectly natural and justifiable negative emotions. So what I'm saying is allow yourself create an hold a healthy grudge, which is then assaultive symbolic commemorative Justice object, and that's constitutes that person. Not having a clean slate. You remember what they did? You don't think it was? Okay. You'll learn from it. You'll protect yourself with it. But you can also at the same time move on emotionally and continue the relationship in a positive way. Or not only not exactly so you know, you you can hold you a grudge without hatred without bitterness. Just it's a thing you won't to remember because it has a live relevance charge, and you can forgive emotionally, and you can decide you don't want that. Person in your life anymore. That's absolutely fine. The nothing on healthy. Oh, damaging about thinking. I've got a grudge about Bob. And I don't think I won't to spend time with bulb anymore. You can do that -solutely. The only thing I say people shouldn't do is allow bitterness and rage and really unpleasant feelings to consume them because that isn't a healthy over necessary Paul of holding a grudge there are times though in life where things happen people do things that are horrendous that are just horrible and impossible to forgive or or maybe people don't wanna forgive. They they need to hold onto that anger because they've been so hurt and betrayed or or whatever. Absolutely. So, you know, yes there I'm not by any means suggesting that forgiveness is always the desirable outcome it in many situations. It is if it's a petty or trivial slight than than often forgiveness can be the best outcome. But sometimes it isn't an in that case, there's no need to try and forgive anybody. If that doesn't feel right. I would say the even if you even if you choose not to forgive someone. If you consumed by bitter and hateful feelings that's never going to be good for you. So however, horrendous the thing is that's happened. I mean, we know that many people go through truly awful life experiences on somehow find a way not to let bitterness consume them. And that has to be the best possible way to proceed a few can manage it. I know people I can think of a couple of people who. Have have been hurt too or had disagreements with people. And it it ran so deep that. Years later. It's all they can talk about in. That mean, it's just like it it it is become part of their identity to to relive and talk about how horrible this other person is. And I wonder if it must serve a purpose. But I can't imagine what that is. And it's awfully hard to be around people like that who sing that one note over and over and over again in and cannot let it go. Yeah. Yeah. I I know exactly what you mean. And I think the reason people become like that is because of all unhealthy attitude to grudges. I think will often happens is this something wrong. Only hit full is done to somebody the person than is angry and upset and immediately people around them try to minimize that. They try to shook a coat they say, oh, well, you know, come on. Don't let it bovi. Don't let it get to you. There are two sides to the story you should move on you should forgive. Don't hold a grudge and the response from the wo- build lodge seems to be in some way negating the importance of the original transgression if on the other hand somebody what to say, oh, someone's just on a terrible thing to me on the willed which respond differently if the world richer respond by saying that's terrible that that happened that's grudge worthy. I don't blame you for being angry. I be really angry. If that happened to me, then the person on the receiving end of the transgression would feel validated and undestood, and it's amazing. How often well meaning people in that desire to sort of make things okay? Will basically tell you that you shouldn't be upset about what you're upset about. And that you shouldn't be angry about what you're angry about. And that whoever attacked you probably didn't mean it on their lovely chap really hit. We. These reactions all the time because people won't let to be no problem. And what not does is it makes you dig in and become more entrenched with those negative feelings. Now, my reactions to people who've been hurt or upset produced the opposite effect if somebody comes and rents may about someone who's done the metabol- wrong. I say that sounds highly grudge worthy. His how you can create a brilliant grudge. Let's create. Let's then classify it and great it, and we'll get to grudge cabinet, and we'll put in an unjust reacting in that way makes the person think. Oh, okay. Finally, someone someone gets that this thing that happened to me matters. So I genuinely believe that the reason so many people are still going round renting about tiny things that would done to them fifty years ago is because we in general is human beings have a tendency to try and gloss over and minimize home to other people. In many ways what you're saying. I think gives voice to something people do anyway in in a lot of cases where they hear that to to to be a good person you need to forgive and forget, and but people don't forget people don't have a clean slate anymore and those of us who don't forget think. Well, how do those other people forgive and forget 'cause I can't do it. But I don't think anybody really doesn't. And then you fail. It. You must not be a good person. Right. I want to be one. So you try and full yourself to forget and to completely forgive. When either you're not ready, all you just can't do it. Absolutely. I mean, I think if we could all adopt, a different mindset, if we could all think, you know, what a good person is a good person is somebody who Nola ges that when somebody homes them they're gonna fail upset and angry. And there's nothing wrong with that. And there's a wet kind of paradox about negative feelings if we can be pulse. Tiv- about all negative feelings, then they will stop being that they will still being negative, much sooner. So in other words, if I'm walking down the street someone hits me over the head with a hammer and said something very rude to me if the natural surge of Anga that rises up in may as a result of that. If I tried to repress them think no, no. I mustn't think Bob full. He was probably having a bad day. I must forgive him. Then my anger gets much more corrosive because it's repressed, and it knows it has a right to be there. But I'm trying to deny it. Now, if on the other hand, I think to myself, welcome anger. I know why your hair it's completely fine. Use STA as long as you won't all these negative feelings. You're welcome to stay as long as you feel. It's necessary to be the than actually what happens is those feelings don't need to dig in defensively, and they move along a lot more quickly. Well, I like your message because as we said at the start of this the, you know, holding a grudge in the tradit-. Away. Really does do. No one. No good. It doesn't do you any good to hold a grudge against someone who doesn't know you're holding a grudge against them. And so no good. It comes from that. But your way is a bit different. And and does serve a purpose. So I appreciate that. My guest has been Sophie Hannah, her book is called how to hold a grudge from resentment to contentment the power of grudges to transform your life. Thank you for being here. So V. He'll welcome. Thanks for having now. You probably know someone who never seems to get sick. Why is that? Well, research has found that people who rarely get sick tend to have some things in common. They have a set bedtime research shows that those. Somethingyoushouldknow fascinating Intel, the world's Tomek. I and practical advice you can use in your life today. Something you should know it, Mike Carruthers. Hi, welcome. For one of the things. I've learned from doing this podcast over the last. Couple of years is how listening habits can change particularly around the holidays each time for the last few years between thanksgiving and New Year's listening dips a little bit presumably because people are busy their their routine is disrupted. They have a lot of things to do Christmas shopping and all and then right after new years it goes back up and in the case of this year. It's going back up not only do wear it was before but even higher, but the point of all this is if during the holidays, you were unable to hear all the shows that we continue to produce as we do every week two episodes a week, you might want to go back in episode or two or three ago and listen because we did have some really good episodes in December first up today. You know, a lot of pop psychology tells you to look on the bright side, keep a positive attitude or be thankful for what you. Have. And while there may be wisdom in there somewhere that last one be thankful for what you have seems to have some real power to it time and time again studies have shown that performing simple gratitude exercises, like keeping a gratitude diary or writing letters of thanks or acts of generosity can bring a range of benefits such as feelings of increased well-being, reduced depression, and these feelings will linger well after the exercises are finished. Now. A brain scanning study is helping scientists understand why these exercises have these profound effects the results suggest that even months after a simple short gratitude. Writing task people's brains are still wired to feel extra thankful the location is that gratitude tasks work at least in part because they have this self perpetuating nature. The more you practice. Gratitude. The more attuned you are to it and the more you enjoy. The benefits from it. The results of the study suggests that the more practice, you give your brain at feeling and expressing gratitude, the more it adapts to this mindset. You can even think of it as your brain having sort of a gratitude muscle when you exercise it makes you feel better for a long time. And that is something you should know who sleep eight hours or more per night are three times less likely to develop a cold compared to people who sleep for less than seven hours. When reason why is that at night, your body repairs itself and regulate stress hormones that can make you more susceptible to infection. They also eat right filling up on antioxidant, rich foods, like sweet potatoes. Citrus and bell peppers, almonds and red grapes or red wine replenish cells that are damaged in the fight against germs and bacteria. They take a probiotic good bacteria in your gut can. Enhance your immune system. So you may want to consider taking a probiotic supplement, which contains helpful bacteria. They wash up you don't have to go crazy with handwashing, but you can reduce illness by fifteen to fifty percent. If you remember to wash your hands before eating before and after prepping food after the bathroom, and after you, sneeze or cough. Soap and water is the preferred method for handwashing although hand sanitizer is good too. And when you do wash your hands, you should scrub for twenty seconds or longer and people who rarely get sick. Also have close relationships in studies people with the most social support when faced with a stressful situation where less likely to get ill. If exposed to a cold virus and hugging enhance that immunity benefit. And that is something you should know questions. Comments or suggestions are always welcome. You can reach me directly at my Email address. Mike at somethingyoushouldknow dot net. I'm Mike Carruthers. Thanks for listening today to something you should know.

Dr Stephen Mosley Mike carruthers Sophie Hannah Intel mental decline Mercury Bob university of south Florida clinical associate professor Jim American Heart Association cortisol Alzheimer MD Lisi
The Love Is Viral Show Episode 76: Empathy = Survival with Samina Hadi-Tabassum

Gold with Jeanette Schneider

42:55 min | 3 months ago

The Love Is Viral Show Episode 76: Empathy = Survival with Samina Hadi-Tabassum

"Welcome to the love is viral show I'm your host Genetic Schneider? The founder and CEO of live media and the creator of the lift pocket coach on Apple. Are Premise Atlit is simple. A healthier you today leads to a healthier world tomorrow. Our guests include neuroscientists, therapist professors, coaches, authors, yogis speakers, entrepreneurs, and those who believe that had bigger battery life can be found at the intersection of mindfulness and science. Join me as we nerd out with a little bit of soul. The love is viral. Show is a live media production. Selena Haughty Tabassum is a clinical associate professor at Erikson Institute where she leaves the Child Life Program and the online master's in Early Childhood Education program she teaches graduate courses and cognitive development, language, development and her research publications focus on race, language and culture. In this episode we discuss human survival from mirror neurons to genetics, and all the science in between we dig into how humans have evolved why we need empathy more than ever to ensure our survival and the move to a Hetero genus society. Let's dig in. Hi this is Jennifer Schneider welcome back to live. I'm here today with Haughty Tabassum. Thank you so much for joining me today. Thank you. I'm really excited to chat with you. We had a conversation recently about. Our brains, and how they've evolved, and how they they work in correlation with our socialization and our empathy, and the way we frame our social interactions and I thought it was really fascinating and I wanted to get you on and have a conversation because I think more now more than ever. It's really interesting to understand how our our minds work, and how we. Use Our. The Way we interact with others are socialization. And an empathy especially during. Tough times when things are a little bit more difficult I think more people are interested in how we've evolved as humans so I'm curious, first and foremost. If you can share with me why this is interesting to you and what you'd want to share with other, so we understand kind of from the beginning of time why our brains are how our brains were created in order to help us. Thank you I'm currently a professor at Erikson Institute and I teach courses in cognitive development, and we are an institute that focuses on child development in particular. And when I teach this particular class, I start by talking about human evolution, and how over time human beings have adapted to their physical environment and have developed many cultural editions in tools, which has also been allowed their brains develop. In that today. Our brain is much larger than it was thousands of years ago and that as human beings adapt and evolve, so does the human brain as well, and what we do know is that there is that relationship between environment and our DNA right to this question of nurture inert nature is a question that I discussed the time in particular. Students worked with young children, and we get into a debate about what causes that child to develop. Is it the child's environment or is? The child already wired for learning? So for example, if you think about a young infant that was just Borton that in is in mobile. They can't move their dependent on these adults. We know that they're auditory system extending. They can recognize mom's voice from in Utero. As well as the voices, other adults in that environment, we also know that their vision is not intact yet and soon over time they're gonNA. Develop their senses that they need to be able to then grow and develop a in a very typical and healthy non. But we also know is how does this young child and eventually become the sophisticated adult right? How do children learn to master some very sophisticated things that we do from thinking and learning to talking and so on so the question is then how does that child acquire those social meanings and cultural understandings and so one of the things we do know with young. Infants they tend to mirror the actions of the adults in their environment, and so this initial research around children in how children learn led to this whole world of the notion of mirror neuron, so mirror neurons are actually cells in our brain, so in your on cell is a cell that's located in the brain that develops over time and that what we do over time is that we create circuit in our brain, and that these neurons are connected with each other, and they're building bridges and wires through Ben Dried synopses and And they're finding each other right, and that's what allows us to do much more complex things as you get older, but we do know is that if you look at the MRI scans of young babies that mule growth is the greatest in Utero in mothers womb, but then around ages three, four and five. You know there's an explosion of neural activity and urines finding each other. They're growing and actions to each other, and it becomes a time when young children are very much funches right? They can learn more languages they're to. thinking creative ways and so on. We also know that infants in particular start mirroring the adults around them, and that there's a whole network of neurons, but we call the mirror neuron network that's located in the pride. Alot of our brave, so our brain can be dissected into four different Lobes, and the pride lobe is the low bits on top. If I go interior, go inside the prior to low whole section of cells, which we call the motor Cortex, and that the mirror neurons are located within this mortar techs and that. That they can act are visual part of our brain, which is in the bath. He similar part of our brain to our motor cortex that they're connecting what we're preceding visually to the voter cortex, which controls our actions inducements. There's a whole network on your onset are connected. They form circuit and they're talking to US right there. They're talking to our internal mind and conveying messages, and to the argument here is that a child may see that mom smile, and their visually perceiving that mother's smile. And then they Mir, that particular action right, so they're looking at that image, and they are responding without really thinking at all right because or not into the deep intellectual. Thought Processes they're they're not necessarily thinking deeply, not necessarily using knowledge per se, but they are imitating that particular action they learn to perceive first, and then they learned to imitate that particular action which we call a mirroring effect we can also argue that the baby is tooling into that mother's actions, right and trying to meet her in that same direction. There's some kind of congruency that's occurring that they're trying. Trying to be in sync with that other person that's in front of him or her, and so we see this in particular with young invents mimicking the smiles of the adults that they see around them as well as the sound, so we know that young children learn to what we call mouth map that they look at the mouth of that adult, and they're trying to map that sound. That's coming out. that. They're perceiving these sounds, and they're taking statistics, and they're trying to think on Oh these the sounds of mild language that are you know are from my particular social environment. Right? So there's a lot of convincing germs of this is how children learn languages with. This is also how they learn actions. As well into the question is okay. Great infants use this part of our brain called Mirror Niro network. They're imitating adult actions. They're trying to understand how to be a citizen of that environment, right and we also know that it allows them to develop attachments as well. The Vic- mom smile to me than ice mile back. It allows for the. The very deep attachment that I need to healthy human being when I grow older, so there's that social emotional aspect of mirroring so right but then you get into this question of am I just simply marrying an action, so there was wranglings research that was done recently, saying okay, what's actually going on? So in the the last couple of decades people have been experimenting on monkeys as well as human beings and to there's kind of two different bodies of thought on this. There's one body of thought that says yes. Human beings are wired to mirror each other's actions, but it is simply that that they're looking in their perceiving. They seen action. And they're just reproducing back action about really much thought to it right, but what we're finding from researches that it's particular kinds of actions right? I see mom, jump up and down. I'm not really duplicate that action, but you're finding is it's much more driven by the mouth and living at mouth, based actions and hand right. So now the argument is that baby is not just a focus on all actions of mom. is, really focused on MOM's mouth and looking at how the mouth is moving whether it's in terms of the food that the mom is consuming or whether it's intrinsic language of the mommas producing, and also the baby is to enhance the hand that is used to attach to the baby, decided the baby, and so on rights. If I waved to the baby baby, start way ride And so on, and so this is also the reason why many new parents today are using gestures and signed teach young babies right even before they begin speaking. They're doing things like this to say. Are you hungry? Are you hungry like? Do you want some more? Yes, or no? The argument is yes. Babies are looking at these gestures that are really encoded near the mouth and with their hands. Sorry, there's a whole body that says they're not to locating all types. Types behaviors just simply mirroring behaviors that deal with the mouth that deal with the HAM. Could it be also I mean because that's where you're you're. Socialization is right I mean typically the way we socialize or engage with. Someone has to do with the way we're speaking. If we're frowning if we're smiling, YOU'RE GONNA. Get some kind of like emotional charge. You're going to kind of know what's going on with me if I'm using gestures when I'm talking to you. Could also have to do with that social emotional bond where it's like this is where I'm learning how to attach. Of course want to believe that it's because there's this great love emotional bond and I get that. They're kind like you know they're learning. I joke that my daughter was like a little cave baby when she was born, and the emotions came later. But it's kind of interesting to me that it's all of the things that would tell you how someone feels. Yes. That they can't communicate right. They can't produce language for say in the form of communication, and there's this reciprocal back, and forth that occurs between that adult caretaker on that infant and this also gets into this notion. If that infant digits do that, he then they're not going to survive in the environment, and they're gonNA EHRICH it's considered the human evolution question, right? Why do Do Babies cry. We don't know exactly, but that's the only way they can communicate their needs right. It's one of the ways in which they can tell the adults. There's something going on I need your help. And then if babies didn't cry, they would just parish and die Get into this of where did this come from over thousands of years of human development? Right right. but what's interesting is that there's been plenty of studies also set up here. Let's let's look at this differently, so let's see adults do this as well and that's where the research. It's really kind of interesting, so there are a lot of. Studies that have looked for example I might start playing with my earing, and then you might start doing say right, so is it just about infants learning certain kinds of behaviors that allow them to develop over time, or is this something there were wired for in? We're not even just conscious, upright live in plenty of studies that have looked at for example two people sitting across from each other. Conversation they're looking at each other one person plays at the hair and the next thing you know the other person not thinking at all about what they're doing starts to Mir that particular action they perceive it. They see it and the imitated especially behaviors. Related to the mouth, and then related to their hands right so if you you and I are in a coffee shop and you grab your mobbing, you take sip, I more likely to grab my mug and take set right. People also argues. Is like if you yawn the mouth movement, right that I will start yawning as well and that I'm imitating this particular behavior. Some of it could be because once again. Attachment I see you I know you do. Neier emotionally connected in this moment right where you'd being social skinned gather, and where bonding in many ways by doing self, and it gets even more kind of interesting in terms of. When you look at people, having a bears like there's a whole other body of work that looks at why do people have affairs and if they do have affairs, oftentimes, it's with the mayor of their initial partner. If you look at people in the news, who've had affairs, if you look at Bruce Springsteen for example, had an affair with another woman who was just inattention of his wife, right? She was also a red, headed woman slightly younger, oftentimes in the argument is. Part of our human brain says okay I needed with a swimming had children with her? I did well with that, so I'm now going to look for a mere of her might severely that we tend to cheat on a our spouses or partners with someone who's not a mirror of partner. The argument is we know through human evolution that this partner worked for me and who they are the children, maybe not, but then I'm just. GonNa go ahead and then have another. There was almost near that person. It is always kind of amazing to me like you don't look for somebody. WHO's The opposite You look for someone who's similar. So. Where did that come from all these adult behaviors that we know? If I see so mistreating seven. I do that in simply merely actions right so this is a bit complicated. In terms of so, there's still a lot of research that still needs to be done like simply just imitating someone, so she's an adult. When you've formed certain types of logical ways of thinking that should kick in for you, then just simply imitate someone right. Not only as live like coach in your pocket, but we have coaches in three D. as well with their most recent upgrade, you can sign up for one on one coaching with a person on the phone. Who will hold you down full you accountable and offer you perspective as you build your big bad beautiful new life. Apple users consented far premium plus plan the APP. APP or check out our next level and mastery options at loves VIRAL DOT COM forward slash coaching android users. We haven't forgotten about you. Live coaching is available to you as well just reach out to us at deer live at love, his viral dot com, and we'll fill you in on all the ways live can create with you. Live pocket coach welcome to your life. What are the questions I? Have is because you know you mentioned like our brain is the largest. It's ever been right, and that it kind of grows with where we are in society or our needs change, or what have you, but then I've heard a lot of people talk about how we have a two million year old reptilian brain. That's either fighter flight, and we have to learn these honest techniques that help us to move into more awareness, and what have you? But it sounds like in this conversation that it's kind of a mixture of both there's there's probably more conscious awareness, but it sounds like sometimes that that the desire to survive or that primal reptilian brain, as it's been referred to is still alive and kicking. It's still trying to ensure our survival. It's still trying to ensure that we remain a part of a pack. It was so funny. My daughter was telling me the other day that she she's like. Do you know why the dog comes into the bathroom with me because she's protecting me? Because when dogs like through evolution, when they woven packs, and one of them's using the bathroom or giving birth, they all kind of surround to make sure that they're safe and it was just so funny to me because I'm like there's some things that are so instinctual. Different species, but so instinctual to us that to me it sounds like they ensure survival, but I'm curious what your take is with those two kind of schools of thought. was interesting because we do know that. Me Mary, you tells everybody that you and I are of the same tribe, so I do agree that we probably overtime linked to marry jeffers, actions and behaviors, so that we can stay intact in the tribal form right, it is otherwise we would die if I lived by myself as an individual, I would not live very long. I need a communal society for me to be able to go onto the next generation. Right to be able to create children to move onto. Onto the next generation, and so on, so we do know that human beings are wired to live in these communal tribes, and that we want to continue to evolve specie, so we're going to continue to be these kind of collective tribal societies, right and today. What we're finding is with the biggest challenges. The United States because today. Individual in the United States can literally survive without much human contact at all right I could work from home and I zeal maybe not. Code from a computer, I might order my meals. Neal's get left at the door, and I can truly survive without much human contact, but is that what's best facility and I think we're at a crossroads right now United States as to how how much of individualism arena lounge tolerate in how much of we as a society has to against this pandemic is a classic. Classic example, right? We're all on lockdown in there. Lot of us who are saying no, you know what I the individual have a right to go out and do what I want to do, but then there's the mule part that says that you can't do that because you're gonNA. Affect that heard by in that. You'RE GONNA. Affect all of us. It's going to have this. Exponential effect on we as a humane society, and so we're really much at that same kind of crossroads of we allow that individual of to to to live as to how or he wants to or do. We all have to be a part of our tribe refinement and put on a mask. You should put on the mask right so that we muir each other so that we can. become a part of a tribe that's going to protect itself so. Interesting unleashing thing. Yeah, I've had a lot of people like I did and I did an episode where I interviewed a couple. That's married. That are also relationship coaches rate. We had this conversation about surviving. Corentin with your spouse, and with that looks like because there's a lot of opportunity for growth. A lot of conversations being had a lot of triggers right, and I had so many people comment like what about the single people? It is so hard for us. We are so isolated and I've taken on a few clients lately. Who their biggest thing has been like I'm so isolated I'm so depressed. Right so there are those those introverts who probably like. I'm good, even myself as an introvert I, miss my friends. I miss that community sitting across from someone and feeling the energy, as you lean in and mirror and talk and commune. That I think it's. It's really interesting as to like what part of Aleutian plays part technology plays. In the way we look in the future. That's a great question because we know from technology that the human brain is actually decreasing in size, so people have actually seen within the last two decades at its decreasing in size matter density. What's interesting? Though is that? Let's go back to that in fed right in that infants need to attach to feel secure to feel a sense of physical security and stability. Stability Out. We need that throughout our lives, not just in our early years that adults need that sense of human attachment to feel validated right in oftentimes it's the mirroring of somebody else is the bearing of another biological creature that cell that has the same type of cell architecture that I do. It's not a robot, right? It's not an inflatable taller. It's GonNa. I seen like seventy years of these new robots, and like the guys like this is great. I'm like this is heading a really tragic direction, but I'm curious because this is one of the things that's very interesting to me like we talked about how especially as a child they're marrying. There's not a whole lot of thought behind it. Win Does empathy come into play like I. knew some of our social and emotional. Like just the sheer desire to connect has a lot to do with our survival, but I think empathy plays such a huge role into who we are as humans, and how he relates when another win. Does that start to kick in? That's a great question. So around three four and five young children develop what we called a theory of mind. They're able to mentally think about not only their own desires, but also the desires of other human beings, but before that they're very egocentric. If you've never raised a two year old and those two year two year old ten trump tantrum are all about me me me me, mason young children are. Are Very egocentric, and then around three or four and five, the bill, the ability to take on the perspective of others rights. There's a famous experiment done by Alison Gopnik. Call you know fish, crackers, versus Broccoli and you as a researcher would say the child you know. I really love Broccoli. Can you give me some Broccoli and you? The child or sitting at the table and there's a bullet. Broccoli and there's a bowl of crackers. The child knows that Broccoli is awful. It's horrible right and so a child that hasn't reached. The stage would say you want Broccoli you want crackers. I love fish crackers. You should also love fish crackers to. Chocolates older than they're like look I love fish crackers, but I know that Genet- loves Broccoli. So I WANNA. Give her Broccoli I understand her wants and desires into I. try to use that sense of empathy right I can share your perspective I understand you want even not my own I nonetheless will step Broccoli towards he so that theory of mind, a young child ability to understand the wants desires, the needs of a human being other than her himself. And it's a pivotal moment where children develop this notion of empathy into there were also experiments down where you might be with a four year old, and I might walk in and I might drop my purse and then four year old. Run over and try to grab Mommy's person and give it back to mommy right or oftentimes I remember you know if I had a horrible damn crying in the kitchen. My young children will come up to me and try to comfort me right in. They're gonNA show empathy in that way as well like they understand that mommy's not feeling good. doesn't happen when they're adult. lessened by way disappear no. Argument here is that's when young children understand that. This is how mommy's feeling and she's happy. I'm going to happy in so on right, the question is that apathy. Is that Mary it gets it to this tricky question. Right so people are you bad? Amphitheater is a totally different round of cognition than Mary. Marrying is really about physical imitation. It's about stimulus response. It's about mouth movements in hand movements right? It's something that were wired for a young age in May. Continue different forms over time, but to be something that's more connected to this idea of theory of mind this ability for us to. Step on of ourselves to take on the perspective of somebody other than us right, and then to then perhaps take actions, so if you look at those three terms right there, sympathy is this notion of I. See someone who's homeless on this gene I feel bad for them, but I'm not really know what it feels like. APPLEBEE's like. Oh, I see someone who's homeless on the street. I was poor myself I know what that feels like. I can empathize with that person right, but it's the person who pulls down the window and gives them money. Who's doing something altruistic their coniston defects. Person's going your hard time. I know what it feels like, but matching do a physical action to demonstrate that intention that I have the this question of intention analogy right so when you empathize with someone. Are you necessarily mirroring something or you actually doing something? That's much more action oriented. It's much more intentionally driven right. Where does that come from? So give me a classic example. I remember taking the train in New Jersey a few years ago and there was an elderly woman who. was leading unsure in immigrants. She fell down and She felt right at the crack of the doorway and the whole train actors stuck right and the whole train. Stop at a call. The matic's I went over immediately and try to comfort her as She was Spanish Dick as I went and started using my own Spanish thinking ability to, but then I remember it turned around and everybody in the train. I was the only person that train that ran to her and tried to comfort her right, and so that is the form of embassy. This notion of I know what it feels like to have fallen I'm GonNa come over, but then it gets to this altruism like I'm GonNa. Come over an actually take actions right? There might be other. People are sitting in the chain and. Dice with her CEO so horrible. I Hate I mean my dad had that happened I'd get it. You know fall, but then there are some people who had sympathetic like this is so bad for I. Hope She's GonNa be okay, and there are also people who were angry late for work. Had No no connected to her at all it, so it's like a whole wide range of actions that occur into this question of his empathy. Come from right so love is horror human. That says that okay. If I see Selena go over and try to help this other woman. Maybe I will cheer right. Maybe that will get up and say I will do it, too. I saw some dude I'm GonNa Mirror that actions. There's some aback. That can occur right to some of us will say. If someone fell on the street and one person goes over to help. You will probably automatically go and try to Mir that same actions right, but not always the case and some people say this is silly. It's not magical thinking like if someone goes over to help somebody. By magic do we all run over and try to help that person? No so weird, a sympathy and apathy in particular come from. There's a lot of argument that it's socially driven. I raised you at your culture. Well and that's what I was GonNa ask you. I feel like sometimes our level of empathy and her desire for action also. Could be nurture right because I know that it's important for me to instill compassion and philanthropy and my child right, and so I show her examples of things or tough situations, or you know we sponsored a child WHO's. She and her mother had been taken out of an abusive home, and we made sure that we got her some bedding as she moved into a new apartment and we did this and we did that, and so my daughter was able to see that someone needed help right, and that was kind of a nurture situation, but I'm curious from your perspective especially with what's happening right now, right? We see empathy, sympathy and altruism. Across the board happening in all manner of ways and I'm choosing to focus on those, and not the people who are angry and upset, and what have you eight now? But the people who are singing from their balconies and sharing food with others and staying home, and making masks, and sending them out to their neighbors and sharing food from their garden. Because there's this we all get it. We're all in the same boat. And we all have the desire to survive, and to make sure the people around us are okay, and I'm curious when you when you think of human evolution and dislike I feels like a an inflection point right now. Where do you think that we're heading? Do you feel like this is a step in human evolution and in the way we work together as as people are just part of. The way things have been, and this is just the first time we've experienced it. That's a great question. I think you hit a one of the word survival right so when we look at this over time thousands of years ago, human beings were in these tribes with the research shows that the tribes that showed empathy men showed care that showed love for each other are the ones that survived and the tribes who didn't ended up killing each other in perishing. So we have two ways to go about this, we can destroy each other and kill each other in perished, and they have been many cultures for example end up on an island, and there is they just don't get along. And they ended up killing each other in perishing, and there goes that entire species, so we know over time that's ABC's have just been obliterated. Eat within the homo species. Different variations of home beings that there's been the whole annihilation or Of a particular species and the question is what caused that we know from warfare brutality towards each other hoarding food into that others. Don't get food right of hoarding food water. All the ways and others just harish so we know through human history that those tribes that cured for each other showed love that should attachment is what allowed that next generation to continue to be healthy a now. There's this whole field of research epigenetics which I think is fascinating. The argument of Bat love that Ye show. Your tribe carries on fourteen generations thereafter by what I do today right now with this particular tribe of people that I'm with will have an effect which we just recently discovered. This notion of what happened to us fourteen generations ago, whether that's slavery, colonialism genocide, still impacting us today at where somehow wired by things that happen to our ancestors generations ago and just as we faced. dyers awful situations that we persevered in knelt resilience. We also developed sense of them that they say about that moment. That I helped that woman on the track night thought what caused it. Is it because of my immigrant ancestry and Americans collective people? We we have to ourselves, decided everyone image together, or is it the fact I remember like a moment that I had an early childhood where. We recently, we recently mcglinchey United States and this man literally died on the sidewalk in front of us and I. Remember my my family like all around him holding his hand. Mutual Americans were walking right past him, and I thought about that moment, and I thought okay. Is it because I have to smell it with my family that was triggered. This moment when I saw this woman fall, which then led me to kind of respond in that way? so the more and more apathy research is showing that it it has to do more with how you've been raised looking after social conditions and environments in which you've been raised. It's looking at the role that your family played the role that your culture play right in developing that sense of Aberdeen that this is not something that we are mirroring because otherwise that would be what a lot of research as magical thinking, it's a magical. It'd be wonderful if we all kind of married each other, and and and really truly helped each other all the time, but that's not always the case, right? And so it goes back to so much to that social environment that you create the conditions that Ukraine to allow that baby to have a very healthy attachment, the adults in his or her world. Whether, it's the maternal caretaker or whether it's the teacher whether it's other members of society that say to the childlike. Yes, your loved, we love you. You're worthy were going to protect you, but it's that sense of security. And Safety allows the child to them understand that I can do that to others right healthy tach at a young age than leads to you having healthy attachments at a later ages. Well, so some of this goes back to question like the people who didn't get up I mean. Where was their sense of attachment to? They feel that sense of intimacy insecurity is a young child, and it's really kind of complicated when you start to unpack this. This right. Why are some people much more empathetic than others There's also going to research went back to our remorse empathetic people from our own Dr, so this was a racial background. Urge Different gender like did I want up because I saw that she was an immigrant woman, just like he caused me to get up and help her, or if she was of a different race, or if she was a man, another woman like. There's all this research in the sense of. An pathetic wide for empathy, but we might be doing it more for people from our tribe people who look like us right and in sound like us it's. A really tricky and so they. There has been research also John. Mirror neurons, and do we tend to imitate someone who looks just like us will imitate someone who's from a different racial backgrounder, different gender background in the research actually shows. That, we don't tend to mayor as much as someone who who's from our tribe right into this notions of are, we wired for them, and is that bias and is advised something. We can undo now. I think that's one of the things that's bothered me so much over. The course of this is is seeing how much implicit bias there is within our entire global. The United States has been put on under a microscope with what's happening and you even have people from other countries like saying like we're sorry for you for the very first time we see how much. Racial bias and cultural in. Every single flaw that we've ever had generation really seems like it's just been put under. It has felt that way. I think every day for so many people. But it feels like it's really been. Blown wide open, and that's like one of the things that makes me so sad because like on this platform I so want to talk about why we need to work with our children to make sure generational weird, creating a completely different message, right? I thought about like with my daughter. I grew up believing that I was unlovable, I had a tough childhood, and when I had my daughter I never wanted her to feel that way, so I made sure to Mir. Not Things that I knew things that I would have wanted right so I wanted to show her affection and show her healthy attachment with apparent figure, and show her all these things that was so funny. 'cause Wendy, I asked her. I was like. What do you think your superpower is? And she was like I'm so lovable and I was like yes. I ended that so fourteen generations hopefully believe that they are loveable and worthy and have healthy attachments with their children. But then when you get into some of the deeper darker aspects of our society. I'm like I. Don't I wish I? Had the magic SAV, but it's like there's so much work that needs to be done. Even, within families, even even realizing what bias there is that we don't even recognize, we don't even see you know. Right. Dependent fascinating concept writes the argument is that we're going to help people from our own tribe because they're like us and if I help you and your from tribe, we'll help me right, and so we've lived like that for thousands and thousands of years but then all of a sudden we started interacting with people from different tribes, and it gets into this notion of flight versus fight right, are you my enemy, or you might back into there have been moments where tribes together, and they call us together under under tribes, fight in kill each other off right, but what's? What's interesting is bad. We're used to seeing differences in human beings to a certain degree United States is unlike any other country in the world, the amount of racial diversity even place like New York City, so man that our brains are not for it yet, so there's a whole other argument that says that this idea of heterogeneous communities in which Soma different types of languages in races and cultures come together live together is just a recent phenomenon that our brain is still stuck in this ancient world of flight versus fight like you're my tribe where you're not might drive. Haven't adopted our brains to this idea that heterogeneity is the norm now that we have to rewire ourselves, I think the work that young. We're doing with young children. Particular is amazing because we've gotta wire young children to look at Heterogeneity as the norm. You are my tribe. Right hide you get to see that. Look differently from them in sound differently for them are of the same bill right, and that's the challenges and I started much better than when I was a kid. I think today's generation. Is starting to open up to the fact that I'm just like you unite, look different each lane, but we're all the same tribe, and that is what's going to cause us to to to really rewire rain literally neurologically rewire Yeah I've had to realize over the course of conduct. I can get frustrated. Right like I. do all of this stuff and I speak in? In I like I want will, and then you watch the news or you hear something terrible tragic. That's happened and you're like. Is this ever going to change? And I think one of the things I'm taking away from. This today is like you can affect. What's going to happen in the future? It may not change in my lifetime, but I haven't influence generational on how. How we evolve, and hopefully we're all kind of doing our part I'm curious because you know this entire platform is of the mindset that you have to work on yourself. Your own stories, your own bias, your own. The lies that you've told yourself right and really come to love yourself. Flaws in awe. And then carry that forward. The concept that love is viral. What what do you think that we have to do in order to make that concept? Like? What do you do in your daily life in order to make that happen? I think the most important things that I tell. My students tell myself is lowest about repair. That all of us have a whole moments of people, and we sever these attachment, but we know. Is that they can repair those attachments right and that you might have had all day with your spouse or your children in the next you wake up and go okay. I'm going to start new. We're going to start I'm sorry what I did. Let's start fresh start a new day, and that's what love really is. Is You're too? Humble and to save yourself I have an attachment here that I need to prepare. It might be severed it. Hardaway go back in in gain redemption in that moment, and it will have gone through trauma entire lives you know eventually do end up repairing those attach fence and eventually become healthier, but it's not until you can repair that you can. Move Forward. I love that. I think that's really beautiful. I think it's it's valuable in in our relationships as well as with ourselves and. A beautiful reflection I wanna, thank you so much for everything you've shared. It's been fascinating. I have like all of these words written down that I wanNA study I. I've I've. I've doubled a little bit in EPA genetic so now I'm more curious and. I just want to thank you for sharing your knowledge and your heart, and I appreciate you. Thank you so much. Have a wonderful day thinks he was well. Thank you so much for joining today I got goosebumps when Selena shared that the tribes that shared. Were the ones who survived. Wrap your heart around that fact and get spreading the love. You can find some at some you tabassum dot, com or on twitter at Sabina Thomas. As always please subscribe either of you and don't forget to share with your friends. We are always interested in content that uplift surf. You have ideas. We'd love to hear from you. Email us at deer live at his barrel dot com. You can also find us on instagram. At love is viral dot media or visit? Our website at loves viral. Dot Com apple users. Don't forget to give the live pocket attract by downloading it for free for seven days.

US Selena Haughty Tabassum Apple Broccoli partner Mary Erikson Institute founder and CEO Utero motor Cortex Ben Dried Jennifer Schneider professor Bruce Springsteen New Jersey Alison Gopnik Early Childhood Education Mir clinical associate professor
How to Beat Pandemic Fatigue

Here's Something Good

06:50 min | 3 weeks ago

How to Beat Pandemic Fatigue

"We are so grateful to our launch partners founding partner PNG and Bank of America together we're bringing you something good every day and it wouldn't be possible without their support. Welcome to this episode of here's something good a production of the Seneca, women podcast work and iheartradio. Each day we aspire to bring you the good news, the silver lining the glass half full because there is good happening in the world everywhere everyday. We just need to look for in share it. Here's something good for today. Call it pandemic fatigue call it hitting the pandemic wall, call it what you want, but it's real and it's everywhere, and after almost seven months of corona virus people are certainly burned out. We are ready to be done with Kobe, but there doesn't seem to be an end in sight for example, while earlier in the pandemic overworked parents could look forward to schools opening in the fall now, more and more districts of resorting to online learning and surveys show the impact in July fifty three percent of people in Kaiser poll said, the pandemic has negatively affected their mental health. Americans are weary, worried and frustrated. A lot of people are eating their emotions or having trouble focusing or sleeping. But there are lots of ways to get your energy and enthusiasm back to find out how we talked a friend of the show. Dr Gail Saltz Dr Salt is a clinical associate professor of psychiatry at the New York Presbyterian Hospital and bestselling author. Here's what she had to say. This moment is not normal and I think many people are feeling burnout out because usually at this moment, people had some sort of summer break right there kids has had some sort of break maybe they've taken a little bit of vacation but there's been a sense that always the summer recharge your battery somewhat. and that's fall brings sort of the renewed vigor that you have to dedicate to something that albeit is new and that therefore that's often exciting and positive. But you know it's going to require more effort on your part and we're in this very weird place. Do the pandemic where people have not recharge their batteries fact anything there there have been increasingly exhausted deprived lockdown That has caused more burn out and the idea that you would be beginning and transitioning into the new you know with timber new time of year, exciting has been brought down by the idea that many many people are not starting that new thing or they're doing under these bizarre constraints. Circumstances that does not give a feeling of excitement of a new adventure and I would advise people. To think about it this way. That, they're not alone. Many people are in that way be that it would be helpful for them think about how they can inject either something that does feel new and potentially positive into their lives. and something that feels like a bit of play a bit of a break even if they can't be in the usual ways, you did it. So many people just sort of going along getting along. But even if you take literally, you know one weekender one overnight to do anything to have a change of scene to do something that feels like it's somewhat playful somewhat you know wrestle. And is a departure from your day in and day out looking your computer screen or zooming or meeting or whatever it is that you've been then. Forced into doing essentially then in terms of turning to fall. It is thinking about again. How can you take the situation that you're in? And yet from it as many things at possible that your old fall situation had, it's going to be different things for different people depending on your family circumstance depending on the covert activities circumstance in your area who really even just doing this kind of problem solving hope with the feeling of burn out what else helps with burn out lying not somewhat. So this is a good time to say, Hey, I'm reaching out to you because wow, I really felt overwhelmed. Do you think we could put our heads together or do you think we take turns in doing an offloading responsibility whether that's with siblings? About aging parents whether that's with friends about how you're feeling whether that's with parents about your children in the community turning to others and saying I do need some support. In you will find other people feeling the same way is a great way also to manage burn out. We always get such great advice from Dr, Gail, Saltz, and as we know a slight shift in perspective can make all the difference. So. Here's something good for today. There's a cure for Kobe burnout and it can start with a change in routine Dr Salt suggest doing something that feels new and positive, and that's a break from the routines you've built up over these months. Brainstorm some ways to get your needs met whether it's for me a community group to help with childcare or setting up a classes after problem solving is a great mood booster. Finally reach out to others admitting you need help support or just someone to talk to can alleviate those feelings of loneliness and frustration and don't be surprised when the person you reach out to is grateful to talk to you too. Have, a great day. Thank you for listening. Please share today's something good with others in your life. This is Kim. Co Author Fast Forward and Co founder of Seneca women to learn more about Seneca women. Go to Seneca women, dot com, or download the Seneca women APP free in the APP store. Here's something good is a production of a Seneca woman podcast network an iheartradio. Have a great day. For more podcast from iheartradio, check out the iheartradio APP apple podcasts or wherever you listen to your favorite shows. We may be living in uncertain times but there are certain traits all American share strength. Resilience creativity. And a belief that when challenges arise we rise even higher. Our Partner Bank of America and it's more than two hundred thousand employees are committed to you build a tomorrow you can look forward to. Visit Bank of America. Dot Com slash community to learn more.

Dr Gail Saltz Bank of America Dr Salt founding partner Seneca Seneca Kobe New York Presbyterian Hospital PNG Partner apple clinical associate professor Kim Co founder fifty three percent seven months
Show 1163: Should You Trust Your Prescription Drugs?

People's Pharmacy

59:06 min | 1 year ago

Show 1163: Should You Trust Your Prescription Drugs?

"I'm Joe Graydon, Terry Graydon, welcome to this podcast of the people's pharmacy. You can find previous podcasts and more information on a range of health topics at people's pharmacy dot com. Millions of blood pressure pills have been recalled because of contamination. Is there a problem with FDA oversight? This is the people's pharmacy with Terry. And Joe Graydon. Many medications are now made abroad in countries like Brazil, Slovak, Lia, Mexico, India, and China how good is the FDA at monitoring manufacturing quality in such places. Do you use mail order pharmacy? Many people do because it can save them money insurance companies may require it. What happens to your prescription drugs? If they have to sit in a hot mailbox and wait for hours coming up on the people's pharmacy. We talk with a pharmacy expert, a former FDA medical officer, and a farmer whistle blower. First the news. In the people's pharmacy health headlines. The spreading measles epidemic has left more than seven hundred people sick in the US. Young children have been the hardest. Hit cases are also being reported. Elsewhere in the world, especially in Brazil, India, Madagascar, the Philippines, Ukraine and Venezuela, Israel, France, Greece and Georgia have also seen outbreaks that means international travelers are likely to spread the virus around the world, the CDC is encouraging Americans traveling overseas to bring their vaccinations up to date before they leave in two thousand some public health experts declared the US measles free. However, if the current outbreaks continue, it's likely we'll be facing more evidemce in the future. We first heard about Chagas disease in one thousand nine hundred seventy three while we were working in southern Mexico. A friend was examining people who were infected with the parasite triple sonoma's cruzi. They caught it from a so-called kissing bug. That was common in rural communities Chagas disease can cause congestive heart failure and sudden cardiac arrest if left untreated now the kissing bug that carries Chagas disease has moved north. The CDC reports that it may now be found in Virginia, Maryland, Illinois, Delaware, and Pennsylvania. The kissing bug is also widely distributed throughout the southern US if someone suspects he's been infected there's a blood test that detects antibodies to the parasite the CDC distributes anti parasitic drugs for treating the infection. Elderberry, salve long had a reputation for fighting the flu must physicians undoubtedly have considered this just another old wives tale. L, but scientists in Australia have recently clarified, the mechanism using juice from commercially grown elderberry. They investigated the effects on human cells during the process of viral infection, the chemicals in the elderberry juice kept the virus from getting into the cells to infect them even more impressive after sales had been infected exposure to the juice kept the virus from replicating and spreading to new cells in response to elderberry compounds the cells released cited kinds inflammatory chemical signals that alert the immune system to the presence of a pathogen. Apparently, the protective phytochemicals are anthocyanins compounds they give the berries their deep purple coloration the orphan drug act was signed into law in nineteen eighty three. It was supposed to provide incentives for drug companies to develop medications for rare diseases. The assumption was. Is that sales would be modest because so few patients would take the medicine the FDA even had a name for such pharmaceuticals significant drugs of limited commercial value in recent years. However orphan drugs have been a bone nans for pharmaceutical companies. The latest example is a little known medicine called HP act thar gel, it's prescribed for a rare type of seizure disorder and babies two decades ago this drug cost around forty dollars, a vile, the company increased the price over that time by almost ninety seven thousand percent of vile now cost close to forty thousand dollars. Whistle blowers have revealed that the company quest core pharmaceuticals pay doctors to prescribe the drug often for unapproved uses such as rheumatoid arthritis and multiple sclerosis as a result Medicare reimbursements for this medication increase more than ten fold over the last several years. The Justice department is now investigating another week. Another drug recall since last year there have been dozens of recalls of NGOs, tencent, receptor blockers or a RB's. These are blood pressure pills such as Val certain Erba certain and low certain last July regulators discovered that the active pharmaceutical ingredients for these drugs had been contaminated with nitrosamines these compounds are suspected carcinogens over the last nine months. Millions of bills have been pulled off pharmacy shelves. The latest recall comes from one of the largest generic drugmakers Teva. The company has announced that it's pulling thirty-five lots of low certain tablets the best way to determine if your medication is on. The suspect list is to contact the dispensing pharmacy, and that's the health news from the people's firm. See this week. Welcome to the people's pharmacy. I'm Terry Graydon. And I'm Joe Graydon. How do you get your medications? Do you pick them up at a pharmacy? Or are they delivered to your mailbox? The FDA has very strict rules for storage and shipment of medicines. How well do mail order pharmacies. Follow these guidelines to help us answer that question we turn to Dr Steven echo. He's associate dean for global engagement and interim chair of the division of practice, advancement and clinical education at UNC Eshelman school of pharmacy. He's also a clinical associate professor. Welcome to the people's pharmacy. Dr Steven echo. Thank you. It's great to be here. Dr Michael a we'd like to talk about mail order pharmacy. A lot of people are required to use a mail order provider by their insurance that says if if you want us to pay for this medicine, you have to use our our mail order service. So can you tell us, please, what are the risks? And what should we all understand when we order our medication by mail? Well, mail order is becoming a very popular way to receive medications just as you described and first of all we are utilizing sort of e commerce as a as a business platform for many items these days, and so it's natural that one would expect to receive their medications through the mail or the internet because of other things that we received their while that seems like a convenient way to receive medications, the the are some issues that are associated with it. I think the the first one we need to recognize is ensuring that the medication is what it says it is in. So there is a risk of receiving falsified sub-standard counterfeit medications because you might be getting your medication from a era. Reputable source, but many of the mail orders that your insurance company's going to to have you go towards are going to be a reputable source. So you don't have to worry about that as much, but you got to ensure that the medication is kept in a way that would not allow for any type of let's say degradation of it. So for example, is it if it's a room controller a refrigerated medication you need to make sure that it it maintains that that cold sort of temperature all the way to receiving it. Because if it got outside of that range, it could lose some potency the same thing about room temperature. If it gets place in a very hot place for a long period of time. Again, you could lose some potency of it. I think the third issue that you need to worry about in this sort of spectrum is you don't have the opportunity to talk to a pharmacist face to face. And so you're missing out on the opportune. To ask questions or for them to ask questions of you that you might bring up information that's important for them to know. Dr Eckel, the FDA is very clear. It's a little unusual sometimes because the FDA can be a little opaque. But when it comes to temperature fluctuation, they have very clear instructions on virtually every medication that they approve so room temperature for the food and Drug administration is sixty eight to seventy seven degrees Fahrenheit. Now. They recognize that when drugs are shipped. There can be what they call brief. And I quote them excursions between fifty nine and eighty six degrees Fahrenheit, and that's presumably a couple of hours. Well, hey, wait, just one second. If you're shipping medicine from a distribution center in let's say Montana to an individual in. Oh, let's say upstate New York it in the wintertime, those delivery vehicles may be out for hours and the temperature could. Well, be below freezing not not for half an hour, but basically all day long. And if you're delivering in the summer to Florida or Arizona, they may be above one hundred degrees Fahrenheit for hours. And then if you stick the medicine, it a mailbox at a rural route, I mean, it could sit there again for hours for somebody to get home. That's way beyond the FDA's temperature guidelines. You're exactly correct. Those things could happen. And we don't know when they're going to happen. And then the other thing we don't recognize is the impact of that on the of the medication generally speaking, it's probably not a problem. But again, you don't know when the ones that are happening that you need to be concerned about and so if we continue to grow the mail order side of the business, then I think we need to be able to put some inexpensive ways to ensure that the temperature that product was maintained throughout the course of the the delivery one of the things that we've done many years in hospitals, very simple thing. But in a clinic where let's say, it's a it's a refrigerator that storing flu vaccines, and they're not open on the weekends. And and there was a. A power interruption that happened between Friday and Monday. Well, you might not know that the power went off and the refrigerator stopped cooling the medications because it came back on by Monday. And so we actually put a little bit of we'll take a Cup. Put some water freeze the water and then put a penny on the top. And if for some reason we come back on Monday in the penny still on the top. Then we know that it's maintained it's it's freezing temperature. But if that sort of became liquid the ice became liquid the penny fell to the bottom, and then refroze we could tell that. There was a change in the temperature in that that medication that was been stored in that refrigerator is probably not something that we want to use in. So we could develop some different ways to be able to monitor the temperature. So that when that patient receives it through the mail. They can at least have shirty that there has not been a significant breach. Now, you bring up obviously, the mailbox situation in that may. Might be a little bit more difficult. But again, if we're going to use this we need to be able to provide information to the patient that what they received is the right medication, and it's still safe to use Docker. I wonder if you can give us some examples of what might happen. If a person when out to the mailbox picked up the medication started to use it without realizing that this medication has actually been damaged by its exposure to either extreme cold or extreme heat. I think that that probably the the situations that would be most concerning would be around a medications that we refer to as narrow therapeutic index whereby the fair -peutic window of -ffective nece is pretty pretty tight in. So for example, let's say individuals had a transplantation of some Oregon, and you have to put them on immunosuppressant medication. So that the the organ would not be rejected by the body while in that situation, you need to have a certain medications within a therapeutic window, and there's tight monitoring of that. And so if for some reason, you're continuing that therapy, you have an optimal does. But for some reason that medication is not at the potency as you would expect you could create a situation whereby in that situation, you would fall outside of that therapeutic window, which could lead to some of the problems that we're talking about Dr echo we received a. A message from one of our readers. This person said I have staged for metastatic breast cancer, my oncologist prescribe rants shipped by UPS. I happen to be outside. When the delivery truck pulled up. It was ninety seven degrees here in Florida with a heat index of well over one hundred degrees. That's not appropriate for this medicine that I hope we'll save my life. I talked with CVS specialty pharmacy. Pfizer the manufacturer. And the FDA I have no interest in filing a lawsuit. But if I can't get my medication ship safely. I will the FDA and Pfizer both recommended. I not take the pills delivered that hot day. The order was replaced. No, one seems to know exactly. What temperature any medication starts degrading? How can we make sure everyone gets their medication safely? Do you have an answer? Well, I think you're you're bringing up important issue. Because as we as we talked about earlier the growth of mail order whether it's being mandated by the insurer. Not is something that is going to continue. And so we probably need to do much more research. Situations like this to determine either if we cannot demonstrate that there is a tight temperature control throughout then we need to come up with some better policies around are there some certain medications like this one for a cancer treatment, whether they should be restricted from mail order as opposed to being required to go there because of some of the issues that you're that you're highlighting right there. And I think we probably need to come together as an industry to further dialogue and come up with clear guidance Dekel is there anything we consumers should be doing. Well, I think first of all we all believe that going to the pharmacy is the best way to get your medications. Not only beyond the safety things we've talked about. But you have that opportunity to dialogue with a pharmacist to ensure that those medications. Our meeting your needs. There's no side effects. There's no drug interactions. And so the first thing that I always tell people is you need to have a relationship with your pharmacist because they're going to be looking out for you. You know? And then secondarily, it's you know, trying to have a plan that allows you options, and how you get your medications. And but then Thirdly, if if for some reason, you are receiving your medications do mail order, and if you ever have a concern or question about the integrity of it. You should feel comfortable calling up and asking for a different shipment of it. And they should be willing to give that to you because of its sat on my porch in my mailbox for a extended period of time. And there was significant temperature fluctuations that day that Stephen echo. Thank you so much for talking with us on the people's pharmacy today. Thank you. It's been my pleasure. You've been listening to Dr Steven echo associate dean for global engagement an interim chair of the division of. Actes advancement and clinical education it UNC Eshelman school of pharmacy. He's a clinical associate professor. Dr Michael is also associate director of pharmacy at UNC hospitals after the break, we'll talk with a former FDA medical officer. And learn what they do. How does the push for lower prices affect the quality of your prescription drugs. A number of blood pressure pills have been recalled over the past year because they're contaminated with carcinogens. How could that happen? Does the FDA look at the paper trail for medication instead of the actual facilities making it learn about safe handling and storage of medicines. You're listening to the people's pharmacy with Joe and Terry Graydon. The people's pharmacy podcast is sponsored in part by Kaya by Addicks K, A Y A -biotics offers the first probiotics which are both certified organic and Hypo allergenic I'll probiotics are produced in Germany under laboratory conditions with high quality ingredients and under strict regulatory oversight. The three available formulas are created for very specific purposes such as strengthening the immune system, fighting eastern factions and helping with weight loss to learn more about Kaya -biotics, probiotics and the important topic of gut health you can visit their website Kaya, -biotics dot com. That's K A Y A -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the people's pharmacy. I'm Terry Graydon. And I'm Joe grade if you would like to purchase a CD of this show, you can call eight hundred seven three two two three three four today show is one thousand one hundred sixty three that number again. Eight hundred seven thirty to twenty three thirty four or find it at people's pharmacy dot com. You can also download the free podcasts from IT tunes. The people's pharmacy is brought to in part by Verizon a-, an analytical laboratory, providing home health tests for hormones, gut health and the microbiome online at V E R, high S A N A dot com. We're talking about the trade off between quality and price, especially when it comes to generic drugs. How well does the FDA monitor generic drug manufacturers both here and overseas? Our guest is Dr David Gort ler. He's a former FDA medical officer for two decades. He's worked as a pharmacology expert in the area of drug safety. He's a professor of pharmacology and biotechnology in Washington DC and consults for the group. Former FDA dot com. Welcome to the people's pharmacy. Dr David Gort ler. Hi, thanks for reaching out. Dr Gort layer, we noted that you are a former FDA medical officer. Could you tell us what are the responsibilities of an FDA medical officer? While the responsibilities are, many and complicated. But the bottom line is what we do is. We review new drugs or existing drugs that want new indications and all we do is make sure that the drugs are safe and that they do at their intended to do. Of course, there's a lot more than just that. Dr Gort ler we've seen recently an initiative for lower prices. This mostly means generic drugs. A lot of times. These are very inexpensive generic drugs you can get a month supply for just four dollars at some big box stores. So the question is are there consequences of? Driving the cost down so much. Does it have an impact on quality? Well, it certainly does and goes back to the old adage everyone's heard you get what you pay for. And I think everybody would agree that drugs should be more forcible. But the problem is nobody's really talking about the quality of those drugs and right now in order to save on labor costs a lot of pharmaceutical companies are either emerging or American pharmaceutical companies are transferring their business to these third world, countries or labor costs are very low. The problem is is that in those countries. The quality of the drugs aren't very good. And I think the consumers are being duped by going to pharmacies and not knowing where their drugs are coming from. I think this is something the consumer should be able to choose from. I think they should be able to decide if they're willing to take sweatshop type drugs or not. Now dot ca Gort ler. This has all been brought home to Americans over the last six months or so with regard to a class of blood pressure pills called our Angie, tencent receptor blockers drugs, like low certain herbs, Artan and vowel. Certain there've been so many recalls of he struggles that we've completely lost count. It's it's over fifteen major recalls with lots involving hundreds of hundreds of products. Am pills hundreds of bottles of pills, and the most what we've heard recently is. Well, initially, it was N D M A, and then it was N D A. And now there's a third contaminant called N M B A, and they're all nitrosamines. They're all probable carcinogens. And it's like how did that happen? And how is it still happening and people are kind of SRI? Drugging their shoulders and going, well, how can I trust the drug companies that are selling these generic drugs to make sure my medicine isn't contaminated. Well, unfortunately, what happened with these IRB's in a arby's these drugs as far as contamination issue and a safety issue coming on that's something which was really inevitable. And this is nowhere near the end. This is just something that we happen to have caught right now what we've heard is that in the case of the arbs the manufacturer was trying to improve yield that is to say make it more efficient, and they changed the manufacturing process. And apparently, some of the companies may have been re using the reagents the chemicals that they use to make these products and that in turn has led to the contamination with nitrosamines, I think that most Americans assume. That the FDA is inspecting these plants very carefully, and is really on top of the manufacturing process. You've implied in one of the articles that quoted you that that the inspections involve looking over paper records or electronic records and trusting that they're real instead of actually randomly testing the medications can you elaborate on that. Of course. So what's important to know is that when you reuse reagents or you change the process in order to try to get a higher yield. That's something which has to be applied for an approved by the FDA not doing that reusing reagents or changing any process is a violation of GM P or good manufacturing processes. Now. The problem is is that when it comes to inspecting drug companies most drug companies that are going to be inspected that are located in the United States army. To be or Canada are inspected approximately once every twenty four months in the facilities overseas. It becomes a little bit more complicated. When you have a FDA inspector travel overseas they have to well. There's a process they have to go through with with our State Department and the host countries State Department, and sometimes it can take months, for example. India is a democracy, which is great, but like their early democracy and early democracies tend to be corrupt as as can be seen. So because of the corruption issues when an application goes through to our State Department to to India State Department, sometimes somebody is tipped off. And because of the delay. It gives these drug companies time to clean up their act because of this delay overseas, drug facilities are only inspected approximately once every five centimeters that can also be a language barrier. And there can be a a lot of the times the people who are producing these drugs. Don't really know what they're producing there. Engineers, and that's one of the things that these companies do to keep the prices of drugs down. It's it's very very upsetting to people like myself who dedicated their lives as a pharmacist and a pharmacologist people taking sake drugs that should work one of the things that Americans love are lower prices. And there've been a lot of calls to lower the cost of prescription drug medications. The problem. Of course is that. The prices have gone into the stratosphere. I mean, it's it's not unusual to see the cost of cancer drugs in the six figures and higher over course of of a lifetime. But we also love generic drugs in insurance companies love them, you know, hospitals, love them and patients love them because they can get medicines at a much much lower cost. How many of our drugs are now generic and how many of them are coming from overseas, while approximately I think it's somewhere around eighty percent of our generic drugs right now are coming from overseas. And the problem is, of course, the only problem is with having lower prices is is I believe and as we've seen historically reports are lower quality one of the things. Elizabeth Warren has brought to the forefront of wanting to bring all drug manufacturing. Back to the United States, which is a good idea. Of course, we don't know how much that would cost. But the idea fundamentally is is a very good one. And I know everybody likes to save money on their drugs, and I'm figuratively. Slamming my desk over here, you have to talk about quality. You can't just talk about price when it comes to pharmaceuticals certain things, you can certain things are generally interchangeable. If you want to if you just want to buy them for the cheapest price possible of like a pair of gym socks how much what could really be the difference between one pair and the other other than the material of which they're made. And of course, some people are very specific about where they buy very certain items, but they sorta see drugs as a fungible product, which of course, that they aren't but one there's no way that one could actually know that by looking at the pill in the palm of their hand. Because nobody's doing the quality control testing these drugs. People think that's the FDA's job. But really it isn't what hap-. Happens is when the FDA goes in for an inspection Bill, look electric records or handwritten records or whatever the look at. And they'll trust the company when they say that one of their drugs is we tested this batch. And we found it to be with an order of magnitude. It's it's a ninety seven point whatever percent pure, but anybody can write anything on a piece of paper anyone can enter data into an electric record and say, yes, this is ninety seven percent. Nobody is looking over the shoulder of these drug companies, whether they're the United States or its overseas. And that's where my frustration comes from. Because it destroys the higher continuum of trying to treat patients. These drugs are approved the pharmacies. Dispense them the insurance companies pay for them, the patients, take it home. They're compliant with taking it every day. And in the very end these drugs, which everybody goes through all the efforts to dispense have paid for by shirts companies aren't heresy subpar and ineffective, or in some cases, like the. Val Sar, tan, even toxic. Gort? Do you have any advice for our listeners? Well, this is something which the state boards of pharmacy is really haven't taken a lot of time to address. And of course, you can't really blame the pharmacists either because the pharmacists are just looking at the bottles, and they're taking it for granted of something says one hundred milligrams of metropolis, or whatever that there's one hundred milligrams in there at this point. I think action is required. Either people should be knowledgeable. But were there drugs come from on the pharmacy label, or I think there needs to be some sort of double check on these drugs that are being sent to our consumers. I think a laboratory or there since the FDA is not doing their job of actually proactively testing these drugs, which is a shame because they're supposed to be protecting us. I believe third party has to come in has to step in and do this for them it. This is something which needs to be addressed. Now, it should have been addressed nearly a decade ago. Everyone should be throwing their attention. At this matter. Of course, I'm a little biased. I've dedicated my life to the safety of drugs since my background is pharmacology in a pharmacy. The I think it's the most important it's an existential issue which threatens the American population. The lawyer I recognized that the issue of drug quality is is very complicated in where they're made in under what conditions is really important, but there's one other aspect to this, and it has to do with what I would call storage and shipping or handling. And if you look on the prescription information the official prescribing information for all medications, they come with very clear FDA guidelines about what the temperature fluctuation can be for shipping these medications short term and the long-term handling of them. And then how both the pharmacy and the consumers should store them either in the store or at home, and what fascinates us is that, you know, these guidelines from the FDA are actually not implemented as far as we can tell I mean for the most part the FDA has no jurisdiction over how the pills. Shipped from abroad to this country. Or what happens once they arrive here? How long they stay in the port of entry. And then finally how they get from the port of entry to the pharmacy distribution centers. And how they get from the distribution centers to a local pharmacy. That's state by state board of pharmacy kind of thing. How important is storage and handling when it comes to quality the storage of drugs at the correct temperature is absolutely fundamentally critical. And so what the FDA considers to be room temperature is between sixty eight and seventy eight degrees Fahrenheit the storage of drugs is probably second only to the quality of drugs as far as importance goes. And one of the things that I focus on. So when the problem arises to is not only if drugs are not meeting quality controls to begin with. But whether they're being stored properly, this is a problem, which which needs to be addressed. By mail order houses, most of the drugs. Dispense in the United States now come from mail, order facilities and those mail order facilities. The vast majority of them are located in the state of Arizona where everyone knows Arezzo Anna's a desert, and it's exceedingly hot over here. Humana. Has a mail order pharmacy in Glendale. Arizona. Walgreens has a mail order pharmacy in Tempe. Arizona til Pac which is owned by Amazon is in scenic, Sarasota and Express Scripts which is the largest Mailer house in America's located in ten P Arizona, I think United health also has a facility in Arizona's well, unfortunately, the FDA gives recommendations for room temperatures are but the Arizona state board of pharmacy in the attorney general has turned a complete blind eye to this. I'm not sure what their focuses. But for me the storage of drugs is the most critical now most people just see a white tablet or capsule in their hand. And just because it is an ice cream. It doesn't melt doesn't. Mean that it isn't affected by adverse temperatures. They absolutely are in Arizona when it does get hot. Now, if you want exceed these temperatures just a little bit in some other states, you know, perhaps it's not that big of a deal go from sixty eight to seventy eight degrees. And maybe you hit eighty five for you know, for a little while. Maybe it's okay. But when you get your drugs from mail order pharmacies, of course, because these are publicly traded entities. You will be getting the cheapest available drugs that will be coming from the aforementioned countries with poor quality control the third world countries. But on top of that these drugs will not be mailed express. And these drugs will be mailed mailed by ground in UPS trucks, and they'll be stored in a facility before they're mailed in in a facility, which is not going to be refrigerated. And when you see the temperatures, perhaps, it's okay, if you're just transporting a drug from your card your home, but when you receive a drug a weekly. Later. That's sitting in the back of a UPS truck in Arizona where the temperatures routinely exceed one hundred ten degrees and even one hundred twenty degrees in the back of a UPS truck. It's not uncommon for the temperature to exceed one hundred fifty degrees. It sort of feels like an Zona I grew up in Arizona, of course. And you know, whenever you bake cookies, and you, you know, you open up the oven to see how they're doing. And you kind of get that whoosh in your face of that hot air coming out of the oven and hers, you get that just opening the front door your house, and even when it's hot outside you sort of get that whoosh of hot air when you open up your car door, and these are the conditions under which these drugs are being stored and the state board of pharmacy of Arizona doesn't seem to care one can think that a lot of these state boards, and this problem, which is endemic all over the United States are infiltrated with pharmacists from chain pharmacies or executives. And so when these issues come up, they of course, are gonna. Say things that are going to favor their employer and kind of just brushed the issue away. But the store of drugs are absolutely critical. And that's something which is also being ignored. And again, people could be taking these drugs. They could be taking birth control pills that could be taking their drugs for their diabetes for their cholesterol. And there's no way of knowing if these drugs are are going to be working, especially if they're stored inappropriately I would say that they're more than likely these drugs are not stored correctly or not produced for actually they're more than likely not to be effective. And in the worst case scenarios some of these drugs can even mutate in the presence of of water or high temperatures into a poison. We don't see that very often. But we do not the case with doxycycline and a few other drugs. So absolutely. This is something which is key an absolutely it's critical. David, gordon. Thank you so much. We're talking with us on the people spy Masih today. Thank you for reaching out. You've been listening to Dr David Gort ler. Former FDA medical officer and professor of pharmacology and biotechnology he consults for the group. Former FDA dot com after the break, a whistle blower will describe why his former company was fined half a billion dollars. What did they do wrong to justify that penalty? Generic drug malfeasance isn't limited to one company or even one country. How can we assure data integrity and drug quality find out what we should do? So that we can trust our prescription medications. You're listening to the people's pharmacy with Joe and Terry Graydon. This people's pharmacy podcast is brought to you in part by Verizon dot com. There is on a lab offers home health tests that allow you to monitor your hormones and health conditions. You can take control of the quantitative assessment of your health and learn about male and female hormone balance, the stress hormone cortisol leaky, gut gluten intolerance, or your gut microbiome take a more active role in tracking your health and take twenty percent off your first order of a male intesting opportunity with the discount code people. That's upper case P O P L E to learn more, go to various Saana dot com. That's V E R. I S A N A dot com. Welcome back to the people's pharmacy. I'm Joe -gree. Carey Grayton if you would like to purchase a CD of today's show or any other people's pharmacy episode, you can call eight hundred seven three two two three three four today show is number one thousand one hundred sixty three the number again, eight hundred seven thirty two twin T three thirty four or you can place the order at people's pharmacy dot com. You could also download the free podcast from itunes or from our web store. We invite you to consider writing a review the people's pharmacy is brought to you in part by Kaya -biotics probiotic products made in Germany from certified organic ingredients. That's K A Y A -biotics dot com. It isn't easy for the FDA to keep tabs on generic drug makers in other countries. What are the obstacle? Nls and what could be done to overcome them both patients and doctors might need to pay more attention to where our prescription. Medicines are coming from our guest is diminished talker he worked previously in the pharmaceutical industry overseeing drug development after blowing the whistle on his former employer ram back. See he's become a public health activist focused on improving the quality of affordable medicines around the globe. Welcome to the people's pharmacy. Deneche talker. Thank you Terry been a longtime listener to program. So this is indeed a pleasure to speak with you diminish. It is a real honor for us to speak with you. You are a whistle blower. You have accomplished. Some extraordinary things when it comes to pharmaceutical overview, perhaps you can tell our listeners a little bit about your experience with the pharmaceutical industry. So I'm a chemical engineer by training. I've into the shifty Hampshire got a master's degree there in. I've looked at Mr. Myers Squibb of a large pharmaceutical company for eleven years and then had opportunity to go work in India. And I'm from in two thousand three in an and then that's how I got into sort of involved in understanding how the genetic Trump industry works. I worked in the industry in India. For just about eighteen months. And then, you know, one thing led to another the nights, you know, sort of did things on my own. And I think what I told FTA back in two thousand five became public into the teen event. The company that I've worked for pled guilty to seven concept criminal fatty and agreed to behalf a billion dollars in fines to Scott hold on a sec. How much did you say half a billion dollars? Yeah. It was five hundred million dollars in all I was largest to you know, any penalties. Did that is assistant that unity a member of the drug industry by the US government onto the time? So they pleaded guilty to a number of counts and they paid half a billion dollars in fines. What did they do wrong? You basically were actively involved in revealing some of those problems. So like any other invest? Negations? I David a CDs of set of things that I thought they were doing all which essentially I talked with DA toll the fifty about. But then in the company pled to and essentially sort of agreed that they were doing wrong where to sell substandard medicines in the US market. They copped a plea to seven counts of criminal felony saying that and the settlement agreement lists out what drugs to wear, and you know, how much does what kind of you know, it's upside medicine that they've been actually selling in the US markets. That's what they agreed to plead. But in my experience, the wrongdoing was not more provocative than that. Well, it's not just ram baxley. Although you were the whistle blower with the company that you were working for there have been a lot of companies not just in India, but in China and other places around the world, including the US and in the United States that self where the Janette. Eric manufacturer got into trouble with the food and Drug administration. Could you tell us about that? Yeah. So I think that you know, what came to the surface as part of what happened at backseat opened the door for a neom sort of area of compliance, which is commonly known in the industry parlance, estate integrity. See I think in the United States. You know, the FDA has done such wonderful job of convincing us that if manufacturing gets approval than the genetic nation that is much cheaper than what the patented farmer nation is is bio equivalent, meaning that it works. Exactly the same bay that the patented combination should work and for a long time in behead audibility to control ad oversee enforced quality betta manufacturing was primarily within the United States that you did a wonderful job of doing that. Because they had the ability to show up at your door on announced in Oscar to to to show how you made it valley fide that the doing what you said that you would do. Do. But those things don't necessarily work the way the artwork when the manufacturing facilities half the world away. And can you just spell out for us? Why it makes a difference? Whether the inspection is unanticipated or whether somebody is all ready for you to come and inspect if you're an FDA inspector. So for the long period of time, the weight worked at that venue, get an approval from FDA, but you go to the FDA say, you know, this system medicine that I think I could make I have done studies on it. I know that it works. I have destined in the lab of tested on patients. I find it that this of taking this medicine is smaller than the benefit that it will deliver the FDA. Would then ask you how you're gonna make it? What does it be for you to make you know in large quantities? Right. It's one thing to make a pot of chili for dinner for two people. But if you have to cook that for hundred people who are coming for dinner at the large gathering, it's a quite an amount of process about and so what companies would have to do is tell the FDA. This is the basically would make it if you know a batch of hundred thousand pills, right, and the FDA would then say yet, we know this makes sense. And this is the controls that would exercise. But because to bathing setup in the US, fifty a dozen actually testified product it works on August of saying that you said this is what you will do pediatric leaving will come to your facility PDR deeply will come to your kitchen to to make sure that you're using the right amount sought right amount of tomatoes in making Chile to make sure that we have consistency in taste in texture in the way that you serve right? Right. And that you're not putting anything that shouldn't go in. You are washing your dishes in between. Right. Exactly. Exactly. And so that process worked on an honest system and behind facilities within, you know, obviously area of control that they could just knock show up there. Don't and say opened the door. He wanted to see how clean it kitchen. This do you as you said clean your dishes in between making two different batches shimmy, right? Did you there have minutes to make sure that you don't have hair falling into clicking? You could do that the facility was in Ohio in Puerto Rico in upstate New York while in the facilities located in Nashik, India. It's not that easy to do. Right. So you'll have to send you it inspectors on a flight while they kind intercountry without reason. Right. So you'll have to get a visa to these people until two thousand thirteen you know, the way that you gotta Rieser is that that the company would actually digressed of visa off the Indian embassy located in Washington DC, or in New York and say, you know, these inspectors were coming into inspected facility. Can you give them a visa guess what? I mean, if you know that you're getting them visa, you know, why they're coming. Right. So imagine if you're running kitchen, and then you know, when when the foot inspectors gonna show up are you going to try and not make sure that everything is span before the show up. Of course, you are. And that's exactly what happens. So if you tell them head of time that that in these inspectors, remember, you know, the. Timing hoffy across the globe and the ad for three or four days. I mean, I don't know how often you traveled overseas spit. If you traveled India like, I do all the time. First couple of days. I'm Jeff Locke come not as functional as I am here. Right. And same thing happens to be when I come back. It takes me a couple of days to get back on my feet. So if you had there from its ill week you land there, you know, you Hoffman across the globe. Ben it's deal with it. It's night over here. Your body gets sticks time to get adjusted. And then you don't know the language, you don't know the layout of the place. So you you'll lying on the company to shop it on you take your head over you you need to go to do what you need to do. How effectively do you think you're going to be at that point in time? It sounds as if it could be a stage managed process, I believe those were your precise words, and it's a snapshot in time once the inspectors leave six months later things could be quite different decisely. And so, you know, if you know on sit and date, you know, you have this people show up you'll make sure that everything is picking span. Liam editing is done by the book. And then, you know, once people leave guess what you go back to the same. You know, what you needed to do to try and get the parked out the door. And I think that what has happened in the last four or five years is the did are some FDA inspectors who will become very very good at spotting dispenses between what is said, and what is actually at presented. I mean, I can talk about one that I know off who I suspect a lot to bake when he was in a base of the daily office of the US FDA. He did some amazing work. I mean to the extent that essentially become forensic inspections in undestanding what the company and the management was telling you, and what you'd actually see on the factory floor when event to inspect. Right. But that takes a knot tying and lot of expedients to try and. Get to the point d Nash, what do you recommend for consumers because what we've been talking about is quality sometimes for life saving medications, if you've had an organ transplant, for example, and you have to take an immune modulating drugs. That's going to help prevent your body from rejecting that Oregon. There's no room for air if you have a heart condition and the medicine that you take to keep your heart regular or under control again, no room for error blood thinners, no room for error. And yet we've had conditions where heparin as for example. I blood thinner was a real problem made in China. So what can consumers and patients due to be able to protect themselves from these concerns that you have raised about quality standards and quality control and the FDA's over. Site. So I wish there was a simple answer. I could give you Joe. I don't have a simple answer. I did a few different things that I think that at least I'm focused on the first is education. I think that the discussion in our country right now is primarily focused on price so focused on price. And for good reason. I think that a lot of medicines out of reach of people will be they need that. But I think that the discussion also needs to include an element of quality. I mean, what good is it? If you end up buying cheap medicine that doesn't work right? Exactly. You've just wasted the little bit of money you were spending on and and you may have a terrible outcome and possibly put your health at risk precisely. And so I think that that is some, you know, we need to broaden this discussion a little bit. I think price is important, but I think qualities equally important, and I think that we need to educate ourselves better. The second thing that I think that we need to do is. I think that we need to look at a regulatory framework. I think that what they have to you. A setup for and how they help sort of ensure quality work extremely valuable could control our manufacturing within the continental United States. Whether we like it or not globalization is he had to stay beyond going to disown medicine Samedan ocies acting that we really need to think carefully about the model that the FDA hasn't point at the moment in the way that they are actually ensuring quality of address apply. Right. This honor system that sort of, you know, relied on for many long period of time is done the night market because the facts have changed from the consumer point of view. I think what's important visit every time to go to get your prescription filled with it CVS award rates of IT, look carefully at the manufacturer's name. You know, it's in the back is in said the piece of paper of the give you along with the bottle. It counts, you know, who Des faction, est and take a moment to go on Google and check them out and find out how many? He calls have the had what kind of reactions have had right with dot information. I think that you can go back to your and see I'm concerned about this. You know, if if you feel that that incident hobbled the medication that you're taking it's not working Bates was to work precious. Not coming down. You don't feel the way you feel. It least to have a piece of data that you can take back. I mean physicians like had lever. I'm sure you've spoken to him is being a great. I'd work in in educating even the medical fraternity up to this aspect of it because most physicians don't even pay attention to this. Right. So if you have the data, you can at least have a conversation with you with your doctor, maybe unable to get you a different formula thirty the one that doesn't have the kind of issues dealing with. So I think these these things that I can think of I fished him a simple answer. I just don't know. I think it's gonna take some time for us to resolve this issue. If you go to buy a shirt, or if you go to the grocery store and buy an apple they have the country of origin on them creek. You will know exactly where that shirt or that apple came from? We can't do the same thing very easily with our medications should we have country of origin labeling. Absolutely. Let me also flew the you need to have his on that package and sitting in addition to the name of the manufacturer, we meet to know what facility made this. Denise Sheehan in summing up your work and research over the last decade or two it seems to me that the focus here in the United States in particular is is mostly about price. And we keep hearing over and over again how great the food and Drug administration is about saving Americans money on generic drugs. There's not a lot of discussion. Regarding quality of basically, the FDA says, hey are drugs are the safest the best in the world. Don't worry be happy. Let's save money. What would you like to tell the Commissioner of the food and Drug administration? If you had his ear. I think you know, a lot of what somebody like me would actually say is to go back in have deft e look at the data. Right. I mean, thankfully, if days mother agencies that actually reasonably transparent, they put out this FDA dashboard. That tells us how many inspections the undertook what they found. You know, what are they doing differently? I think that they've had five years of data now off the model that the country employing in ensuring the quality of the medicines of life on our country. The question that road is deputy Commissioner this given this this date, given that you see repeated violations of the similar nation of the manufacturers. What is it that you're going to do differently to ensure that the quality of a drug supply continues to be the same as it has been for the rest of the FDA history until about five years ago? The next Tucker. Thank you very much for talking with us on the people's pharmacy today. Thank you, Terry. Thank you special race. You've been listening to Deneche talker. A public health activist working to improve the quality of affordable medicines across the globe as a whistle blower. He was responsible for the prosecution of Rombaks laboratories for supplying adulterated drugs to the US market in two thousand thirteen the company plead guilty to criminal felonies in the US court and paid five hundred million dollars in fines, Mr. Tucker now focuses on the need for data integrity in pharmaceutical manufacturing loon, Seagal produced today's show Alydar ski engineered Dave and at its our interviews. People's pharmacy is produced at the studios of North Carolina public radio W UNC people's pharmacy. Theme music is by BJ Liederman. The people's pharmacy is brought to you. You in part by Verizon a-, an analytical laboratory, providing home health tests for hormones, gut health and the microbiome online at V E R, I S A N A dot com to buy CD of today's show or any other people's firm ac- broadcast you can call eight hundred seven three two two three three four today show is one thousand one hundred sixty three that number again, eight hundred seven three to twenty three thirty four online at people's pharmacy dot com. And when you visit our site, you can share your thoughts about today's show. Have you had any experiences that led you to question? The fall of your prescription drugs at people's pharmacy dot com, you can sign up for our free online newsletter or subscribe to the free podcast of the show. You'll never miss another episode, and you can share it with a friend when you sign up for the newsletter. You'll get our free guide to favorite home remedies in Durham, North Carolina. I'm Joe Graydon. And I'm Terry grading. Thanks for listening. Please join us again next week. We hope you enjoyed this podcast if so please consider taking a minute to write a review on I tunes and thanks for listening to the people's pharmacy.

food and Drug administration FDA US India medical officer Arizona Terry Graydon UNC Eshelman school of pharmac Dr David Gort Dr Steven echo Joe clinical associate professor China Chagas disease Joe Graydon tencent
1377 Dr. Eric Pulver & Dr. Jeremy Krell on the Impact of AI and Machine Learning : Dentistry Uncensored with Howard Farran

Dentistry Uncensored with Howard Farran

1:04:26 hr | 6 months ago

1377 Dr. Eric Pulver & Dr. Jeremy Krell on the Impact of AI and Machine Learning : Dentistry Uncensored with Howard Farran

"Accelerate your career and reach success on your terms coming this March the ADA accelerator series offers on demand access to financial leadership and wellness resources designed to fast. Forward your life your way. It is just a huge honor for me today to be podcast intervene to legends in dentistry. On your left We'll we'll start with a on your right rave your hand Eric Eric. He's on the Gosh you're both brunettes. How do we describe the Blue Shirt? Dr Eric. Pulver received is bachelor degree of science in biology from the University of Western Ontario in Canada and his doctor dental surgery from the University of Toronto in eighty nine. Dr Pulver trained is a hospital based general practice resident at Mount Sinai Hospital Toronto. He then furthered his studies as a clinical fellow in the Osteo Integration Dental Implant Unit Department of process at the University of Toronto under George Zarb. He received diploma and Oral Max surgery from Northwestern University in ninety five. He has served as an assistant professor at Northwestern University Dental School. He has been a past director of oral surgery at Michael Reese Hospital where he was responsible for resident education. He served as a member of the craniofacial cleft lip and politics associated with the shriners organization. He held the position of clinical associate professor and Chief. Oral MAXA Facial Surgery University of Chicago hospitals and medical centers from ninety nine to two thousand six. Dr Paul was a team oral. Maximum facial surgeon for the Chicago Blackhawks in the National Hockey League from one thousand nine hundred sixty two thousand six is that just because you're an oral surgeon and the tooth was already not doubt you knew you wouldn't even have to pull it. They absolutely I just got to watch the game. That's what was good for me and on the left. Another genius legend in Dentistry. Jeremy Krill D. M. D. Mba. He's a general dentist and currently oversees provider and clinical initiatives at quip the oral health and Subscription Electric toothbrush company. Jeremy also practices Dentistry part-time sits on the board of health care and dental startups. Including dinty. A I floss bar patient plus Verena solutions and violent and is an angel investor. Jeremy is a fifteen year proven track record with startups through several successful multimillion dollar fund raising acquisitions. He started his career with three web and graphic design startups and moved into a luxury good and commodity venture door made for College Students. He later founded a venture incubator. Ceo in a box and led strategic provider Innovation and development at Oscar health insurance following his NBA as Chicago Booth. Germy lives with his wife daughter and a Pug in Jersey City New Jersey. He enjoys playing and following professional tennis having attended all. Us Open since he was born. Jeremy is a Foodie and has been Vegan for ten years before it was cool. You you helped Some other guests. We've had on the show Eva sfjazz of the floss bar. You're just Quite the man Jeremy in Krill D. M. D. MBA will gentleman. Thanks for joining the show. Today thank you for having us much for having us. I think we gotta we gotTA start the show. Obviously with the big news thing that the markets have tainted there. I'm they they were actually trigger. Today I know the corona viruses a big deal but you guys between the three of us. We got a lot of college. Here is this hype is going to be a regular flu system. You know. Twenty eight thousand. Americans died the flu or Jimmy. Urine New York. That's got to be Ground Zero for international travel or you guys worried about this much. I'm super worried about our dental shows being cancelled I'll tell you that But you know to me and and talking to some of the friends that I have now I think I think the numbers are actually being pretty underreported even those here in the US. I think a lot more people carry symptoms are not actually symptomatic and so this is potentially looking a bit more potent than it is. I think there's a fear factor associated You know it's really hard to say but I think that if we can activate and take precautions you know in a in a reasonably expedient fashion we may be able to Reduce the impact and I have read some information out in In Asia when the World Health Organization went out to to check it all out and they said that's part of the use of we chat because it was so well Fred helped to contain the virus in Monitor Public Transportation It helped to reduce transmission because they weren't using currency and they were able to really get the population to take seriously and control them in a way that that they weren't sure anywhere else in the world could do But I think that if we take it seriously and look at things in the proper way maybe we can reduce the spread. And and certainly. There'll be some unfortunate outcomes but you know we'll have to be very aware of what we're doing My my personal promise I am. I had no idea how much I touch my face. I did not know that until I was just a week ago. They're reading this up. I touch your face. I'm realized my Gosh. I'm always touching my face so artificial intelligence. It's kind of one of those things where I mean you know it's roots go clear back to the fifties and IBM but it seems like something's changed with Ai. I it's no longer this thing from nineteen fifty for the last seven years. It seems like in dentistry in just the last year or two. It's it's The Phoenix raising what happened in AI. For this big breakout after seventy years. No I think that some of the reasons that we're seeing it more now because of the development of the of the GPO use computers our ability to break down data and information and share it more Efficiently and particularly with computer vision because computer vision Now we really wouldn't be able to do what we were doing. An elastic went back to those first meetings When people at darkness where and even before that I think initially they thought they could do it in a two month project. And it's still going on but I think without standing on their shoulders to get to where we are. We wouldn't be able to move ahead so quickly I think. That's with our ability to evaluate radi grass and radiographic interpretation is so vital to what we do in dentistry because almost all revenue generating and diagnostic. Procedures in. Dentistry are based on a radiographic interpretation. So it's Kinda lent itself well to a window into using. Ai Machine learning in dentistry together. With the fact that we have Pretty pretty much a technology revolution going on in dentistry. Whether it's scanning or oral cameras I think in general. Most of my dental colleagues are tech forward. They're interested in in the gadgets at home. They're interested in bringing it into their offices. And I think that it's a welcoming group of people to be able to utilize the technology within and they and they said that when humans read an X-ray they couldn't even see like what forty percent of the lesion. Yeah it's interesting The computer vision going even back to logicon was helpful but logicon wasn't using machine learning to continually improve with increased data points being entered into the the algorithms in the system. So I think that's We were able to look at the images a little bit more accurately now using the computer vision and we find up to about thirty to forty percent of the early incipient and moderate lesions aren't found and one thing that we really feel as important at. Ti is our evidence based algorithms who've had academically annotated Algorithms so we worked at the University of Louisville and we've published a paper it was in the Louisville Research Twenty nineteen competition at won first prize in clinical research and The fellow doing that is now going to the. Isd are and a Dr Meeting so present. Their got selected to do that and it found. Interestingly enough that posted on your website t d. I don't know if it's up there yet but I certainly can share that with you What would I go? I don't know what to do. You know if that's online we'll have to follow up to me after the show. Yes so we found that incipient immoderate lesions were found at almost fifty percent higher findings in in In the trial was done than the maximal facial radiologists and we thought it was really important to take these findings carries identification and not just say it looks cool but to really base it on on some of the sharpest minds in our field Because I think we're going to be ushering in this new technology to the dental marketplace. We WanNa make sure it's validated and that it works well and it's not just crowd sourced so we've been very careful for each of our findings to do that. So he worked at the bill scarf at the University of Louisville worked with John. Tyndall at UNC. And we're going although we do multiple findings of nine pathological and pathological findings including I might mention going back to Dmitri to`solve founder and he's from Russia really interesting person a genius when it comes to programming and talk Really one day you'll have to have on I'd love to and Dimitri worked with Michael. Bernstein and Michael was at the University of Hong Kong at the time and they published a article on Using panoramic films and it was identification and detection and not automated numbering. And that's what we based our smart Chart Automated Charting Algorithms on so we're able to take a panoramic image and within seven to ten seconds or less identify non pathological and pathological finance. So we can see where there's missing teeth we can see where crowns are present endo's overfilled under fills bone loss And a whole number of of items and that was published that you can find pubmed. That's Tuzon T- JOZY O. S. S. And just if you put a I and T to detection that should pop up and That was sort of a groundbreaking Published article it was In the Would sit in the British Journal of Radiology. I think our the Academy of Radiology just recently in March. And I think that we're able to use the radiographic images and use validated studies to move forward and slowly use it into clinical practice and That's what we're beginning to do now. we have a sort of a suite of solutions Enterprise individual dental office a lighter version. We have dashboards that will collect Key performance indicators We'll be able to. We were also able to work with insurers as well so there's a whole kind of explosion of opportunities out there and it's it's been fascinating and really interesting to follow along you kind of walked into a glass door when you mentioned pubmed because that's big time in the news where the American Dental Association letter to President Trump has said Cova nineteen could kill the four prophets science publishing model the change would effectively nationalize the valuable American intellectual property that we produce and forces to give it away to the rest of the world for free according to December eighteen letter to president trump signed by the American dental association and it was picked up by the La Times. Do you think used to be no governments and state schools. Do all this research. And they'd pay the lion share but then they'd have the deal with a little of publisher and a publisher would get all that information to put it in their journals and all that kind of stuff and now with covert one thousand nine hundred coming out the rest of the world sand you know. Forget I'll forget all that crap in pubmed and everything just make it all open source Do you think over nineteen is going to finally make pubmed a free thing to the people whose tax dollars actually paid for it? Well you know it's it's really interesting I and part of a couple groups in AI. One of the groups has gone out and tried to collect information on Kobe. Nineteen and trying to see. How can we use? Ai in this community to find things using natural language processing to look at charts to to read things in look at different friends and to listen to calls because sometimes you may have five hundred thousand calls coming into a center in some of them. You have to follow through in some of them. You can't and you can't really keep up with all of them and we've also seen where Some I that's run through. It has found early increases in respiration and respiratory right In patients when you're comparing with the flu so there's certain simple findings we don't know really how to put it all together but your point being this is sort of on an open forum and it's you know if you can share it and you can share it quickly. Maybe it can make an impact in that may ultimately have a an impact on Tibet. However I think that's a peer reviewed article and You know understanding the bias of an article when it's published and written if if the institutions maintain those standards is really important. Because you know we have to trust somewhere we have to. We have to expect that people were following those standards so it could be a combination. And that's what's exciting about the future as we never quite know where it's going to go. We can be curious about following those opportunities and certainly we've seen a lot of change over the last thirty years in the dental industry. So maybe we could have improved. Change because of this unfortunate situation. I'll add to that if you just had just a moment. I think a is a really interesting term. It's it's become a very loaded term. It means so many different things to so many different people out there Density I has been in our space of You know helping to read radio graphs and and providing valuable information about the pathological findings therein At but it means a different thing to do a lot of different companies in. It's it's so nice to see others start to kind of jump on the bandwagon and join us and I think the point around pubmed. We have a lot of education to do. We need to educate dentists in their in their practices about all the benefits of of of Ai. And with any new thing. We also have to Kinda dispel some of those those myths as well. I think you know opening things up to whatever extent possible. Making some valuable information available helps us and helps You know all the companies in this space including those those older and we've been around Situated themselves like us as well as the new ones that have kind of joined in. It's kind of interesting. How a lot of people associate with Tele Dentistry? There are kind of linking together. Did you see I until a dentistry go hand or these two suffered issues? I mean I can speak to that a little bit. You mentioned today. Shoutout to to floss bar here in organization involved with as well it certainly can be. They're out there doing preventative in Diagnostics. They're taking district people That often involves digital and portable x rays something like a nomad And then using a platform to be able to analyze those giving insight to providers who may be off site depending on the state so I certainly think hey. I could be highly involved in higher highly lucrative Taking community health approach dentistry housing. Duan Elliott was doing great. She is plugging away on sales and really growing the organization. Twenty thirty plus states and You know a few different models operating in the office setting up a fleet of vehicles popping up pods all over all over and kind of bringing a great brand to to mobile dentistry. And you're also you help Simon and ever and ever. Yeah Yep director quit yet. I'm dental director equipped So Simon Kinda took me Andrea early Able TO PROVIDE INSIGHT TO OUR PROVIDER. Channel So provider marketing providers sales providers support All the way. Through to of a variety of different business development initiatives within the dental industry clinical studies and more heavily involved with quip for for the past few years and so you. Wendy's listing for first of all your journey. I mean my gosh. Where did YOU What what was going on in the busy life of an oral surgeon I mean you guys I mean all I mean that is one of the most brutal jobs and you're in charge the residency I mean I. I'm reading your resume and I thought you didn't have time to sleep. Let alone all dental company on the side. Where we're does this come from I think I'm always curious about what's happening next and I feel that you know you don't know what you don't know and I feel I. I've quite artificially intelligent. You know and I think the more I can learn and and move ahead The more contribution that that in general we can help make in in oral health and systemic health. So what happened was after I'd been in a lot of the academic situations I I felt sets. I we could group together with the number of specialists in general dentists in lab technicians. Go Back Down to Indiana University and teach at Interdisciplinary Treatment. Planning course and It was really rewarding to do and to learn from all the interdisciplinary ideas and learn from the students. And in doing this we tried to take some of the concept's from And I've forgive me if I leave a few out. But you know Frank Spears urge on toys R. Gerald chiefs or Vince Coca Chin. You name it a whole number of people that we were exposed to and we were lucky enough to maybe have learnt from our mistakes and we thought it would be nice to back to the students to avoid the same thing from happening so we created this course and through the course we started creating checklists and a process of critical analysis in evidence based decision making and I started getting very interested in some of the incubators in Chicago M Hob and matter health. My son was there in the summer working at these places and I started getting involved in some of the startups and thought it was exciting and fantastic and I always had things I was doing on the side. Whether it was a t shirt sweatshirt company or a changing incandescent light bulbs to you know fluorescence. There's always something I would like to always doing so by doing this course. I fell upon machine learning and I started to learn more about machine learning and it was on a trip back to Toronto and Toronto is one of the hubs for machine learning in a I in the world I was talking to some friends in that space and I told I was interested in doing by trying to take our course and using machine learning. Because there's so much information Howard I. I'm sure you've found this too. Is that when we got out of the school? You know we knew a lot and it took a little while you're so you're and a half before a lot of new knowledge came out and now now they're saying that almost In seventy three days or so there's a whole new Group of knowledge knowledge is doubling instead of taking thirty years or twenty years or ten years so he felt it was hard to keep up with all that information and I felt as oral surgeon. I just had to learn oral surgery and as a general dentist. It's it's huge the amount of information that you have to now you have on us. Artificial intelligence machine learning almost like. You're throwing them both out back and forth or are they. The same are they. Different is well I should. I probably should say machine learning because I think that's We want we want to use the algorithms to improve so if we have the finest annotated and we're very specific in Halle Moore -tations and then we take that ground truth. Send it out into a big database. We're going to get better results And they'll keep improving so we have some and we keep track of this is how how I'm GONNA explain it. We keep track of different groups that would do the annotation and as the machine learning improves our accuracy and specificity We can Then look at certain groups of annotations and say we can't use that group anymore because the machine learning has improved. Maybe it's getting better than a certain subset of of annotations that we want to use. Artificial intelligence is more of an umbrella and I think that you see ads today. Saying you know we use artificial intelligence but it's really not artificial intelligence. It's really smart computer programming so I probably you know should be more specific with that. But that's how I see that Howard I can add kinda two perspectives to this One of them is for the average. Dennis specialists. That's out there. That practices like Eric and I You know they yeah. There are a lot of words throwing around artificial intelligence machine learning computer vision. I think what people have kind of envisioned in in in their minds. The robot takes over the world or takes over their jobs right. It's not that Is is a tool that is meant to help. Great providers beat even better in the quality of care that they're able to deliver A. It's something that none of us as as dentists are our perfect meal. No human can catch absolutely every single thing in this is simply meant to illuminate More more opportunities to provide the patient better care which ultimately will feed to having a really great practice for those patients. The other thing I can say is I went to that. Ids Show in Cologne Germany. The biggest Donald Trade Show in the world back in March Twenty nineteen. I walked away from their saying. You know there are a few huge growth areas of dentistry I saw a density. I on display in the booth of a of a very large Partner in the in the radiology industry and walked away. Saying wow I A is here. It's it's come and the market is is ready for it They're kind of two other major areas. I saw as well as emerging and. We'll call out those here too I think one area is the area of live chat right. You know being able to to have a human speak to somebody on on a website Even having their speech supported by a and you know. But it's a real humid on the other end and they can even kind of direct schedule if if the office would like that to happen. Companies like simplify out there. You know Dr Ryan Doing things like that Another one is the dental supply world. You know it's it's You know operated in a very orderly fashion over over the last several years In a very predictable way but you have people out. There disrupting that model. Look at Dr Scott Drucker at his brother Jacob trucker with supply clinic out there. You know sort of showing different ways to do it. And they have enterprise and enterprise suite available to de Esto so you walk away from show like Cologne Germany and you see kind of the emerging growth areas with Within Dentistry I think a is a is a prominent one you know and and density I very much at the center of it so supply clinic is using knows nothing. Surly suggest that any of those areas are interconnected with one another. Those are just big. You know sort of big growth areas emerging in the US industry now simplified justify clinic has is led by Dr Scott Drags period honest and his brother Jacob truckers the CEO. Okay so so what? Where's the status of dental a now if you go to identify a Ra what does it look like now? Well well I I just wanted to say one of the thing about Your previous question for one second. I saw that the radiographic interpretation was a window into this space. Where one day and may we can get to that in a few minutes we can help close the oral systemic health links so as an oral surgeon. I've spent a lot of time in the hospital and I would see a lot of Effects from oral health that was impacting systemic health and it was often overlooked. And I think that's we as a group you can use machine. Learning to help highlight the important role. That dentists can play in the overall wellness and and outcomes and well being and I think that that's really what drives me to to start at the beginning as an oral surgeon. I'm looking at you know two D. radiographs because they're everywhere and we can move along that spectrum of biomarkers in salary biomarkers and all kinds of really interesting opportunities to impact health. And I think that if we can do that for dentistry we ha- I personally and others have an ability to impact more people than are just visiting us in our and in a real significant way So so I just wanted to touch base on that and then that journey on that DMITRIY IN TORONTO. And we've been working together for about three years and have marched along into dentistry and then getting back to your just the question you mentioned. Where are we today? Were able to really Help improve quality assurance and education We can also help to be more efficient with their time. Perhaps we can intervene earlier providing less expensive care. We can look at outcomes and track outcomes. Maybe we're going to be able to in the future benefit premiums on doctors that have Outcomes that are within a certain range and we can help improve Outcomes that are not in that range big. Dso's certainly are interested in that. They're hiring many many young dentists out of school who I teach group Dennis. I've been doing it for fifteen years in the fourth year students in there really talented and they have a tremendous amount of knowledge. And it's sad experience part That you want and as you gain more experience often you have more patients. That are trusting you but patients don't always know how to evaluate the care that they're getting and I think that together in learning and and and this whole movement will help to clarify that calibrated stand brings standardization to the marketplace. Which will help elevate our profession is what I hope you know. And that's where I see it and Howard the reason I joined. Obviously I'm involved in multiple companies I see is the market leader in this space Eric mentioned the others. There's FDA clearance for Quality Assurance retrospective analysis in education You know that's a very big accomplishment by this team. In addition multiple clinically validated studies at accredited academic institutions here in the US as well as large partnerships in multiple different business development areas from. Dso's to those who have the top of the line radiographic viewing softwares as well as electric health record software's As well as quality assurance assurance in the insurance industry this is really kind of a market leading company that his has really kind of founded itself on partnership to some of the biggest brands. Strongest names in the space and hoping to build trust among the professional community. So is it started. I see on your website. You go to deputy. Da ANTI DOT AI. Says you can sign up for a free trial How long's it been out? Is their revenue coming in or people using it. What are your challenges? And by the way these are no commercials they didn't pay for anything But the next go to Chicago. I'm going to go see the blackhawks and have a beer but How how long is this? Like Benepe is a revenue coming in Dennis using it free trial. Tell me about it yet. There are certainly a free trial so your listeners and viewers are welcome to join up and if they want to put it in your name. We'll we'll give them extra. Tlc and what? We what we've been working on is validating everything and we are able to integrate into electronic medical records. So what you'll get on. The site is sort of the basic to how a or machine learning in dentistry using radio. Grass is helpful to identify decay and were limiting what we are using that. Beta version because ultimately We want it to work seamlessly with very few clicks and fully integrated to API's into the electronic medical records and we're eight. We've been able to do that successfully. was what the very large. Eso and a number of smaller pilot projects we have revenue coming in from coal development projects. And we have some very interesting trials going along with some of the largest distributors and Emr's and a Tech Radiology technology groups. Right now and finding. It's a large one. Rick Workman Hartland. It's it's one of the top fifty Chicago Right I. It's it's a big one and you know it's We we've been it's been a privilege to work with them and to move along and I think that when they're ready to come out with their announcement you know. We would love for for that to be public I I. I'm hesitant to said jeopardize our relationship with them because it's been so strong good But it's a it's a new technology right and we're all Working to to use it in the right way and we just it so important and I feel it can have such a big impact in change things in such a positive way that we have to be very careful in how we bring it's in the marketplace and we want to bring it as dentists as a dental professional to dentists so that we can really use it and understand the power of it and and really have it based in you know some of the finest minds in our industry should help guide this through and we need support from everyone even even the viewers they have support and information. We're happy to address. Well that's why I love what it says as we are looking for early adopters dentists radiologists researchers. Who will help us make disservice? Even better we guarantee free of charge lifetime services access to the features. You helped improve sign up for email. Newsletter Updates So that's That's free dinty. Dinty A. I. Uses cloud based artificial intelligence at interprets dental images by suits specially developed machine learning algorithms? Dentists are provided with augmented support in identifying the reported. Twenty to forty percent of under undiagnosed conditions early detection dentists undetected lead to higher treatment acceptance revenue. So so it seems like a I in machine learning. It seems to be all visual ice. Crown and bridge labs like glide will where they're just trying to see if the margins of the impression In California next door to them I see it in dental insurance where they just busted A Denison San Diego. Because she got submitting the same x ray off the same root canal over and over and over. I think she I think she said in one x Ray for ten thousand dollars for the root canals and is looking at ten years in jail. so Can you make it a is that? Just make sure that the X. Ray we send in we have sent and before and that it's a new fresh fresh one such. That's a that's a basic that that is a basic thing that we do you upload an image it will even say for quality of the image because although we we've been able to take images off of Koogle an image on Google and run it through which I wouldn't recommend doing because we can work with any imaging software in the office but an image just on Google doesn't usually work So I think that our algorithms will show that we can identify fraud. Yes we market ourselves necessarily just to identify fraud because we do so much more that that's that's one of the steps and I think it's an important thing to to be able to do. Yeah but what I'm asking is the future of ai for now going to be things. That are more visual. I mean it seems like visual radio. Grass vigil diagnosis vigil models is more like that. As opposed to like taking the dentist other data from their open dental software and merging it was say quickbooks pro for financial metrics. Is it more GONNA be object? Oriented are as opposed to numbers well. I think that there's an opportunity to move in those directions but I think that the four You can move off in multiple directions. He has to be really good at your core and it's it's very hard To not chase around at all these different opportunities because it keeps me from sleeping the little sleepy head before I have less now because there are so many amazing opportunities and and I think that it's this progression that you can. You can start somewhere you have to become good at it. It has to work well. The user interface experience the of the provider the dentists and has to be accepted and good and then we can branch off into the areas that you're talking about and I do believe that there's a lot of amazing things will look back on in two years and five years and and in the future you know that we never thought existed. Yeah we're far. Are We away before I do this? I do this my office last week. I mean you're looking at x Ray in your what what. I've always done for thirty. Two years of my office is second opinion. That means if I'm in their hygienists and she says it's a do. And I say it's a watch. We get one other person. And it's got to be that one of the Genesis of the dentist and they come in and the third person and that's the tiebreaker. Win When you think how close are we before I a is the tiebreaker. Where we just legitimately say what say I say? I three are definitely going to get to that point but I. I think that you know it would be If if you're driving a car and or stop signs and somebody said we now have a light and it goes red orange and green. I bet you for a while. They had someone standing there with a stop sign or selling to make sure that the light was working. So how long did it take until we stop and we trust the lights? I think that there's a lot of similarities and other aspects of life that we've accepted in time but we don't WanNa come and say accept it today. We want to say you know work with us and and try this out. We believe that. We've we've tried it in the right way. We're bringing it to the market in a trusted fashion. And the go on this journey with us. Because it's GonNa take to some spectacular places and I think that's How you just described you bring in a third person not as how. Do our our annotations in our ground. Through thing we have a number of different people look at it and split up by a number of of weeks and they look at the same images again because we don't always agree with ourselves let alone other people and now they bring all the annotations into a room for any one of the ones that they all thought something different on and they come up with a standard. And that's how we move ahead kind of what you're doing in your office is ahead of. Its time it's in your office right because that's how it is so you'll have now a second opinion wherever you are and it should help make build efficiency into the model find things earlier build trust and then we can provide. Tara reduced cost. We hope it's also it's multiple different algorithms running right. I think everybody has the idea of this one sort of master out. Your Algorithm reformulates multiple algorithms. That are running. They can be deployed in ways. That are both new miracle and metric space as well as object based And it's actually a very similar process just different application or one of the many algorithms that are running right so even when you have sort of one decision to make. There's actually multiple multiple algorithms. It's like having multiple parties to the decision and I think you know Howard there's also kind of consumer or patient oriented component to what you're asking as well right because it's not always just the provider that's asking for that second opinion sometimes. It's the patient I think we've all kind of encountered the patient. That's gone to a dental office and you know somebody told them they have no cavities at gone to another one. Somebody tells them they have. Many addy's speaks to kind of the. The disagreement that that Eric is is is pointing to. It'd be nice to have a fair arbiter there for everybody to lean back on right which is the I. It's also nice right for a patient to maybe walk out of an office for change without something that looks like a bill right. When was the last time a patient walked out of an office with anything other than a bill? Right be be good to have a better understanding of what is actually going on my health. What is what is going on in my mouth right. What can somebody summarize it or me? Somebody put it in. Layman's terms right. I think these are all things that can be achieved by furthering this this direction. Historically I wonder what re run can would think of this day My Gosh it was Charles. Conrad Rent Gun in eighteen. Ninety five the discovered x-rays but they did not do anything in dentistry. It wasn't until nineteen fifty four when the International Longshoreman's and Warehouse Union Maritime Association Union so Beasley afterward. You A lot of people say you know why was economy? So great then. Well when you have a war and you destroy Japan Europe after war to basically the only place that wasn't bombed was the United States has had a huge transfer of wealth. The only transfer of wealth to America that even comes close that but with slightly smaller was a transfer wealth to the Middle East when they discovered oil. But the Longshoremen's union was shipyard so they controlled everything that came in and out of America and the government had put in place Wages freezes. They thought that was a good idea during World War. Two and is a really bad idea. So since the unions couldn't shake him down for more money they shook him down for dental benefits and that was in nineteen fifty four and at that point. Dentist did not even have x-rays there's hardly any use of dental x rays in the average dental practice but when the new longshoremen's dental insurance club which you would know now as Washington St Delta Dental Oregon Delta Dental and California Delta Dental when they covered xrays at one hundred percent my God. Every Dennis bought an x-ray machine I mean it was just a domino effect. The whole country went into radiology. So do you think history will repeat itself and dentists aren't GonNa look at this density until there's an economic reason to look at it or do you think a lot of people talk about The young kids really just loving technology. And we'll do things for technology sake but history says it'll be done for money. We're where do you think we're I think it? I think it's kind of both right You know to to an extent right now it does have to be seamless. To Eric's previous point has fit seamlessly into the workflow so providers across the entire office whenever their processes are able to seamlessly integrated. Not just those like like to take technology take this have this additional thing and take part on the other hand. There is definitely a financial reason right and I think that not only goes to the offices revenue right but goes to focusing on the things that matter the most of the patient because there are limited financial resources on their side and even looking to improve our own processes in industry right. You look at the insurance industry. And you brought up the impetus behind xrays being submitted. I was blown away to learn that most of these large insurers whom you submit xrays for often are not actually able to look at those X. Rays insurance I think everybody should listen in clearly that most of the of the large insurers are not looking closely at those xrays because they do not have the resources to do it. I only a very very small and select number of them are actually looking at those X. Rays right certainly. They can help in an appeal or Complicated claim that the majority of those xrays inter submitted or not read. So how can we actually improve the systems and the processes that we currently have right and and one way is deploying a and how can we make? It fit seamlessly into the office. So yeah. There was a financial benefit both the provider and the patient at seamless to us You know not just by the techies but by everyone and I think that's why Jeremy I also think that sometimes We've all had cases where maybe we get a patient referred to us as specialists that we were going to places implant at a site. There may be a period radio. Lucy somewhere in an adjacent tooth. And sometimes that happens and we often say you know we don't. We don't need this second opinion. We don't need this identity to help us out but we we all make mistakes. The machines make mistakes. We make mistakes are grant as a human. We'RE NOT PERFECT. We tend to look at Evaluating these new technologies if the human is one hundred percent perfect but together we find that using these technologies along with our decision. Our clinical decision skill set We're better off that way so I think that looking ahead if we most of us all became Dennis because we wanted to make a difference My father is a pediatric dentist. My uncles and ended artist. I'm an oral surgeon. It's been in my life for a long time and I think that if we can say if you use this quick seven seconds solution to help augment your ability to provide excellent care to patients and you may find things earlier or things that you may have overlooked. That's GONNA save a a lot of grief but it's also going to still more trust in in in what we're doing is gonNA allow patients. We hope to move ahead with their care more efficiently and we also have quality assurance issues. Where some of our Studies showed large numbers of Charts at work completed and it showed significant Potential of increased in misdiagnosed findings. That could be looked at or treated. So I think that there is A lot of revenue that could potentially can be generated by building the efficiencies and it can also build efficiencies into the insurance reimbursements component as well so so pediatric. Dentists like your father earn ended on us like your article too. Yeah Yeah. They're both in Toronto. My father's eighty five He's on the beach in Florida now. he worked until he was eighty and he loved it he. My father wrote the chapter on. Endo in with one of his residence In pathway to the pulp you know so the book yeah. My uncle's the ended honest But they've both been very involved in organized dentistry and they were great Role models and mentors to me And by you know what I love kids I have three mine. They're all growing the L. But I kinda I saw oral surgeons got up too early and work too long and somehow I became one and I just loved what they were doing. And that's the direction of your three kids. End Up Dentistry. No I I have a A masters of mathematical finance. Who's doing programming? Crypto currency exchanged in Toronto and I have a daughter About to graduate from two lane and perhaps to a business analytics master's program and I have one daughter going to college. Wow busy busy. I mean she's she's about to enter. She's she's distressing has convention that crypto currency is a real thing. And it's going to be a good thing is I believe in blockchain. I think immutable truth. And the transparency of the of the public. Ledger has a lot of interesting potential. There's some interesting companies using that in re credentialing. Hashtag and different things. I think it's fascinating. He works at the Currency Exchange. So he programs were people change or exchange or trade crypto currencies. So I think that's a pretty interesting place to be. It's it's been a fast growing startup and he's enjoying it a lot. I don't know a lot about crypto currencies. Yeah I know I know a lot of the old guys the Warren Buffett people. And YOU'RE IN CHICAGO. Where my Hero idle Jamie. Diamond Lives I've I've had the honor having lunch with that guy three times. Anybody who lives at his office Like Wall does he love to be Lived about the fire station. Jimmy Diamond He always lived above his office in the bank. just an amazing man. But he he's He's not very impressed with it as a currency yet or anything. So so what? What's next for you guys did say I had it. Now what's on your to do list We have a big to do list We are moving through some of our initial pilots. And we're hoping to get this out to you know slowly. Roll it out to our education build up our education side in the very near future and It's been exciting we. We have a lot of interest from all different aspects and road maps to get into the marketplace so we have the DSL concept we also have the EMR's going on we're able to Trade Analytical Dashboards to give a practice in analytics into you know representing what the image is look like an and into the Treatment plan options and compare them and help. onboard new dentists and also for individual dentists to see what's going on within their practice. We have educational opportunities from a number of schools That were pursuing as well that help with calibration and education with the students And you know we're continuing to grow and build our team and you know we wouldn't be here today if it was for. You Know Dimitri and masks and Lamilla a group of our machine learning programmers and Dimitris multifaceted as CEO and the business aspect is well. He's a sommelier. He's had a number of successful start ups in Russia and he's a real fascinating brilliant Individual that's a real pleased to have no one and be able to work with So it's IT'S. We're real strong grounded in in our validation evidence base and we're sort of moving ahead with Our full integration. I think that one of the most exciting thing is our patent pending a smart chart so we we have that Which is pretty unique in industry To be able to automatically chart and identified the teeth. So that's pretty exciting yet. Dmitri's amazing that the Russians They they were the first to land. something on the moon. The the first satellite for Woman's face Dogan's face. I mean those guys are just intense. I lectured over there. I mean what do you think it is about that Russian culture where they just are mathematicians? I mean they're just scientists from the word go You Know I. It's hard to say but I remember. Dimitri telling me a story that he was in in grade school and I think George Soros donated computers to his school and one day he went and took the computer apart and rebuilt it and then soon he started teaching his computer teacher how to do computer science and soon he went off to some special schools to train his his mother's a physician and he was always interested in healthcare and he has a really interesting story and how what led him all the way up to where he was and he was in charge of a research develop in for while way software for Russia for a while he worked his way up to that and he met Yawn Luke Kuhn and he had a discussion over wine About machine learning and he went back to school to get his. Phd In machine learning And he realized soon that there wasn't a lot of published data in dentistry because he had a root canal and they mystic canal so he thought well I bet you I could figure out how to find the canal and if I started addressing what I'm doing in Three D. imaging Onto teeth and then he realized that there was more to d. out there currently and he started focusing on d and he saw in dentistry without the chart as a basis from which we take our information. We can identify things but we can't put it into a simple place that we can make sense of it. So that's how he started developing his algorithms to do the automated charting and It went from there. I was lucky to have met him when I was visiting Toronto. Yeah they asked him Worm Ireneusz from It was an interview he had done and So what is the value proposition? And he says increased availability of basic automatic service increased number of pathologies detected earlier. Visualization of information for the patient provide data ownership directly on the cloud and can be forwarded any Dennis for the data system means But I've seen this so many times because in my life I've gone to doctors before and with other people and Bennett. Dennis and like doctoral be Showing something to a family member and they'll say well you know I'm not sure but it kind of looks like this. The words they're using aren't very. You're not convincing the patient and I. I've seen that so many times where they said well you to me. It looks like this or we could watch it or I mean I mean the I don't know I just would rather have a measurement this you know. It's seventy eight degrees outside today. this is a cavity. But you know what I mean I the wishy washy terms that dentist shoes Then combine that with the fact that most of them have the personality of a failed. Geography teacher It it's not going to get treatment done. Yeah Yeah it's It's interesting that we we from feedback similar to discussions. Like what you you just discussing. Now were able to have a an adjustment in the probability of our findings being present so the adjustment of the sensitivity to the sensitivity is how likely we are to find the decay. Specificity may be the false positives. And we err on false positives because it's easier to remove them and they do occur Then to avoid them and not see them but we can look at and do an analysis at five percent probability of a finding being present all the way up to ninety nine percent and we can decide where you want to look and I think that having that clear vision and that clear decision making and feel Wants solid ground. Saying this is what I see and look my friend over here is also agreeing with me or I didn't see this and what's interesting is we. We have A good friend of mine. A Scott McLean Used said a keynote lecture. He he's from. Halifax sound of you've had him on the show if not. He's fascinating does a lot of digital Dentistry lectures a lot with Nobel Seattle. Study Club past College football champion Super Great Guy. He used it in a case where I said. Hey Eric I know you're doing this stuff. Can we use your algorithm end on this case? I did Where he treated his football coach and we found fifty one percent probability of periodical lesion at the end of end Donna Treatment that wasn't initially seen and then later. When it failed it was at seventy in the seventies so we can track Something that we may say. We're GONNA watch this but when you watch something. When do you know when it's time to intervene? Other than when you have a bombed-out tooth but how about if we said this is thirty. Five percent probability of finding here. And we're as as symptomatic but we checked it and you're coming at six months or a year later and now it's seventy five percent probability and we see that it's increased then. We're more likely a with some evidence based decision making to move ahead with treatment that would be accepted so we can change the way that we do things and just because we have artificial intelligence or machine learning or this augmented ability to help doesn't mean that we should or anyone would go just do treatment. That's not necessary. We're still human and we're still have to be there and we're the final end of the road is is with us and we want to be able to sure we. We provide the best care possible. And I think that that's what excites me about this technology and the ability to you know be with you today and share it with with your listeners and viewers and have a discussion with you about it and raise awareness and really make an impact. Well I'm glad you mentioned Scotland claim because he made a course force on dental town for implant dentistry and it's an online course and you have it online course you. You have continued dent. Continue and and Got Some online courses on there. I think this another very big thing that's changed in dentistry. And maybe you started the show with your worried about. The current virus is going to start canceling dental meetings. They just canceled major dental meeting. Did you hear about that Friday? Yes Well which ATS meeting or the we were supposed to be at that this week. Yes that was in Vancouver Washington. They had the Pacific dental meeting just recently in Vancouver Yeah it's a You would imagine it would be kind of Nice to have these online meetings And you know other than that interaction with people which which I love. I love meeting. People learning what they're doing understanding you know being exposed to new things. There's something we can't ever Replaced with that but I think a lot of times. You could do things like you're suggesting online and have a great experience and it's can be right. You don't have to travel. So how is continued doing? Are you seeing that trend? Where people are doing online. You know I'll tell you continue. Then I put it up there and I got it out and I got involved with the DNC. I and I and I really haven't promoted it. I Have A. It's a took me three or four years to put together. I have a manual a book and just I been. I had to sort of put it on the side. So what is it? It's an online core of its fifteen. Yeah Yeah Yeah. It's an online education course to allow I was working I have many many referring doctors and I was working in my area and I was seeing that. Patients would see advertisements on on TV and go to some of the big all four centers and they would often be patients practices With dentists. That were there for twenty years and the intensity would say. Oh my patient had this done and the patient would say why didn't know my dentist could do this work so I try to break the whole concept down into a simplified it into how do you make a complete denture. Listen Orthopedic Surgery was kind of. Were you put? The insides allege right to to lip. And and where's the mid line? And what's the inclusion like and it was all based on that prosthetic component of denture designed. So I broke it down and I broke down some of the barriers so that people would be comfortable treating one or two patients in a year but they were trusted patients. So you say we care for you and we care about you because we know who you are and I- educated the staff in the office. I provided marketing materials for them and I helped them walk through each step of the way so I got very aware of how to do. The workup prosthetic workup and also helped them to become exposed to it and feel comfortable taking care of the patients It was from the beginning from the introduction all the way to the follow ups in the hygiene and the maintenance and the schedules and so forth so it was sort of in line with my education past. Because I've been in academics and private so it's been sort of you know It was really interesting doing that. I learnt a lot myself and I've helped a lot of offices. I hope in the area that I get to work with on that. So that's how it came about and what it is. You could put some of that on dental town. If you've already done I love to love to. It's just so I haven't there. I just haven't really yeah. We'll we'll talk about that. Love to talk to her about it. It's there and it works great. So last you guys gotta go. We pass an hour. You're an oral surgeon. I'm getting what is it. World Surgeon. Think of all this. Well I think that's It's it's fascinating because it's I see it more as like I mentioned before a window into this whole opportunity to Work with our medical colleagues and and bring some new technology bring dental awareness to what's happening in medicine I I spoke I was. I was lucky enough to be included in the last eight. I met conference out at Laguna so it was kind of Nice to be at Laguna Beach and I. I got to meet some really fascinating people that were doing. You know real game changing things in medicine and To be able to represent dentistry and talk about the impact of oral healthcare. What we chew and what we eat affects of vitamin B twelve albumin levels folic acid and we're talking more about you know. Acid reflex embarrassed the software giant as we're talking about gut bio one of our advisers has machine learning Kevin Woods He's a gastroenterologist. Has a machine learning company And and they're doing some fascinating things and we're talking about linking what goes in your mouth to your gut and we know that these things now Impact age related illnesses They impact our health and our overall systemic health and wellness. So I think those things really get me going and I think that coming into the market and being a leader in having sound algorithms really making an impact in dentistry can have those those big impacts because one day we're going to be looking at different payer opportunities come Payments I see tend to quest has a number of studies that they've come out with and pay presenter quite interesting in that area So there's this whole revolution going on and it's exciting and I'm glad to be in a little bit at least aware of what's happening and being able to meet the people that are helping to implement such huge potential with predictive analytics and oral systemic health links. Out there with a I. It's really exciting. To be on the cost. Well Eric Jeremy Any Any final words. Now I give us a shot. Go on their try it out and You know if people have a any interesting aspects. They can always email me they want. I assure you share our information somewhere for them to see and thanks thanks to you and and all your listeners and viewers for the opportunity to to make a big impact in dentistry and help our patients and and implement change. And you know I I love I just have to say thank you for taking the time to have us on here because I love being on this show. It's it's I can't believe I'm on the show but it's you know it's it's pretty amazing. Thank you for all you've done. Thank you thank you. Thank you for coming on the show. Have a great day.

Dennis Eric Eric Toronto AI Jeremy Krill Chicago United States Howard American dental association flu Ceo director Chicago Blackhawks clinical associate professor a Russia Dimitri Jimmy Diamond Dmitri University of Toronto
Dr. Sophia Yen

Two Broads Talking Politics

25:03 min | 10 months ago

Dr. Sophia Yen

"Hi this is teddy in your will to Dr Sophia yet onto rods talking politics Eh Woah. Everyone this is Kelly to broaden talking politics which is part of the cast family of podcast and I am on with my co-host Sophie. Hey Sophie Hey Kelly and joining us. Today is Dr Sophia Yen. She is the CEO and Co founder of Pandya Health and also a clinical associate professor at Stanford heard. Hello Dr Yan. Hello and thank you for having me. Yes so we are excited to talk to you so maybe just to sort of frame the conversation if you could tell us a little bit about you and how you came to be founding and CEO of Pandya Health. Yeah so. I am a pediatrician. That specialize in teenagers so I did double the years of training just to specialize than what we call sex drugs rock and roll a little sports medicine in some acne and being a academic clinical associate professor at Stanford Hanford. I had to pick an area to choose but just my passion has always been women's rights reproductive rights and specifically birth control preventing unplanned pregnancy. The preventing sexually transmitted infections and more recently minute passion is. I'm all about hashtags has had a period optional and and letting anyone who bleeding one week out of four no that that is optional and we now have the technology turn that off and how much better would like be without without random blood one week out of four hitting you in random places at random times love it and How kings have become the CEO and Co founder of the only woman founded women lead? Dr Founded Dr Lead Birth Control troll delivery Company was I was giving a talk much doctors. Why don't those Pesky women and their birth control and one of the top reasons glove? We didn't have time to run to the pharmacy. Go get it and my friend and I were like. It's two women. We all saw this. We will ship it to him in and keep shipping it to them until hill. They tell us to stop. And then when we ran ads for free birth control delivery sixty percent of the women. That responded didn't have a prescription either expired fired or they never had one to begin with and I'm a doctor. I can write prescriptions so we added in a synchronous telemedicine where you just a lot of questionnaire. Same questions I'd ask you to came into my office. You know what medical problems you have given your blood clotting disorders with drugs have you tried like you know etcetera etcetera and Mana and Self reported blood pressure Selfie a government. Id to prove that you are who you are and then our doctor looked at it. If it looks good we write the prescription billet Tier Insurance and pharmacies and to your door set it and forget it what happened. Yeah health worries. And you don't have to so doing that. Because it's kind of culmination of my life's work. Is You know helping women make their lives better. So what type of control are available with Pandya health. Yeah so the beauty of Penny health is that we are a pharmacy so we carry all the birth control pills patches and ring. There's pretty much nothing that we don't carry. There may be a specific generic bran that we don't carry because our pharmacy doesn't have that contract. But I would say ninety nine point nine nine nine percent. We've got you covered. And we take all insurance except for Kaiser and we're working on Medicaid in different states cause some states deep have one medicaid for the whole state. So that's easy contract. But if they have is a California a different Medicaid for every single county then you have to deal with like fifty different counties and we are all about access so we want to get those medicaid contracts so we basically are services free if you have on an existing prescription at a pharmacy. You just tell us where that and we move it from that pharmacy to our pharmacy. We bill your insurance ship it to your door and then we also conclude a goody every month so sometimes it's height you very popular and now it's gotten colder. We're GONNA be chocolate which I'm excited about Gear Delis it's peppermint Bark as well as sea salt caramel and mint and then We also Provide information from other female founded founded female lead companies Were sending out some makeup By I think it's pocket pals. Forgive me forgetting the name wrong but it's you put it in your person so if you're an emergency emergency needed a little lipstick or Mascara or some rouge. It's already in there in this little pocket pal. I believe we've also given out. Feminist pins condemed Wyndhams a free subscription amid magazine a discount off of my friends vibrator the most Internet of things vibrator if you WANNA check that out lioness I mean company uh-huh so and all that is free The only thing you have to pay for is if you do need a doctor's appointment we absolutely prefer you use your doctor or your provider but if is not we WANNA make sure women have access and so in California and Florida and soon to be Texas and soon other states as soon as we get that going. It's twenty nine dollars once a year. Air To use our doctors reliability legal and all that and you have accessed relearn sixty four days to our passionate excited academics. And so as I'm listening to you say that this is all about making things easier for women I am struck by how many of the reproductive laws that we are seeing being passed around the country are seemingly designed to make life harder for women to make things Accessing healthcare harder to make things like making personal autonomous choices harder. What are ways that we could be? Better advocating four four laws. The that do exactly what you're talking about that make access to things easier instead of harder. That puts choices and decisions back in the hands of women doctors. Instead of lawmakers I think with the current administration and the current people that are in power in the Senate. It is dark times for anybody with a uterus and I don't understand the Republican Party when they say they want small government. They want to get into your bedroom into your uterus My favorite frayed my uterus my choice nor uterus your choice and this country it is about freedom of religion and even amongst the same religion Catholics for choice. They believe that you listen to your conscience and your connection with God what is through your conscience and what God wants you to do with your uterus And not from some outside force telling you what to do so I I love that attitude attitude and I love the diversity that this country represents and I don't think one religion should be pushing a view on another religion and I think that reproductive rights needs to be seen and as bodily autonomy and freedom of religion as equality. I if I'm not here to be your breathing cow how you know and if somebody rapes me that doesn't give him the right to my body and to grow whatever he wants to grow inside my body my body my choice oyster your body your choice so What our company does is unfortunately needed? I would love a world where our company isn't needed it though not for our investors but just that everyone had access all the time but we also bring birth control to wherever you have Internet in the mailbox. So it's about care convenience and more importantly confidentiality so you can't be slut shamed so that you have access people who live two hours away from the nearest clinic. Two hours away from the nearest pharmacy. People who worked two jobs and don't have time to run to the silly pharmacy. Go get their medication or even in Liberal California where I'm located gated you walk in the pharmacy. Your comes in after sees you there and then the Pharmacists Sophia your birth control and then your boss knows and and then everyone else behind. You knows nosy. Nancy then tells your entire village you know so I think this is the future for Medicine and from the policy side. What would help us is to One for the public. I don't think they realize this has come up. A Lot. Is these p. b. m.'s. Pharmacy benefits managers. If you guys haven't covered this before They are a monopoly and they control the mail order and brick and mortar pharmacies overseas. And they're squeezing out any possible new innovation competition but also the Independent Pharmacy They make people signed contracts that that make them lose money. which is crazy? Talk though when you signed a contract with CVS or care mark or something like that and you're a small independent pharmacy. They'll give you wolf. Oh for this drug. We'll give you ten dollars for this drug. We'll give you five dollars and some of them. You make money but some of them you lose money and I'm like how can they force they don't force worship take it or leave it but how can they even give you a contract wherein you lose money and and that's that's the sad part. We're seeing a ton of independent pharmacies. Die Why because of these monopolies and the government is not aware of them and I was on a call with the newest youngest congressman. And he's out there to reform reform pharmacy and he didn't know about pharmacy benefit managers and I was like. Oh please educate yourself and get people who know stuff right. So that's the other small matter. Week is telemedicine laws. So the question is what is defined telemedicine who is allowed to do Telemedicine tele-medicine and interstate licensing or physicians. So we answered this to take a national exam for the American Board of Pediatrics. The actress and I shouldn't be practicing pediatrics. Any different in California than in Florida Than Maine or whatever but I need to get licensed in all fifty fifty states or a big portion of it if I want to practice telemedicine and I'm happy to pay the fees if I have to but to fill out all these forms and and get certified by every state is absolutely ridiculous so we we need to reform that and then the other thing is whether or not Insurance Company wants to reimburse different types of telemedicine so ours is a store and forward method where you capture the information and then you Ford it. It isn't by phone isn't by video and we like that for the convenience and the confidentiality But some people consider that telemedicine some people say is explicitly not telemedicine. Some people say you can't prescribe unless you physically seen the patient but If you were to come into my office I wouldn't do anything anything differently. I would ask you these questions. I would check your blood pressure and medications so to make it invalid or not legal is decreasing people's IOS access to birth control and same thing going with specific laws against abortion pill. That's not my company but I have a lot of friends in that field and and they're facing specific log going after them. So as I was looking through this sort of process of how you get control with India It made me think about how it's a lot of it is sort of a formality and it made me wonder about sort of the ongoing. I'm going to be. It's over whether birth control should be a prescription medication or be available over the counter. And I've heard until recently it was mostly Asli People on the left. Who wanted to see it be available over the counter but recently there's been sort of pushed back on that Where people are saying well but then insurance companies could up not to cover it? So I'm wondering what you think about birth control as a prescription medication and whether how you think we can resolve that kind of dilemma. Yes I think. It's unfortunate that the Democrats and those who believe an access to birth control do not want it to go over the counter because they're they're afraid insurance won't cover it so the solution is not to not let it go over the counter. The solution to pass a law that you will cover it right and that is what has been done under the affordable care act any. FDA approved method of birth control for women have to be covered by insurance whether it's over the counter or prescription Only and Some insurances have some insurances or some companies have been opted out of it for religious institutions. Unfortunately we like Georgetown University or Jesuit colleges. Certainly you know Catholic church unfortunately might extend to Catholic. Hospital have opted out of covering birth control. And as I said it's fiscally stupid and morally wrong to not cover birth control because for every one dollar you spend on birth control troll you save six dollars in healthcare costs and that is not including Pre and post natal care and the effect on families lies. When you have an unplanned unwanted pregnancy it should be over the counter of the American College of Setris and Gynecology in two thousand twelve and two thousand sixteen and I believe again in two thousand nineteen hundred affirmed firmed? Did they believe birth control pills and consequently the patch and the ring are perfectly safe if you give women twenty questions which are the twenty questions we ask them on our website website. They are perfectly capable if they mark anything in the wrong column to realize this is not safe I will get a blood clot and I could die and so they will exclude blue bins where they've actually done research with our. They had a bunch of women take this quiz and St. How many of them got it wrong and decided to give birth control? They didn't give it to them. Just you know questionnaire are and all the women excluded themselves correctly from taking birth control. I would still like to see some physician guidance. Only for if you have Difficulties picking it or if you are obviously fit in any of the no categories then you need to see a provider to deal with that but I absolutely absolutely supported going over the counter and I think the solution is not to not get over the counter for fear of not insurance coverage but rather to mandate insurance coverage via the affordable care act and California has passed an extra law thing if the forcible character is reverse then these contraceptive rights and access are guaranteed that it will continue to be available with no co-pay no deductible as long as it's an FDA approved methods of birth control. And I believe probably five to ten other states have done similarly all the progressive states Washington Oregon Are often in well. Well it strikes me plenty of other over the counter medications. That people don't always exclude themselves from practically. Yes we always say that a tylenol. Aw is far more dangerous than a pack of emergency contraception then thing than a pack of pill. You can't do too much damage with one packet. So so what are the other things that we talk a lot about on. The podcast is a women's executive could have power. So we're we're talking on another series of episodes about the possibility of a woman president and one of the problems. People seem to have an envisioning joining a woman. President is that they don't envision women in executive roles at all We have very few comparatively very few women. CEO's for instance. So I'm wondering wondering if you could talk to to to that piece of what you do of being a CEO and a woman and and a doctor and an how that role in seeing women in those roles is so important. Yes I have heard the phrase and I I believe that Sally Ride. If you can't see it you can't be in certainly unle. Many of us have shattered. Glass ceiling entered areas where others have not been before and we definitely have our male allies and I am thankful for all those that our are allies but being a woman. CEO has absolutely opened my eyes to the continuing ceiling against against us. When I go and pitch I have all these negatives seen against me? I'm a woman I'm a mother. I'm a doctor. I'm over the age of forty five and I see vs all as benefits because I'm over forty five. I've got amazing connections and networks. Because I'm the mother I know how to multitask because I'm a doctor. I know the field inside and out and I will make sure that our customer gets the best care possible and and I think it's really important that we as consumers and we're going to start a movement it's going to be either called full and then female founded female lead our heart heart full and the glasses half full and the sky is at least half full or it's going to be while like growl women on women lead and and we're GonNa have a stamp of approval that says this company is women owned women lead women's founded because I don't know people arch checking when they look at the companies out there that this company is run by this run companies. Run by a guy. This companies run by a guy. Who's a lawyer just wants to make big money? This companies run by a woman who was passionate and just wants to prevent unplanned pregnancies and make woman's life easier and make the world a better place for her our two daughters. Which company do you WANNA patronize? And people are just like going for the cheapest possible option and we are. Prices are very competitive additive. But it may cost more because we have better doctors we have providers that are coming from. UCSF UCLA harbored These kinds of things and But it's a different the five dollars a year. You know or or a couple of dollars there but mainly I want people to look look at the company I'm choosing who is the founder who is the leader and ask for accountability if you own shares of stock look at how many boards awards have women on it and I am perpetually horrified and shocked whenever I get this vote on your stock thing that only one out of ten one out of twenty on t it is their woman representation there and what's beautiful being woman. CEO is that my daughters and those around them all know that so you can be a CEO. What really touched me with my daughter for Had John Wayne at her summer camp where you can dress up in June or July forget in and whatever costuming wanted and she's just us as a CEO so that was really. There's a picture of her. I always wear my Pandya. T T shirt a white skirt and I carry on bag and I was like do you want to carry the combat is like no mommy a dote but she had. She had the shirt that she had this skirt and I was talking to sleep. And she's like mom and giving them business cards hand them out semi camp Camp Counselor and I was like yes. They'll do the perfect target audience. Audience here takes them business cards. And so you know. I love that. She seeing this and knowing this and I love my husband for his support in my family and and everyone anyone out there and they're for anyone contemplating there is a huge community of support for you but it is a hard and long haul and I hope that women realize realized we have the money we have the power and weakened in power more. CEO's if you purposely look for a company run by woman and Support Court that if you have money to donate You can actually help. Fund female founded female lead companies through various organizations that just portfolio or impact acid. And you can actually do it through a nonprofit donation impact assets if you have a donor advised fund or if you just have money and and you can also just do it straight up with your money if you WanNa make money. But sometimes people like doing it through their non profit donations so I think it's really important to get more women. CEO's out there but also more women CEO's found funded and we need more women to invest. Women are really good at donating but they're not investing and we need you to invest in women. There's also she. EEO Give a shout out for them. And we're you know I believe the minimum vestments like a thousand dollars but there are other platforms where it's I think like Iceland women in like zero dot. Well you have to give something to invest in a woman founded did one in life company. Is there anything else that you wanted to make sure we talk about. Yes I just want If any real listeners WANNA learn more about turning off period and the safety and the science behind it to go to Pandya health dot com slash periods optional and on top is a nicely presented and find some safety on the bottom. Is My tech talk on the science and safety in the middle is if you're on the pill patch ring how to do it and also WanNa give a shout out there. We're GONNA have a black Friday cyber Monday special for those of you who want to check it out. We can deliver again to all fifty states and Lincoln Prescribe in California and Florida and soon to be tecos and soon the entire United States But always happy to answer any questions about periods about reproductive rights and One parole I always like to give Pearl is no that there are four types of emergency agency contraception and two out of the four are better than the one that most people know which is plan B or leaving gesture all generic and those two are the copper. IUD Is the most effective ninety nine point nine nine percent effective and the second most effective is the prescription only emergency contraception called Ella and because under the Care Act etc it should be available. No Co pay no deductible AKA free if you have insurance and that one is better at every time period and if your BMI twenty six or greater and I say you know my Bmi twenty-five and after Thanksgiving it's probably GonNa be twenty six no Don't be using plan. Be An generics. Ask Your providers prescription of L. A.. And have it on the side as they fire extinguisher anguish or just in case of emergencies. And when you get to ask your pharmacist for the one with the farthest expiration date after one expires today excellent will put it links up on our website and links to your youtube channel as well. Because I know you've answered lots of questions on there as well so we'll put links up for all of that. Thank you so much. I'm yeah always happy to chat about The horrible attack on Women's reproductive rights. But hopefully that will change everybody the vote and everybody who donate twenty twenty all right well excellent. Thank you so much for joining us and I'm sure that Hopefully everything will go great. And we'll get that our laws but if we have more attacks on women's reproductive health which we likely will maybe we'll check back in with you. Thank you so much for having me and I love what you guys are doing and I love women helping women all right thank you thank you. Thank you for listening into two bras talking politics. Part of the dim cast podcast network. Our theme song is called. Are you listening of the album elephant shaped trees by the band land and we're using it with permission of the band. Our logo and other original artwork is by matthew wetland and was created for use by this. podcast you can contact contact us at two broads talking politics at g mail dot com or on twitter or facebook at two brides talk you can find all of our episodes at two broads talking politics dot com or anywhere podcast found.

CEO California CEO and Co founder Pandya Health CEO and Co Sophie Hey Kelly Florida Dr Sophia Yen FDA Dr Sophia Dr Yan founder Stanford Stanford Hanford clinical associate professor
Shaili Jain, M.D.  The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science

Science Salon

1:12:09 hr | 1 year ago

Shaili Jain, M.D. The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science

"Hello and thank you everyone for tuning into the science alon podcast i'm your host michael shurmur and i bring you the show from california once a week as part of a larger mission of the skeptics society to promote science and reason and to ensure that sound and scientific viewpoints are heard worldwide is a five oh one c three nonprofit we rely heavily on their ongoing in generous patron inch of listeners like you to pledge of support please visit our website at skeptic dot com slash donate thank you my guest this week is shelly jane md her book is unspeakable mind stories of trauma in healing from the front lines of ptsd science darker you're shane doctor jane is eight ptsd specialist in medical director integrated care at the v eight palo alto healthcare system she is a trauma scientist affiliated with the national center for post traumatic stress disorder in clinical associate professor affiliated with the department of psychiatry and behavioral sciences at the stanford university school of medicine her work has been featured in the new york times enter essays and commentary have appeared in the journal of the american medical association station the new england journal of medicine on public radio and elsewhere so we get into the book and i think this is probably one of the more practical podcasts would have done given ptsd is they a widely we recognized and widespread problem particularly since the afghan war in afghanistan has been going on for over seventeen years now more in iraq years less than that in in the category itself self the bendy what constitutes ptsd has has expanded a to recognize the reality of these traumas and what they caused people psychologically in so it's a huge problem many many millions of people experiences suffer this and a she's a practicing psychiatrist who works with this and the frontlines everyday some of the conversation is really really super interesting about how you diagnose somebody like that and then more importantly what do you do about it so with that i give you a doctor shall we jane new host michael shurmur and you're listening to science some serious conversations with leading scientists scholars and thinkers about the most important issues of our time shelly jane thanks for being on they show you're new book is unspeakable mind stories of trauma in healing from the frontlines of ptsd science yours maybe the most important book i've had yet on the podcast in his much as a apparently millions of people suffer from ptsd you're on the frontlines of diagnosing and treating this issue it's a appears to be much larger than anyone realised just in the last decade or so a but one of the things i like about your book is also i always appreciate this firm authors is a personal touch to it a first of all the title you give us what the title means they don't speak your mind with your program from judas herman in her book trauma in recovery ordinary response to atrocities is banish them from consciousness certain violations of the social compact are too terrible to other allowed this is the meaning of the word unspeakable so thanks to your work and that of others in in i think culture is becoming more receptive to it we we are now speaking about this drama so start off with your own personal story where you begin chapter one with a background in in how this led to to to you go into this after a medical school so yes i think the scene thought unspeakable mind would probably son decade before i was born in nineteen forty seven partition of british india june dividing instead accompanied the partition all british india into india and pakistan there's a lot terrific into communal guidance and my paternal grandfather was motivated not by lynn and that was something i've always known about in my life and my dad was ten at the time so as a result of my grandfather's murder my dad was orphaned and he lifted the refugee in india and 'em he was still financially destitute he would use force to the child labor a couple of years so i you know fresh for twenty years later my dad would end up moving to england and that's where i was born and raised so even though i would be separated in geography in time from that tragedy there is something about that how rowing social descend of what happened in nineteen forty seven something about you know that those unspeakable events what happened in nineteen forty seven still very much president in my childhood was still comfortable even though we were separated so much 'em in geography in time like i say from those events and so you know i ended up becoming a psychiatrist and and so you know you could probably argue that on some level i was just trying to figure some stuff out at the puck urinating in the background 'em you know like how do people leaving yes domestically unspeakable why do some people seek oblivion why do some people seek revenge on and then it was only on a two thousand road trip that i took my dad one time as a psychiatrist and when he was retired and he was able to kind of know right this cohesive linnea soulful who story that it became clear to me oh okay you know these people these aware i am from and and it kind of lead to me thinking about what are they gonna do with my career and metropole a to help those who have to lynn after surviving unspeakable and that's what let's look at the ptsd specialist in a troll a scientist and then ultimately this book right beautiful 'em so a i mean we often a quake ptsd with war victims and rape victims say but when you show is that there's a lot of different things that can happen to people in their lived that can leave this at least some of the symptoms of ptsd after reading your book a you know i kind i felt like i was born and raised in disneyland a even though i've kind of had the normal ups and downs my parents have all died i had for parents to stepparents and i've gone through a divorce after a twenty year marriage and that was a miserable experience but it's nothing like what some people have had delivered through and when you think about the long term trends and violence in centuries past you know we have a pretty good today compared to centuries ago but on the other hand there's still a lot of violence in the world and yeah yeah sorry yeah i think 'em well with this price from me one of the first things that i learned when i was studying to be a trauma scientist and doing this fellowship in ptsd on these major traumatic events they're actually not uncommon experiences you know to me when i meet some of them you know a rape combat surviving a national disaster survivors of a of a you know a a life threatening car accident accident all these type of horrific things on they fell extra ordinary but then not 'em fifty percent of american men sixty percent of american women will at some point report having lip through such a trauma and there's a subset of americans who report multiple such traumas so there is this kind of weird situation which home it's a fact of life millions and millions of americans now the vast majority will heal naturally you know they will not developed ptsd i'm not saying it all the fifty percent of americans ptsd that's incorrect the vast majority will heal machine that's pretty good in that that testimony about the recipients of the human brain and how psychologically we didn't we we are public because it's centuries of surviving horrible traumas but it's substantial minority will not much her name but the big to begin we'd even substantially not a lot of people like you say at any given moment in time six million americans have got ptsd that needs treatment you know when i was writing my trip drawn restorative justice in the moral arc i read a bunch of accounts of people that met where the perpetrators a these guys are in jail and a lot of work kind of petty crimes burglary in and the you know the person comes home where the burgh burglaries in there in one case it was a british guy who confronted the burglar they got into fisticuffs and so on an you know there is no physical harm really the guy got arrested now he's in jail but this guy carried with him for years that that that five minutes of encounter that just really bugged him bugged him i mean it just kinda eroded away at his sense of joy of life is gone and it wasn't until he met with the guy and conveyed to him you just fucked up my life with your little act and the guy was like but it was nothing like it was everything i mean you know did you encounter physical violence they're just five minutes change this guy's life and there must be millions of examples like that you're bullied as a child or you're you're battered is a spouse or even just verbal battery in her something that just kind of chips away at the joy of life in at some point in this is a hard problem at what point does a tip over into something like ptsd in how would you define it in from the normal stuff that happens and we kind of get over well you bring up a really good point there's a dose response relationship with trauma ptsd so you know a lot of times you know people think of of ptsd is you know someone leaving a perfectly normal life then something terrible happened and life is not good the reality that fine though is oftentimes people have experienced many trouble along the way and i'm just meeting the appointment jenny where they happen to be the trauma that kind of broke the camel's back do you know what i mean so so you know i wouldn't be surprised if in the account that you just gave up the person who were burglarized and had those episodes of physical violence i wouldn't be surprised if there were some past history of something and this is just the tip you know that pushed him over the so 'em dose really matters so you know that explains why a military you have higher rates of ptsd 'cause obviously their occupation exposure involves exposures trauma first responders have higher rates of ptsd low income women have higher rates of ptsd fifty and they used to awaken high climbing a city because they just they just exposure to dallas is much higher a lot lower socioeconomic women why because their jobs or more physically demanding more sexual abuse on the job or i just don't think they have right they don't have a voice they don't have a platform so day easy prey right right you know if we look at the me too movement in the last couple of years i mean obviously it's a psychiatrist i can't help but being courage by that but you gotta wonder who's gonna benefit the most from that if people who have a platform who have a voice with the following who have the resources i ridi worry that low income women who don't have that i'm not gonna be benefit from the same way yeah there were that story circulating about 'em after the first couple of me to a stories came out in the new york times wines dean bill cosby a few of the others they were inundated with calls from like women minute mcdonald's you know my boss you know keeps harassing me sexually and so on and they're like sorry honey we you know we we can't deal with all these we have this big celebrities and politicians and ceo's we gotta deal with it yeah right now i would hope that it will trickle down you know i think that's generally how movements like usually people who have some kind of started to start a movement 'cause they have that influence i would hope it would trickled down but there is so much work to be done to make sure that happens but yet literally i think throughout history people who marginalized to don't have a voice they're all gonna be more vulnerable to trauma because they then easy easier to get away with late to get away the traumatizing them right to live yup yup so i'm a patient come to you a and yeah and what characteristics would i express you would be under the console say yup i think you have ptsd so typically a history of trauma like we just discussed and those kind of major life events that are life threatening threatening the sudden the person feel helpless they feel horrified in the moment you know some kind of getting that sense of what the reaction was to the trauma that will obviously very firm individual individual so definitely sending out of that history of trauma and then typically the kind of quintessential textbook symptoms of ptsd ridi these intrusive symptoms so they bothered by intrusive memories of the trauma that kind of involuntary vivian invade their day 'em they could manifested full full blown flashbacks where they are reliving the trauma in the moment 'em they could manifest as a nightmare you know all the trauma again with reliving the trauma in their sleep on it unique saturated a donald reaction you know they they just see danger every way they just quick to kind of freak out and and feel unsafe knows how to textbooks and ten i think often gets missed is the toll ptsd take someone's emotional life life amen gets emotional life baron people they don't love the freely they don't lives as freely they they living life off and on a break comes in a very constricted way to kind of protect themselves from being hurt again and that impacts the way they love the they look the way they price it chips away at life in an insidious way i think that that's what gets missed indefinite even mood states have like shame and guilt job to identify then say like ongoing depression those get missed a law and does a key in trauma shame and guilt a very pivotal emotions in trump gill toes in survivor's guilt why did my daughter and my buddies do oftentimes survivor's guilt is it's huge and even even even if you talk about family violence right a lot of children who were raised in environments where finally violence is a fact of life day facto like they they very conflicted they feel guilt they mayfield and the legions to these people who raised them in who at times may have been loving lamb supported supported them but yet very conflicted about on how they should feel in response to the violence and shane they felt a being a you know abused victimized in that way so to kill is vini these kind of perpetual thing by the time you engage with somebody they're having problems in their life that's why they're coming to see you in the first place it's interfering with their jobber marriage or whatever so it really the the tipping point where you would really be on that spectrum it would be if it interferes with their lied to the point where you feel you need help that would be definition of ptsd yeah and that's such an integral to the diagnosis in the dsm five it's not sufficient that you have fenton you know decent and have to be present for a significant the amount of time plus they don't really disrupted the way you feel like you know and that's what you're kind of sitting out for so oftentimes like you said people don't necessarily come in to see me saying that they have nightmares but they do come in saying my wife is about to leave me 'cause she's had enough right or you know what i'm getting bitten a work for performance issues like they get hit really hard at the kind of day today functions you are i might take for granted and that's when you get a sense okay this is lifting to be armed normal adaptation then we just make it a lefty tend to consider it to be in the bomber pathology little bit like alcoholism drug abuse you know how do you know when you have a problem well when you're spouse leaves you you get fired a gun you know you have a problem interference was you know normal life functioning 'em as a practical matter let's say giving are messed up healthcare system you know if i'm on h demo of kaiser blue shield or whatever and i feel like i need help who who would i even call and asked his wife would go to a gp and then he gives me a referral to a psychiatrist and then psychiatrist gives me a referral to bts these special is something like that so i think come a i always tell people stop you're making a doctor who knows you that you know you intended to gp who you may have had a relationship would forgive go see them fun you know as much as i love talking about the symptoms of ptsd the reality is you still need healthcare professional to diagnose it so you really wanna stop have that conversation with a healthcare professional who could just make sure that that's what it is and there's no other stuff going on that needs to be ruled out or you know like blood tests stole something else that needs to be addressed stop that if you you're lucky enough to have that kind of relationship and the good news about going to a trusted ducks i think they probably already good mental health professionals at these type of things and so then we saw we need somebody they trust and they had that kind of relationship with food that they couldn't communicate wade and that's where it starts unfortunately we don't have a lot of ptsd specialist we have a lot of mental health professionals ptsd fifty specialist is still really tiny good it well chain mental health professional will definitely be up to make a good stuff mhm intended laughing treatment and helping i need to listen to your two chapters on the brain and the body walk us through what what happens when you encounter trauma again a war trauma raper violence of some time what happens in your brain neural networks rewired or something in her brain chemistry what happens to your body's those stress hormones and why why does it continue you and why do some people their brain doesn't give rewired others it goes okay so yeah i'd say so so i'll talk a little bit about the neurobiology ptsd i'm happy to summarize what we know but i'll do the copy this is constantly shifting landscape the mini i almost tell you what it is you know so so again that's just the way you know science is constantly shifting as we get better ways to pro the new secretary of better way to investigate bought in essence i i think it's safe to say that in the ptsd brain some things puppy up put the hippocampus which is a part of the brain where we stole memories longtime membranes we know it's smaller and people who have ptsd we don't know why or when it became mona we done if they were born with a smaller hit the compass always being exposed to ptsd somehow shrunk the hippocampus we don't know but there's something going to put the campus and then there's two parts of the brain disney migdal on this primitive part of the brain that regulates fear and pleasure and an anger that overactive in people who have ptsd they just tend to not only detect danger danger doesn't exist but they even their response susan exaggerated response so you know you're typically example would be road rage right that's a classic symptoms people ptsd often have they haven't ridi disproportionate reaction to being cut off on the end of a long time to come down so they make deliveries overactive and then at the same ten you'll frontal lobe the part of your brain but it's so integral an execution in judgment in planning you know that is underactive right sixty combined this overactive make delivered interactive friend club you could see why you start how some of these issues with recklessness or or anger role you know 'em hyper vigilant that people with ptsd complained of some intense us kind of nirvana gene structurally that's what's going on in terms of chemistry we definitely know no adrenaline adrenaline you know those chemicals that we need to fight and fight reaction we need that human beings we need tipped mount a fight or flight reaction when we're under threat but but but there's something about that response and people with ptsd doesn't come back down again to baseline so they have high levels of no drama adrenaline circulating in their butts bloodstream there's definitely something up with the human stress hormone cortisol we don't know exactly it's a bit complicated picture but definitely dies implicated in the past the genesis of ptsd and then on set a tone into we know the seventeen adjective function nabi contributes to the mood issues that i mentioned it in some of the some of the clues about goes on into my brain and body when they have ptsd i could feel it when i get anger anger angry or i'm super stressed out i could feel the stress hormones bump into my body fat passer heart rate but it just feels differently and i can only imagine i mean i get over it i whatever a couple of hours later everything's fine but i can only imagine and being in a war situation and something where this is just constant day after day for months years and you multiply that by a hundred thousand several hundred thousand soldiers 'em regardless of which way the causal aero goes even if it's like ten percent of the hundred thousand thousand that are born with a smaller hippo campus and they they just don't respond as well as the others either way you get that much trauma it's just gotta take some kind of tolan on your physical body oh yeah absolutely so we know now that independent heart disease because obviously having a little bit chemicals are higher levels in your in your body for extended amount of time that's not healthy that impacts diseases including disease in cells oddly systems open so we know people who have ptsd high risk for heart disease cancer obesity 'em you know you name it you know this kind of false dichotomy between mind and body in my mind it's false you know it's it's definitely had a whole broadly system condition i can't remember if you cover the opioid crisis in your book if there's any relationship between now and then ptsd or people self medicating worth paying a long term painkilling drugs well we definitely know peachy stanton addiction go hand in hand very tight relationship between those two and as you said part of it is because of the south medication the allure of self medication to release some of these symptoms but then oftentimes dot use of substances just becomes a full blown addiction in of itself and then then the ptsd becomes very hot trait in terms of the opioid crisis there are a couple of big data studies that took a big bird's eye view and they looked at people who are prescribed opioid pain pills to chronic pain 'cause there's a big overlap between chronic pain and ptsd something like thirty five percent chronic pain patients have ptsd blasted the study that looked at people who had ptsd chronic pain in had opioids prescribed to them especially people who just had chronic pain opioids the group that had the ptsd much much more likely to run into side effects with the mets like accidental overdoses or intentional overdoses foles or getting into problems with the meds and so in my mind the take home message today i made people using prescription opioids to treat emotional psychological dust on foot we're gonna run into problems when they need treatment for that psychological condition yeah but guy goes comes back from war he's got injuries or whatever and he goes to his doc i'm in chronic pain here's some hydro code honors some one of the opioid derivatives than any feels better you know i i i get this because i i had total hip replacement so they gave me hydro code on this for two months or whatever and then recently i had a two to thing and they gave me a one month it's not just did it knocks the pain back i feel way better like energized happier just more engaged with people and i thought holy crap i could just over this like every day for the rest of my life and i get more work done what problem at some point the dose they're giving me it's just not gonna do it so i'm gonna get more attendant you're gonna build the tournament so you're basically describing like and you find success acts of violence in addition to the pain it's knocking at paine but there's some additional you know psychological enhancement and that's the problem you're gonna need more and more of it and then of of course these meds come which side effects you're gonna develop side effects tolerance you're gonna need more and more and then you're gonna start using it even when you no longer have pain and you can see how quickly this could get out of control especially if you have a psychological condition the closing you suffering and immediate relief from that i mean it really really tricky situation and they think pivotal to is is clinicians just being hyper vigilant about this right you know we're not gonna withhold pain medicine from people who are in pain but you know not everybody needs a month supply right right right you know i mean people have been too liberal and how much they did shall you'll be no no my my dog said no shurmur were not given you any more 'cause you're hip is fine i'm like oh darn okay the twenty nineteen response or recently dot com that's g a this kind of epidemic is shown the ducks not wasting the response but luckily think the shifting in a better direction but yeah i always worry about addiction we'd my patients were living in ptsd it's just part and parcel of the territory right now one of the frederick symptoms of ptsd suicide so why why are these people killing themselves which is just it's two picks to remove the pain or is there some other motives so i think just the nature of mental health condition the vast majority of people who have mental unless they just hire odds of dying by suicide period you know it's like people who have heart disease that higher risk of dying from heart attack and it just comes with the territory it's a part of it is just that elevated risk i think we know a little bit better about the profile of people with ptsd who are more likely to commit suicide so for example people who have a lot of those kind of debated sinton the hyper vigilant the anger of and then more likely to commit suicide if people have other injuries so for example let's say somebody survived a bomb blast and in addition kevin ptsd from the bumps busted up a brain injury among them more likely they are at higher risk because now they're dealing with ptsd dealing with a brain isn't looking that well right you know and then they think 'em manmade climate human made climbs always much more potent to recover from insane natural disaster you know there's something way humans wyatt if it's a natural for disaster connect to god weaken somehow let go of it more than if another human intentionally set up thomas and you know and then back to that guilt and shame survive uglies huge and intensive at the reason and then shame if people felt they should behave this way but they'd beaten if they feel they let in south down if there was some kind of morrow said that philosophical injury you know and i wonder if there's something in are evil moral emotions where a an earthquake or natural disaster feels more random whereas somebody did something to me and i should dial up my paranoia about other people so that doesn't happen again an end and so maybe this happens to you and i once or twice but to the war veteran or whatever sexual abuse victim it's happened so many times they they've just hit the point where the rational decision is i don't trust anybody yet oh how the time you know this kind of exaggerated cognitive reaction a you know the okay don't trust anybody but hey he got the puck let me just like social isolation this emotional aviation any nation that in itself is is such a problem right i mean humans wired to be social beans right so if we cut out sells off from the will like that you set yourself up to so many other complicated psychological symptoms so greenie is this time of the trauma so by the end that's like early intervention treatment is key before those those thoughts take hold you know and becoming changed but at the house is been but darlene i love you i i'm not one of the bad people they're approaching it like it's rational thing you could talk somebody out of but it's not that simple not at all and the the statistics show if you love someone with ptsd de odds of you yourself developing ptsd depression or anxiety go up people yeah people who literally ptsd they they're much more likely to be double multiple times they're much more likely to have problems non emotional tennessee sexual intimacy to so we have that you mean the the spouse married to the ptsd victim gets divorced and remarried and kerry some of that with them into their second marriage and therefore they're more likely to get divorced oh so you know i should clarify the person living with ptsd they themselves are much more likely to be double all right okay yeah and and and they probably more likely have issues with emotional intimacy sexual intimacy contribute to the demise of the mom edge oh well right yeah but at the same time trauma is infectious so i think spouses who have been in long term merges people got ptsd it's way they're gonna scape landscape themselves and they public all gonna take advantage to to future relationships as well so what do we know about the children of of of ptsd victims yeah the same families are impacted you know 'em now what's it's really fascinating is and we haven't we touched on it and it definitely was mentioning this whole phoebe of kind of at the genetics and you're intergenerational transmission of trauma because there'd be some only worked on it still in its infancy but definitely worth mentioning this notion ocean that if somebody who's been exposed to a very major trauma it impacts if it's a minor impact this bum if it's a woman x impact eggs in a way that is an adverse impact on then those changes at transmit it too many subsequent children by this process of intergenerational transmissions so these children literally carry these changes in his own abilities in their blood you know altered newer chemistry all new biology so even if these kids themselves have never been exposed to a traumatic event if at some point in their life they oh they're gonna respond at inherited kind of vulnerability so you know when we think of master mitigation when we think of torture genocide slavery you know you could we start to get impacted deep footprint that ptsd kennedy yeah i've seen these epa genetic studies brought up in other books dealing with is a civil wars in in in terrorism and things like that little skeptical we don't know the exact mechanism how that would change the gammy an also the social learning people say well but if you're raised in a family where there's any tst surely there's a huge environmental effects is well yeah absolutely and conventional wisdom up about twenty years ago that was the conventional wisdom but if you re re by someone who has ptsd that it's gonna all to you will see that's gonna impact you in a in a in a negative way how you navigate the world just sell psychologically but a couple of the studies that have come come out and most notably i'm talking about the will will come rachel you're huda from mount sinai they started to delineate a little bit in separate out those social factors by using maka cortisol all right quarter so yes it but it was like i said honey jay yeah it's a very very complicated things try and figure out but did he know that we should be curious yeah it's more than just a social environmental learning there's something almost biological to give us a quick quick history what you do in one ear chapters on why it took so long for us to recognize is given that in the civil war in the first world war it was clear shell shock and then a lot of these guys were totally messed up so we knew about this but it didn't get interpreted correctly the history of ptsd is one symbols of everybody forgets about it but basically what happened after world obama due to the civil war like everybody gets very very interested because i think countries in whole government is a political incentive to be interested and then unfortunately after the war it just it just languishes the field just languishes amazonian nineteen seven cheese in the nineteen seventies after the vietnam war and really throughout active advocacy on the part of vietnam veterans who will like this the thing we need to pay attention to it and then a lot of women's rights organizations who are advocating on behalf of victims all you know domestic violence and then they were shifts and changes to the laws that protect the rights of the victim and then i think we were able to get over that hoop and not forget about ptsd but it didn't end to be official diagnostic nomenclature till nineteen eighty which is which is really insane if you think about this condition it's being described in ancient texts you know like concrete techs and it goes back to the millennia you know freud talked about a young to buy like hundreds of years ago nineteen eighties when he was officially recognize so many ways it's very young diagnosis it's like forty years old yeah probably still suffering from this idea of this mismatch between if you have a medical condition people are more sympathetic and were gonna treat it with some physical thing whereas if you have a mental disorder just get over it lack of self together together but now we know enough about neuro chemistry that it is really no difference to medical models mental or physical relievers the same well yeah i liked my heart i'm a clinician that's what i was trying to be that still what i do and i'm like you know what even if i can't see fits the clue what's going on with you i can see suffering you know people don't make it out i could see suffering in the rules might be invisible but to the train die you could see the consequences of those was so 'em so i think people have have suffered unnecessarily they have had been overlooked and i should add i think part of the reason ptsd with so late accepted is this a societal collusion to we don't wanna see chocolate either it's not just individuals with whom it's unspeakable so societies too because they ask some very difficult questions you know if someone was traumatized and that means is a perpetrator and how i feel about that and what do we take it puts us in a meeting difficult bystanders situation so there is a collision society didn't wanna see it too yeah i think governments were not to inclined recognizes 'cause it's another cost of war but they have to justify here we are in afghanistan ghanistan seventeen and a half years later still going to remember the name of the it was coming home i think the jane fonda jon voight movie about vietnam i think that was in the eighties and i think that now looking back on it that was kind of ptsd steve recognition film because at the end of the film the other guy forget actor's name that was her love interest he the phil man's with him walking out in it takes all closed up walks out in the ocean kills and yeah i know if you ever saw that movie it's it's i think that was one of the first to recognize in the vietnam war there was something like what we would now call ptsd i climb home they all right so i just got my consult with you a in it's clear i have a ptsd problem i say doc what do i do so 'em if you wanna look at the best idea we have of what is most effective to help with symptoms you definitely wanna start with the talk therapy some kind of psychological talk therapy 'em something from the overarching banner of cbt cognitive behavioral therapy and there were many therapy to kind of come under that by now you could pick you know things like prolonged exposure cognitive processing therapy nbr comes under that bana 'em and i think since we've never done the dismantling studies to reheat prove what is the secret sauce but i think in essence what is the secret sauce to a lot of affective trauma focus psychotherapist exposure is keith exposure elements and then the cognitive restructuring string and then also just the basic secular education just having somebody will ptsd is and what it does to brain and body can yield amazing results you know just explaining to somebody and then equipping them with tools like we next ational breathing we training or mindfulness those type of things can be very helpful so i think those of some of the secret sauce ingredients that contribute to those psychotherapy being affected meditation meditation is definitely all in trust a there's a lot of focus on things like meditation yoga massage acupuncture those little come under the mind body treatment that a not the data to support their effectiveness isn't as robust as hot what it is to the cb teeth i'm not do the work but the danger is not as robust definitely isn't i just think it could be very useful i don't know standalone treatments if we have the data to support they used a standalone streaming but you know it's my approach when when someone is diagnosed with ptsd did i think we should try when he's tried and tested first and we should work our way through and then if those on effective if you're not getting optimal results then let's try stuff that's not a traitor attested but it's still nonetheless pop pita or that we have anecdotal you know evidence that it might be helpful so if i'm getting thought flooding maybe twenty times a day every hour say of the trauma and it just keeps coming up in my head yeah what do i do to get rid of that knock it back half about or whatever yeah it's hard work on a big part of it is helping the postseason recognize what they told the triggers might be oftentimes those intrusive symptoms that you describe this triggers that sets the brain moms to to trigger that intrusive experience but the survivor oftentimes doesn't know what those chickasaw takes a while to connect the dots and that's what we skilled therapy can help you do so it might be a particular smell now or sound you know or feeling but until you go back to the trauma and ridi dissect it and take it apart you're not gonna recognize what the trick is up but once you know what you saw you i tell people you're back in the driver's seat see again you might still happy intrusive symptoms but at least you see them coming because you know what the truth is a and you have a bit more control in that situation and that in itself could be incredibly helpful in reducing the the the the severity of symptoms i don't think these symptoms as it go away entirely t but you know if you can go from having intrusive memories you know ten times a day to twice a day and that's something you know remembering the me too me too stories was a certain cologne that the the rapist or the perpetrator war then was a trigger for this woman's dot flooding of the trauma now how would you deal i mean just exposure to that alone smell without the trauma would attenuate see a reconnecting over to the trauma or how would that work yeah you could you get that would be one way of going about it they thoroughly of dealing with it but again just making that connection to make that connection because of the white sometimes say let's say this woman ended up sitting next to a colleague woke who has the same cologne if she doesn't know the dot com it's a trick of how she made just such any feel very flooded very anxious panicking need to leave the room but sometimes i think just knowing oh okay that's why i'm feeling uncomfortable you can kind of nick things in the mud but yeah you're right i mean if you really wanted to go deep you could actually do like a a you know in either exposure exercise touchy desensitized to the snow at the columbia people do they go cbd for say snake phobias spite moebius or something like that but it's interesting that just being aware that there is a problem other people they'll have it here a bunch of the causes somehow gives people a maybe it's a sort of internal locus of control like okay this is something i am now aware of so i have some control over residents feel like random assaults on me yeah i think it does and i know it sounds simple but you know that kind of naming detainment philosophy it's it's i can't tell you how many times in my office i'll have an interaction conversation with the patient they had that lightbulb moment where they're like oh okay i get it you know i get why suddenly i have road rage or why i constantly be around certain people in certain situations and it's really reassuring giving sauna name for what they're experiencing is reid reassuring now the talk to because of lack of access to mental health care in a country and the fact that we don't have enough funding to mental health and we don't have enough mental health professional there's a lot of people who want even gonna get a conversation on a public conversation yeah offline i wanna i wanna mention i wanna talk about the robert rosen hand steady david rosen instead we're not talking about that but it's interesting when that was done in the seventies a the mental health system was far more inclusive it was it's easier to get into a mental hospital in pretend to be a patient and then try to get out a okay so that was in the interesting study in in in how we diagnose things things were certainly different than but after reagan emptied the metal institute's and now we have most of the homeless on the street a this itself is is a is a problem and i am sure you must in canada there's a lot of ptsd victims probably end up homeless 'cause they lose their jobs and families analysis and so on so just comment on that in general what's happened over the last half century in our healthcare system of dealing with mental issues like that so to me it feels like mental health stigmatize dionne benny two point i mean it's it's irrational meta comprehend so today i just be hospitalized before i became a trauma science and btc suspicious of the hospital if which meant all my will cuisine and inpatient hospital in a big chunk of my day would spend then arguing with insurance companies and for why my patient needed an extra day in the hospital and these people who've been paying insurance premiums their whole life these people who was suicidal homicidal there psychotic a lot of people with regular ptc wouldn't even end up in the hospital today they're not they don't meet criteria strict criteria that the people were not turned up in the hospital to begin with and then on top of that we have to fight it is the mental health priority issues it in my mind is a social justice issues 'em i you know i like i mentioned to you the burden on family mendez it's incredible it's just getting shifted onto family members who then i left a cab with people who still pretty sick you know and who could benefit and then again disassociate disadvantaged the most hot 'cause they can't afford to pay out of pocket or for big copays and then stops this cycle of social declined they start to lose jobs and they lose insurance then they lose their homes and then the fact that that homeless makes them vulnerable to being traumatized anyway right so just these cycles the people come get out of and it's really distressing me 'em insurance company which is money it's a business and the sooner you could get about a shorter just days the more money we make yeah absolutely because there's less money coming out of that paul and you know as a physician you know i'm the one taking care of the patient i'm taking responsibility for this patient ethically legally whatever but yet there's another person in an office in a different state who gets to tell me what to do i think a lot of physicians it contributes to a lot of bono 'cause you just feel like you can't get your patient flipping need right you know and we're not talking about luxurious cat here went up to a thirty day stays in spa like setting with talking about neutrally keeping people safe right 'em so you know i i think there's a time limit on how someone could be hospitalized list on so i did it for good few years but yeah it's it's just really distressing to me there's just something about this rhetoric that somehow mental illness is not real illness that is so stigmatizing 'em new getting better getting better in some some ways you know like the fact that i could write this book the fact that i could have this conversation with you it is encouraging sign of progress the probably not fast enough given the mental the burden of mental illness you know you're on the society both on button and not just psychological the economical like i yeah i just don't understand why we still have to have these stigmatizing a response yeah my wife's in germany and a you know they have universal healthcare there and they just don't have any of those issues we have they pay a little more in taxes i guess yes probably but it isn't burdensome they still have a incredibly vibrant economy it's the strongest and all of europe terry you so what's the problem is there are system is so politicized my my first encounter with what you just described was a my my mom taught 'em meningioma brain tumors for about a decade and so we're trying this and that a treatment she had five cranium entries by radiation helmet treatments and the whole thing and they finally just said it just keeps coming back there's nothing we could do so i tried this experimental drug m a n they'd cut mayor disney she fell and hit her head it was in a coma so we went to the huntington hospital in pasadena there and they took great care of her and then never forget this is whoever they administrator comes in and talk to me in my dad and says well a this is gonna seem really cold but you have to take her mom out of here by five o'clock today where like she's in a coma what do you talking about beds beds up we got we got new patients come in this is what it costs us data keep remind me of you gotta move to a place that's cheaper and were like holy crap what and we had great healthcare system my dad had plenty of money is not a new issue but it's like holy shit what if we were that dirt pour it hey we'd be fucked i mean like you know anyway i was like oh man this is something that was twenty years ago so wow distracting yeah so stressing and you know like i still feel like you know people can advocate for themselves you you might be able to make an argument to all the people who don't have advocacy skilled tool on educated on the platform it's it's really distressing to see what happens to people who fall through the cracks the healthcare system yeah let us attorney i don't know how to change it i was running for office i wouldn't know what the answer is other than just universal healthcare let's just get over by the book but a yeah so 'em how many people what what's the estimate now what percentage of the american population or elsewhere have do do you see a second up the two to three percent in terms of of the like lifetime prevalence so just depends what statistics you're using but at any moment in time that translates to about six million with active symptoms that need treatment now we know there is this condition called partial ptsd each is not doesn't need the textbook criteria but had the kind of muted form of ptsd there's many many millions more who have partial ptsd and they need some form of help you know it's like having pre diabetes you know you don't the full blown thing but that doesn't mean you're not a risk 'em so collectively you could start to get a sense of how many people were talking about and then the fact that ptsd goes hand in hand a lot of time to depression anxiety substance cities the fact that it's infectious that impacts on and then did you start together in you ever m a write prescriptions for ss are eyes ended the president's their entire anxiety medications for ptsd so a lotta times when people come to see someone like me because i'm a psychiatrist and i kind of get pigeonholed into the medication management role 'em that's that's what they're coming full because it may be tried psychotherapy and it has not worked or they don't want to gauging psychotherapy and many many reasons or and so oftentimes that to get through sets me and then in terms of evidence for wilkes in terms of medications i think assist all rise at center ice puppet the mets that we have enough data for to support but the effectiveness in ptsd definitely a trial up that is certainly one too many people especially if they have plummeted depression or if they've been suicidal all you know they just got moved to be a fall yeah i think you're also in countering in addition to this sort of ignorance of mental illness issue it's not like a physical illness a this kind of post modernism psych psychiatry is not a real science is when we first start a skeptic people were sending me stuff from thomas saws like you gotta research shurmur he's a skeptic like you and you should be skeptical of mental illness there's no such thing all socially constructed andy and then i read 'em to coast book i forget the title of it but basically mental illness was invented in fifteen eighty one or whatever and that a you know if you if you think you you you're kid has eight eighty hd doesn't really he's just active in two years ago he would not have had been diagnosed with eighty hd he would just be working on the farm be inactive her something you know they arguments right i to me i just can't see i can't go that far i mean i could see where there's a society defines things a certain way yes there's always a cultural influence but with something like ptsd schizophrenia any of the extreme psychosis there's obviously a brain chemistry thing going on you just cannot be just culture mhm yeah i i don't know i'm i'm almost befuddled by arguments like that 'em you know i when i was a medical student in those shooting with specialty to go into people were very surprised when i was interested in psychiatry and they a mental is actively getting me to change my mind and their responsibilities stigmatized responses if you imagine that stigma coming from within the medical profession wow and i just never understood it and they only conclusion i could come to his is that these physicians who were literally saying to me you'll be you'll be a we a doctor if you become a psychiatrist neutrally 'em and i think it's just this discomfort with the emotional suffering psychological suffering an extreme discomfort and so i think he's that type of stigma comes from within the profession i'm not surprised at their arguments from without the profession the thing in my mind i think you have to be comfortable with the duality if you're gonna be a psychiatrist pk just publicly over diagnosed but it's also simultaneously under diagnosis you have to be comfortable with holding those two opposing thoughts in your mind and you know the very nature of mental illness the way we diagnose it is open to misinterpretation is offering a puppet classification system i'll be the first one to say that but that doesn't mean we stopped trying i feel like we're getting better so if you look even in history just ptsd alone we have a lot more diagnostic tools and screening measures to the normal precise about diagnosing ptsd then we say forty years ago is it perfect no but in my mind that doesn't we stopped trying or do we throw out what we've done or you just can't carry on refining you know this is the brain at the end of the day this is a human beings infinitely complex you know so in my mind this is a good battle of fighting and we keep on moving forward but yeah it it's over diagnose they get missed all the time there's no you know i don't see the value in just focusing on the fact that it's over diagnose until you correct together as well so the dsm four or five fiber whatever up to now it's five right i think a high so obviously ptsd is covered in that fairly extensively i presume maybe what it needs to be is in whatever they equivalent of that book would be for regular medical non psychiatry students something something like that where they have to take a course in a bunch of these obviously medically based mental disorders that are part of this branch your in of psychiatry but it's just a larger part of medicine it'd be something that i think he can come in those diagnose they okay which will they do but the problem is it's a curious thing america medical education like i i went to medical school in england and it's a curious thing a b average medical student in america is not exposed to that much psychiatry they might the month of psychiatry in that whole medical moms yeah yeah bridge medical students so let's say tomorrow's a general tomorrow's dermatologist tomorrow's unit in an so heavy delays the problem because you know why it's a psychiatrist i may or may not meet someone who has a branch she may or may not meet someone who has devices but i bet you as adema toddler just or the judge and you're gonna meet someone who has a mental health disorder right they get they very prevalent wanna see people will have some type of mental health disorders so 'em timmy i feel like in education only she did just not getting enough exposure so then i think they're not comfortable with it and then when they're not comfortable with it a notch reaction is just not do anything about it you know to ignore ignore it like mastery of it they don't want any minute but i gotta say things are getting better i do feel i do feel there is more attention to psychiatry in the training of medical students but it's just not enough whereas in england because most doctors are gonna end up being gp's in the national health service they have have extensive psychiatric training they have to because it's a population collection based model as opposed to an individual level so you have to meet the needs of the population so yeah it's tough the 'em but yeah you definitely helping people within the profession had a bit more awareness you and the consequences you're gonna go on i mean this whenever they afghan war ganz if it ever does you're talking maybe another fifty years of consequences from from your perspective on ptsd up those soldiers and their spouses and then their children yep i don't wanna be optimistic too because i do think those numbers might not be not defend in years before but we just ignored it right you know i think the fact that way where we're giving you the name of being a bit more bolden stepping up and identifying the problem and also the fact that you know thirty forty years ago ptsd what's considered incurable untreatable day it's very manageable very treatable and it's not disabling which is good news and they should be reason for hope you know and and i see you already i see already inventions to come back and who get treatment we already do really well if they get early intervention as opposed to waiting averaged twelve years right before they get help because i think it's out there is like the people a little bit more open to getting help so so i feel like i shouldn't be doing limit they should be hope here to become a liberal trauma conscious trauma informed society that way even allowing it to exist and accepting existence sixty minutes he sealer a few weeks ago you probably saw people i figured they were injecting something the guys mac yeah it was supposed to go right into the mic deliver something like that that is though did they were doing on a a a a blockade of the ganglion hunter so basically that fight or flight that i was telling you about the out of control and people who have ptsd by injecting the kind of cluster of nerve cells with the anesthetic be idea is that that fight or flight response will come right down and so then people play better able to engage in therapies day to day life and avail themselves of treatments so you know it's experimental what they showed on the sixty minutes on show was a experimental 'em it's not routinely used we don't have that level of data that we like to see the kind of randomized controlled pacino's tiles it'd be like seat to make sure the incident just a placebo response so yeah i mean obviously i mean anything that offers release we're all interested in it i just i just the cabinet and it took about it in the book you know being a doctor for twenty years now i've been through a lot of these cycles and kind of magic bullet come along these things get a lot of media attention 'cause they just promised this instant relief road and if into a lot of cycles these with patient be patient and naturally drawn to these because they bring and they want relief but then unfortunately sometimes these things don't end up hanging out and they over promise and under deliver and then i kind of have to lift through these cycles with patient and and then patients a setting aside to in tight tried and tested treatment but kind of these magic would have options and then we lose ground so so i feel like i'm a bit of a skeptic they understood 'em and i i always keep my ero i always wanna know what's going on but i feel like it shouldn't be accredited evidence if i'm gonna presented as an option yeah so i think it's my job to kind of keep focus and keep objectives yeah it's always difficult to know what to do anomalies like these is one of the vents that seemed like they're gonna change the entire science and everybody says oh you're closed minded shurmur of her not being open minded and it's like well i'm old enough to know that i've seen this happen over and over and over and over an almost nothing comes of any of these a you know the kids the cure for cancer is right around the corner and you know get one and so forth yet a yeah it would be nice if the problem is i think it's just the the human body and brands is so complex but there is there's not gonna be a single point yeah i feel the magic bullet solution to produce teach me it it just doesn't feel like that's a realistic approach the problem with a lot of these magic bullet stories in the twentyfirst century day the hubris remains on internet oh and then now i still i still have people coming to me asking about x y z even though it being dig deep foods proven to be effective but the problem is when it's not affected that doesn't get as much media coverage right well a little bit like they they anti vaxxers still hanging onto that one study done by wakefield back in nineteen ninety six ten refuted bugged retracted declared fraudulent and so it does you know just hangs on there and that's that's really difficult i wanna ask you about another issue we dealt with in the nineties with at skeptic was recovered repress last recovered memories of which were then thought to be a sort of confabulation or constructed memories that weren't really in existence i ask because a lot of more associated with childhood sexual abuse so these were mostly adult women who have gone to therapists in their twenties or thirties with whatever symptoms weight loss regain sleep problems depression and so on and a handful of these therapists said well deesor these symptoms of sexual being sexually abused as a child while i have no memory of this that's because people that are traumatized opting repressed memories and we have to coax them out through techniques of of talking in hypnosis susser whatever now that is far as i know it's been really thoroughly debunked mainly by other victims of trauma who said repressing memory is not the problem i can't i can't stop thinking about holocaust victims were victims and so on i don't know if you if you read much about that that whole issue and it does court get out of the core of memory to what extent do we really couldn't we forget things and bringing repressed things and bring it back and we just forgive him for a while and they're brought back through a trigger or something like that i think that whole chapter with an unfortunate chapter in the history of ptsd and it probably set set us back a lot i i think the conventional wisdom now is look i'm not gonna tell someone they were traumatized if they don't tell me fight you know so i'm not gonna go digging something i wait for someone to bring me and sometimes people don't wanna talk about that trauma and that's okay too i'm getting courage people but i'm not gonna call us anyone not gonna push anyone to talk about something they're not ready to talk about so i think that just general changing the philosophical stance of how we approach trauma victims and that in itself safeguards against a lot of those kind of debacle right way people who suggest developing in having memories implanted so so that i think is very clear i don't tell someone that traumatize they've got a tremendous jew and they don't wanna now the problem is this stuff they only captain i will say that ptsd has been described as a disorder mentally you're a lot of paradoxical issues in memory when it comes to ptsd and i go into it and a lot of length in the book 'em and that's what causes some of the confusion and so in my mind 'em it it is not unusual news you'll meet new people who look like they had a trauma history they behave the way they navigate the world they navigate it like someone who has a troll the history they may not be aware of the trauma he's a lot of times especially in situations of severe childhood abuse children often dissociate right they cut off debate to escape the harshness of the situation they're in they will dissociate to survive that it'd be amazing so they may not have a conscious memory of the trauma but that doesn't mean they're not behaving like someone has a trauma history so that's obviously a very tricky situation i'm what i try to do denny's i just focus on the simpsons again i'm not gonna tougher one right traumatized win win at a luncheon suddenly felt right yeah just just brings to mind that a documentary film leaving neverland neverland about the michael jackson story in those two young men now they're it's in their late twenties they were boys like seven eight years old when they went there and and clearly michael jackson who's having sex with these boys that's pedophilia but you hear them talk about it like at the time maybe they just didn't have the language or even the cognition mission of what was happening to them but they describe him as he was super loving he he was so caring for me and it was a warm environment it was cry love being there you know only later did they kind of figure out oh this was actually not good a so that kind of brings to mind to what extent the society say you know what that's a really bad say oh it's a really bad thing i better be traumatized or is it really traumatic and they don't even know it because they don't have the language or or even a concept symbols to put in there and call realize what it is above but i i think the point that you're making any industry why children they're just so fundable you know when you brain is still growing when you're bodies to grind when the sense of self you emotional send when that still old developing growing as it is in children and these were very young children like hitting five and seven not do you know what i mean on children a uniquely vulnerable to trauma you know we like to think that children and resilient just by virtue of being sitting but they are not right you know they periods in the child liquid they eventually honorable and you bring up is good point a lot of times when you have someone who is a predator you know they sit down to write it doesn't feel like a vehicle you if you're michael jackson and you're the world's most famous person will the power differential is something that i feel like it was commenting on that you know whenever this power differential in any relationship between a doctor and the patient you know between the movie starring in a final a politician and a member of the put whenever there is a power differential there is the potential for abuse period you know end 'em and so i think at this that is an example of how abused feel like not abused at that time to the fifteen but i got picked him grows and he's no longer may be beholden to that person in the same way that posted this victim gross finds their own voice has their own experiences 'em that story can shift and so that's why a lot of times unfortunate need victims of sexual abuse they're not believed because their stories shifts all the time machine right that's the very nature of traumatic memories of shuffled time maybe it's children to join these boys they dissociated from those memories as a way to coat would they enjoy it and you know the physical survival with similar dependent on these other people right so they had to find a way to survive said they dissociate but then it's only adults at these men we start coming back and i think one thing that came up in these toys was it was only when they become parents themselves the date and this happens all the time and people have been abused his kids it's only when they become parents and south because becoming a pair of tickets you're right you're right around children all the time and it triggers you and takes you back and it's only then people start off and deal with those memories but i think the take home they needed a public health message here and i think the good news is i do think the societal awareness about sexual abuse of children like you look at the the the scandal in the catholic catholic and a church i do think the mental health literacy about sexual abuse has gone up i feel like in the last twenty years of me being a doctor i think parents who a lot more savvy lot more clued in a lot less trusting a lot less skeptical but this is good too big a then you're more likely to intervene or not believe someone proactively prevention that is the best thing you can do to prevent ptsd eight i mean if we got rid of child abuse to think would get rid of you know sixty percent of the ptsd problem right so i think in that sense just elevating public a mental health literacy about how these things happened about how someone could seem like look nice person in the world the most loving person in but you know what you need to be skeptical of people who had two nights wildly other amazing thing they came out of that documentary film as they interviewed the parents and they just seem clueless like you're dropping you off the air for three days and there's no one else around and a yes okay how well it's it's seductive it hypnotizing a but like we have to be wary we have to be cautious they have to be skeptical same thing with with parents with their their local police tape a century ago around this half a century ago just never occurred to them that this person in power would do this to my child yeah well that's become pretty evident now that that's a that's a real problem i do wonder i dunno if you give it much thought to this a are are at a file or pedophilia tendency young men going migrating self selecting into the priesthood because there's a there's an available targets there or or did they become like that after they get there and they can't have sex you know the seller dizzy business and all that and that's the only option to them sort of like sex sex in male jails they're not homosexuals they just have no other options or some combination of i don't know icon i'm not checking we think of any data speak to the specific scummy i kind of had this blanket rule that wherever there is a power differential predators will always be attracted to and so you know you you take the case of the the the doctor for the gym not knowing you know wherever there is a power differential i think predators are attracted to those situations and i think all we can do is be aware of relationships where there is the power i mean even the whole me to move but what without a lot of times it was someone who had more power over plus and so they were able to harass them and get away with it so i think the take home message is 'em whenever this power differential you have to expect someone may try to abuse can you do to yourself against out and defend against that and to be aware of that said to me i i do spend a lotta time thinking about these kind of scandals and to me that's that's the crux of it the power differential yeah i think you're totally and that's put all the the training programs emphasize designed macadamia i get everybody at chapman university where i teach every two years we have to take me online a program on on sexual stuff and discrimination and all that stuff and now they have it set up where you can't skip ahead in and do other work what while while the thing 'cause they time it would each unit so like all right i'm gonna just grind through each of these scenarios and they're all hilarious where they they tried to make a sort of politically correct like it's a female professor female professor juanita have sex with the young male students like yeah that happens a lot in any way a an but now i mean it's pretty clear since really the late nineties i would say that you just do not sleep around with the students don't ever do i don't even think about it and then i know corporations are doing this if there's any power differential you just do not date there's no dating you know sleeping around none of that stuff and yet sometimes this stuff is still goes on it when these stories break i'm like what were you thinking dude you've you've had the same same training programs everyone else's had where they clear you can't do it maybe they just can't help himself i dunno yeah well we we're not sure if the training programs prevent we have the same token actually prevent anything i think the organization so that i could they've the jersey legal omi trained him you know i i think it speaks to the unconscious mind i think you know people regardless they can do say one thing and some setting but do something totally different and they're almost compartmentalizing it you but i think it speaks to the power of reenactment i mean reenactment it's a psychological phenomenons really at the core of a lot of ptsd and a lot of trauma were on some unconscious level you i just driven to reenact something prior life you know 'em whether it be in abusive situation you know you'd be aggressive and they're traumatizing situation you be the victim in traumatizing situation so yeah it's a troubling it's a company thing but i i do again like i say i think just by elevating the the the public dialogue about it the fact that you say even in your profession alone a lot of people understand why this is something that is harmful students right you know just just that in itself is a good thing we cannot denied that is not a good thing isn't gonna get rid of professors who who predator predator students no it's not you know we need better ways that weeding out the bad apples but but i think the elevated literacy connecting people more aware to if you if you see suspicious activity you're probably gonna be more likely to not turn a blind eye and maybe intervene you know so so i i think overall it's good though we also this is not gonna stop i don't think as long as it's human nature i don't think this is gonna stop that would be amazed at hollywood casting couch doesn't have i mean it's just if anybody tries to pull that again my god risked allied bailey the studios they probably i'm guessing they have massive training programs now the cover themselves like like that we've been going for

michael shurmur california shane doctor jane medical director scientist clinical associate professor new york times ptsd shelly jane palo alto healthcare stanford university school of journal of the american medica new england journal of medicin afghanistan iraq twenty years fifty percent five minutes thirty five percent
#268: How to Get Sleep in Anxious Times | Dr. Donn Posner

10% Happier with Dan Harris

1:19:44 hr | Last month

#268: How to Get Sleep in Anxious Times | Dr. Donn Posner

"I'm from the Bronx. By the way I'm not shy, not gonNA. Scare me. So. I could tell I got that vibe from you right away. You're not asleep. Sleep expert. No, no, this is. This should be fun. Okay. From ABC. This is the ten percent happier podcast. Dan Harris Our guest today is quite a character in a good way. We'll get to our sleep. Expert Don pose ner and a second I one item of business. Today is the first day of the summer sanity. Challenge, it's a free twenty one day meditation challenge. If you sign up every day of the challenge, you'll get a short video followed by a free guided meditation, the goal here is to help you establish or reinvigorate your meditation habit. You can do this solo, or you can invite friends and family and track one another's progress to join visit ten percent dot com slash challenge that's. One word all spelled out dot com slash challenge. Of course the link will be in the show notes all right. Let's get to our guest. I don't know about you guys, but my sleep has suffered at times quite badly during the last few months. Today's guest really got me thinking about this issue in a whole new way I. he normalizes the sleep problems. Many of us are having. If you're sleeping poorly right now, he says don't freak out. It's natural and normal. Second he has a whole bunch of tips for how to deal with insomnia. Some of which I had never heard before, and I'm already starting to operationalize my own life. His name is Don. Posner he's one of the leaders in the field of cognitive behavioral therapy for insomnia. Titles are founder and president of sleep, well, consultants and Adjunct Clinical Associate Professor Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. Not only did done patiently answer all of my questions, but we also played him. Some listener voicemails from you guys. One last thing to say before we dive in here, you'll notice over the course of this week. That are episodes this week. Have a theme which we're calling primordial needs today. We're doing sleep. Wednesday it's sex, so it's fun week here on the show. Stay tuned for all of that I. IT sleep and on near here we go. Great to meet you and thanks for doing this. I appreciate it sure thing good to be here. You gave a talk recently. That got some attention. deservedly. We'll get now more attention now that we're putting you on the show about acute insomnia. Can you tell us what that means and why? You're worried about it right now especially. Let me clarify a couple of things. Let me maybe work backward. The best way to define acute insomnia is to define chronic or long term insomnia, which we in the field called insomnia disorder. And the way we define that is that a person is having trouble initiating sleep to begin with. Or they wake up in the middle of the night and can't get back to sleep. Or they wake up sort of at the end of their night and never get back to sleep, right? And so those are really three flavors of insomnia if you will beginning middle and end. We like to say chocolate, Vanilla Strawberry, and then there's neopolitan which is a mixed bag right so that's insomnia. If that is happening and we say what's problem with to sleep or staying asleep, it's if you take longer than thirty minutes to get to sleep on average if you are awake for some combination of thirty minutes in the middle of the night, or you wake more than thirty minutes earlier than your desired time. If that's happening three or more nights a week for longer than three months. And you have associated daytime symptoms, that's insomnia disorder and I want to underscore that last piece which is. Really, a twenty four hour disorder. It has to have impact on your day. For us to say that this is really an insomnia disorder problem. You have to have something like fatigue sleepiness. Concentration problems, performance, problems and so forth. So chronic insomnia is those symptoms more than three months. So now going back to your question about acute insomnia, acute insomnia is all of that. Less than three months when I give talks, and when I asked the audience how people here have ever had a bad night's sleep I know I'm going to get a laugh and one hundred percent of the hands go up. We've all had that experience. And all of that is normal nothing to concern ourselves about it, and we don't even talk about anything as diagnostic as acute insomnia until we get to at least three days. But then anywhere between three days and three months is considered acute insomnia, and that means that you're having those problems either initiating or maintaining sleep. And you may or may not have daytime symptoms yet. And it's usually due to some stressor, and we say anything from the Bio psychosocial spectrum. I now say to my trainees. You could probably open the dictionary. Put your finger down on a word and find something that causes insomnia. Whether. It's an illness physical pain a change in your environment, a psychological stress like stress at work tax time those sorts of things and I also hasten to add that. The Valence of that does not have to be negative. Right change is stressful so getting married and getting a new bed partner in your bed. Can Change Your sleep patterns. Having a child. Is a precipitate for an acute insomnia until you can get that kind of straightened away. The thought process is absolutely very much that that's a normal reaction distress. Maybe even a good one because. If we go back evolution narrowly speaking. Sleep is a dangerous activity. Right if you're asleep, you're vulnerable. It must be important for that reason because every species, does it. And so, it must provide very important function, but it's dangerous, so we always say that sleep is deferred when the lion walks into the mouth of the cave. and. Therefore, we could say that acute insomnia is adaptive. If, you understand so even now in our culture. It's adaptive in the sense that you're making changes. You're trying to deal with. Whatever's coming down the pike. But we always expect that. If you then adapt appropriately or the problem itself goes away, or you get on some medication or the stressor itself remits then we expect the acute insomnia to remit, and so all of that we consider to be normal, and it is for a smaller subset, but yet epidemic numbers that sort of gravitate into this chronic insomnia realm, which is where people like myself and my colleagues come in terms of helping people to treat that. If I've heard you correctly chronic insomnia. Is a big issue. You've dedicated your your life's work to addressing in acute insomnia. Make sense given what we're all living through right now. In some people it will escalate to chronic, and that's the source of your big concern right now in one hundred percent correct okay. So what could be causing a a more acute insomnia now than in normal times well, we're all more under stress. We're under stress for a lot of reasons. We're under stress because of the disease. And everything that goes along with that. What goes along with that worries about our own health? Worry about our children's health. Our elders health worry about. Ourselves getting the disease, but we're also concerned about the mitigation. Attempts were making at least some places. We're doing it well. We're concerned with you. Know loss of job. Of revenue loss of our business, I can't imagine the person who's sleeping well through that so again I say, and we'll come back to this later, but the the first thing with regard to acute insomnia is, don't panic. It's normal, okay. There are lions in the cave, so to speak. Their alliance in the cave is exactly right, so we should not be surprised. That said in addition not only do we have our. We faced with a tremendous increase in the amount of stress to a vast swath of the population. We can really say this is now worldwide. It's also the case that the mitigation attempts. Threaten potentially threaten. Our sleep and let me come back to potentially at some point, but potentially threaten sleep because of the changes we make in our day. As we go more into this and talk more about this today, Dan I hope people will learn that one of the major things that keeps your sleep healthiest structure. Can, and we are sort of most of us, forced into a structure by our work in school day lives. I now that's gone for many people, so if you get to work from home, that's terrific, but it also gives you the possible opportunity to throw structure out the window. One of the places we often see what we call a precipitate of acute insomnia, and eventually chronic insomnia, his retirement, and it's sort of the same thing. We've all been forced into this well. You know no need for that clock in the morning anymore that in an avid self can potentially eight acute insomnia, so we have all of these reasons for that and again. None of that is of concern, because especially the stress itself I. Think we've kind of seeing it happen where where adapting as best as we can. It's a little bit of. Of A moving target, but people who have now been working from home I know at one point I tried to get a monitor from my computer at the store and I couldn't find an because they were all gone. Everybody's got monitors now. Everybody's learned to kind of create their home. Office, they're adapting better and better and better, and it might be for those that say gee. This is kind of working. Okay, it's not what I prefer, but it's working. Okay. We could imagine where they automatically just on their own start to sleep better. But there is this possibility that those that have thrown away a lot of what we would call. Good sleep health inadvertently. Are At more risk for chronic insomnia, and those that for anybody who gets an acute insomnia, those that begin to make a shift, and while I say acute insomnia is opt to three months. Myself and my colleagues would start to say that Even one month or so two three months. Starts to get into what we might call a sub chronic condition where we're starting to see this transition or this shift. Where not only is the stressor? The problem distress are sure is what you are concerned with, but you also are now starting to shift your attention. To the sleep problem itself if you understand what I'm saying. and that creates the potential for a vicious cycle. And changes in behavior that serve only to make sleep, worse and more chronic. And, so that was sort of the line that when I was giving that talk I was kind of saying. Let's at least think about acute insomnia and what we might do in that phase of acute insomnia to prevent the epidemic of chronic insomnia. That might follow the pandemic. What could we do to prevent this epidemic? What's on the list? Without getting too SCIENC- about it. Let's understand that as I said. There's an to structure. And if I was going to start that conversation, the place I always start is the single. Most point of important structure is in. That's wake time. And so We all understand. Most of US know that we have this internal biological circadian rhythm. And there are a number of bodily functions that fluctuated twenty four hour basis like hormone, secretions, and body, temperature and so forth. But for the sake of our conversation, what we're looking for almost circadian point of view is sleep wake. Rhythms. And that rhythm is held in. Check is what we call in trained the way to think about it is. How do I get that clock to be well? Set to Chime when I wanted to Chime, and not to chime when I don't want it to chime. The single most important point of data of input into that clock. Is Wake time. which is also a proxy for my first exposure to daylight? And light exposure. And so getting up at the same time at least most days, a week is important, okay? If you are someone who has now thrown the clock out and some days you are getting up at six and some days. You're getting up at seven and some days. You're getting up at eight and nine. That is what we call social jetlag. So imagine if you will just a anybody. listening has to just think what would happen and I'm based in the East Coast right now so I'll take an east coast reference, but what would happen if you flew from the East Coast to the Midwest to say from New York to Chicago and stay overnight for one night and flew back to New York, and then stayed one night, but the very next day flew to Denver. And then stayed there one night, and then flew back to New York, and then the very next night flew to Los Angeles and stayed there for a night and flew back to New York. How would you feel Dan? Feel like a working journalist because that's what I used to do all the time, but it feels crappy. It feels crappy is is the perfect word it feels crappy, and that's of course jet lag, but what I want people to understand is that you can feel that extreme what we'll call social jet lag by varying your times in the morning. Justice much. So if you're not already having trouble sleeping, you don't have to be heavy handed about it when I'm working with patients and trying to write their sleep I talk about getting up at the same time seven days a week to fix the clock, but I will always tell them is a well oiled clock. If you will doesn't require quite the same amount of consistency as a broken clock. To fix it, so the well oiled clock. We will usually say requires what we've seen in most people, which is five days a week. Most of us get up around the same time every day five days a week. And a couple of days usually on weekends we do it a little differently, and that doesn't throw anybody into a tizzy. And so if you're already not having problems sleeping. All I can recommend is get up at the same time five days a week and largely go to bed at the same time or after if you're not sleepy. Five days a week because that will help maintain good Circadian Treatment Good Circadian Rhythm now add to that. Any other regularity in our lives can add to that circadian and train so. For meals, types as opposed to grazing on you know random schedule. Regular Exercise Times. Going back to some structure in your life, take a walk at the same time every day. Do things like that at the same time every day. Maintain your activities during the day. Try to get out and be active. Activity helps sleep, and nothing begets lethargy like lethargy so sitting around and doing nothing. Is Not a great idea either. We are. Diurnal animals, which means we're not raccoons. We don't forage for food at night. We do our foraging and our work during the day. So. Most of us should be on daytime schedule. We should be eating our meals during the day. Our activity and work should be during the day as we transition and tonight, we should make that transition into lower levels of light. We don't have to be sitting in the dark, but lower levels of night and also transition our activities. We probably should not be working right up until bedtime. We should not be letting are difficult. Child who lives on the other side of the country. Call us at eleven o'clock at night. With their problems, we should set a limit for that and transition into quieter, more relaxing times at least a an hour or two before bedtime. Those are just some good health tips for people who are already sleeping well. I'm staying away for the moment from. The typical sleep hygiene so things bedroom environment those are always in place, and should be in place, and we can talk about those later, but in terms of right now. What do you really need to focus on if you're home and not working and don't have that structure imposed upon? You I can say that you know we probably. For most of us the now you might be able to nap a little bit. And napping is not bad. The problem with napping is there's a right way to nap in a wrong way to now. If! You feel like you wanNA build napping in. You can and we can do it the right way. If however you foresee that soon, you're going to be going back to work. Keep in mind that when you nap when you take a C. Yesterday during the day, as many cultures do. That You are reinforcing your internal clock for wanting that nap at that time of the day. So if you think in like even a month, you're going back to work and can't nap. You probably best off trying to avoid that NAFTA in the day. If you could all help it if you do nap because you want to now, just build that into your life as many for instance retired, people might do or you just can't help it because you're having a problem with sleep at night. You're trying to compensate as little as possible so if you are going to nab the ideal time nap and we all know we have this little dip after lunch. This post-prandial Circadian in Rhythm, and that's a normal function that's as it is expected to be. It's biological programmed in. It's a time when our drive to sleep has already been built up somewhat by half of our days activities and yet our circadian rhythm is going into a little bit of a low. So that's the best time and that that is something like seventy nine hours after the you wake up in the morning. Or habitual wake time. And a short nap twenty minutes and set an alarm to wake yourself up is much more preferable so power nap to sleeping for an hour or two. That's going to rob you again of more sleep the next night. And it is going to leave you feeling a lot of sleep inertia. When you wake up, you're gonNA feel worse when you wake in from that nap than you did going to sleep a good short nap. Will carve off just enough sleepiness, and then your circadian rhythms, alerting signals are kicking back in any way that it's going to give you a nice steppingstone for the day. I think I all of those. Notions that you just. listed. There was one thing though that you said it was what you lead with that. I'm still little curious about which is you? Said? Wake time is the sort of. Apex Predator of Levers. You can pull them mixing my metaphor horribly here but anyway. Is Super Important. Let's just put more colloquially I'm having a hard time disentangling net from. Bedtime wouldn't that be the more important input? No, it really is wake time with regard to with that daylight exposure. And Bedtime and when you feel ready for bed is determined by when you first get that light exposure in the morning, so you should. Set alarm figure out what time you? Your body normally wants to wake up and then ensure that you're waking up at that time regularly with an alarm, if need be and then back timing your bedtime to that. Yeah when you say back timing. That's an interesting story because the question is. How many hours of sleep do you need? Okay and I don't think most of us in this country. Know How much we need. That is each individual, but if you think you're good at knowing what you need and you are going to do that, yes, exactly what you said is what I would do. What time do either need to wake up in the morning or now want to wake up in the morning and then backtrack from that for the amount of hours. You think you need so if I'm having trouble sleeping, and by the way I definitely fall in chronic insomnia category so just to say that and I know you can't and shouldn't be giving clinical advice here so. I'm either chronic or acute insomnia and I want to work this first piece of advice that you gave about wake time top. That I would. Think about what is the wisest wake time and then set an alarm to get myself up, yes, and then impose some discipline on the front end around dead time so that I'm getting enough sleep. Yes, to hit that. Okay, yes, and the bedtime is also then not a curfew. I'm not saying you must then go to bed at that hour or else. What we're really saying about bedtime is if in a twenty four hour day. You think you need seven hours. And you're waking up at seven then. Bedtime is roughly around midnight. And you shouldn't go to bed before that. And again you started to make a transition I, hadn't yet made, but is reasonable to do at this point, which is i. we have people who are already sleeping well. Should they maintain some of this structure to maintain that wellness? Yes. If you are starting to have a problem. Now, you should absolutely be doing those things to kind of get yourself back on track. And the second rule I would put on wake time being structured and bedtime. Being structured is don't compensate for a bad night. And that goes along with rule number one. If wake time is wake time. If seven o'clock it should be seven o'clock the fact that I was awake for two hours in the middle of night doesn't mean I should now sleep till nine. It will just make it more likely that I'm going to have more trouble down the road. Okay, so the rule is always whatever your sleep need is. Get that amount of sleep most days or less never go for more. And certainly don't go for more when you are trying to compensate for a bad night of sleep, so it's that person who should neither get up. Any later should not go to bed any earlier. And should not nap during the day to compensate for that loss sleep. We have an internal mechanism of sleep regulation between what we call sleep, drive and Circadian Rhythm. That will right itself. If we allow it by not doing those things I just mentioned. How do we know how much sleep we need? How do I know how much sleep I need? Well, so that's why I say most people I think don't know because unfortunately, my tribe, my brethren, the sleep people in the world. Have Somehow gotten this message out there that we all need eight hours. And nothing could be further from the truth. Now the truth is I do see more and more over the last say five years or ten years. That the message is now you need to get between seven and nine. Or else. and. Even that the data is is not so clear on that. that the range of what people need. Within maybe a standard deviation or so of the normal mean. is somewhere between about six and nine hours. So, that's about where I would put it. That said understand. The average is actually not eight. In this country. The average in the mode is closer to seven and a half. There's at least going to be a standard deviation on either side of that meaning. Yes, some people are going to need seven and some people are going to need six and a half and simply brutal gonNa need eight, and some people are GonNa, need eight and a half. And the question is. How do you know you're getting the right amount of sleep? Because when you get that amount asleep, you feel fine during the day. Now again I. Caution what I mean by. That is when you're getting that amount every day. The fact that you don't get you know that you get two hours tonight and three the next, and for the next, and then get right sleep need for one night. You may not feel perfect, and by the way if you compensate and then all of a sudden crash on the weekend, and get eight and a half hours or nine hours and say gee, I feel great. That doesn't mean that's what you need. That's just you compensating for the bouncing of going up and down and up and down up and down. But if you're a seven hour or seven and a half hour sleeper and you get that every day. If you're getting something every day, and you say yeah I don't feel tired for most of the day. All of us have a little bit of sleep inertia when we wake up in the morning, a little bit of transition to wipe the cobwebs out of our eyes and transition to Wakefulness, so don't use that as your gage. We all have that little bit of dip in the afternoon. And we all it stands to reason should be starting to feel more, tired and sleepy. Bedtime. So I, asked people to gauge how they're functioning at all other times of the day. That's what I wanna know how you doing. Are you tired sleepy? No, are you concentrating well? Yes, are you active in creative and feel good? Yes, you're probably getting what you need. So this issue of what the message your brethren are putting out is interesting. Because coming into the conversation, I wanted to get to this. We had a sleep expert on the show. Six months ago. So pre pandemic pre racial justice protests pre economic deep-freeze all of the things that are providing us so much stress right now, and it was one of the most popular episodes we've ever done this and I. Expect this one to rival, if not exceed that because sleep is such a universal resonant issue. This expert said all the data he had looked at suggested. If you're falling below seven hours a night, you are in danger. I was just reading something about that and I am telling you that the data is not clear on that. It's probably a little bit more likely that if you fall below. Five hours a night. That's a little bit more true. Okay, but you understand that a lot of these epidemiological studies do this by. Doing cut points and the cut points when they look at seven and below seven is, they'll say something is below seven and including below seven. Everybody. Who's below seven so understand? There are people who were sleeping four hours. And five hours and four and a half hours and five and a half hours that are included in that number. And when you do a finer grain analysis of the data. It looks like going below. Five makes a difference. But people who are six six and a half. If you just separate out them from everybody else, that's below six, not so much danger. Okay so I got quite exercised when I heard this. Injunction this. To make sure you're getting seven plus a night and started to get quite fixated on my sleep I got one of those or a rings that tells you how much you're sleeping. And that turned into a mess for me and we some quite passionate people loved the episode by and large, but we got a few really. gloriously negative reviews from people who said I've never had a sleep problem until I listened to this interview, and they went down the same rabbit hole. That I went down, which is. They got fixated on sleep and then started the second. Guess themselves Etcetera Etcetera, so any thoughts on the foregoing yet. You're singing my song so this is why I mean I mean I love my field? And Look I. Mean You know I understand the data that this person? Whoever they were said they looked at it out there. I can show it to you. But what I'm telling you is when you do this finer grain analysis. There are a number of papers that are now saying. WHOA WHOA, WHOA WHOA. And in some ways it doesn't matter. So let me say a few things about that so I will stick with this idea that under six is more the cut point, so give me six to nine. That even between five and six is. Maybe an issue. But not egregious and again it's about this way in which we do. This fine grin. You have to think about how the questions have been asked and the question sometimes have been asked and cut points have been made with regard to these on the our cut points, so what eventually some people did was to look at data below seven hours. When you start to look at between seven and eight, that's a slice and when you look at between eight nine. That's a slice when you look between seven and nine. That's a slice that smaller than below seven. Below seven is everything that's below seven. That's a much wider margin, and so I tell you there are people in that margin that they looked at who are sleeping five hours and four hours. and. Therefore they're being included and there swaying the numbers right so if you look under seven, yes, there's an indication that some of them are more prone to certain kinds of morbidity and mortality. We say, but that may be because that numbers overwhelmingly being swayed by the people who are getting much sleep than that. Going back to your comment, which I love. The other thing they're not doing when they do these studies. Is there never looking at the people I just talked about which is, they're just saying. How much sleep do you get and not? How do you feel okay? So suppose you took a cohort of people who are getting six hours a night. And felt great, and you found ten thousand of those people. That's not what they're doing. K.! They're just lumping everybody in so some people get six hours at night because they're not sleeping well and they could get more. They should get more. And some people are getting. You know being forced into that by work schedules. But, some people get six hours because that's what they need. And if you get six hours and feel great, and you get that every day if you try to sleep for seven or eight hours, you're going to get insomnia. You're going to expand your sleep. Opportunity beyond what your body can give you. You will occasionally sleep for seven or eight hours and put yourself into deficit so that you now no longer need as much sleep the next night and have a night of insomnia, and this is what starts to happen, and then people get freaked out and so I've been saying this for a long time. My brethren are well meaning. We should definitely takes. They're out. They're also saying we should take sleep much more seriously. Yes, we should be attentive to what our sleep needs are and fight like the Dickens to get that. Yes. But to start saying everybody needs between these numbers and you should get it. Is Absolutely makes business for me I. Get people with insomnia all the time who are coming and saying but so and so said. They said and I go again. Okay, let's debunk that. So. You're getting overly fixated on your sleep. Because somebody's told you that sleep is important. You're going to undermine the whole machine. If you're getting overly fixated on sleep for any reason, you're going to undermine the whole machine sleep. That's one of the big issues here and one of the advice pieces of advice I give to everybody, but also especially those people are having trouble sleeping. You cannot make yourself sleep. You cannot sleep. Is such an offer nommik automatic process? It is think of it like heart, rate, digestion, perspiration, respiration, and I. Say to my patients. You don't ever find yourself after last meal thinking. Let me see if I can digest a little bit faster here. Okay and they'll say oh. No, I never do that and say. Why don't you do that and let's say because I don't have any ability to do that now. Say exactly the same with sleep. If you get into bed and you start trying to make yourself sleep. You are done for. I ask these questions in my audiences I. Always ask for somebody when I'm usually training other therapists how to do this work and I always ask for somebody who has a good sleeper in the audience. And I asked them to raise their hand and I say okay. Forget any other behaviors you have in terms of reading in bed or not reading in bed, watching TV in bed whenever your habits are at some point most of us. Close the book. Do all of that stuff and put our heads down on the pillow? And I. Ask that person who's a good sleeper. Tell me what it is that you do at that point to get to sleep. And a hundred percent of the time I get either a shrug of the shoulders a quizzical. Look the answer I don't know. The answer. I'm not sure what your question is. because. That's exactly the right answer. Good sleepers do nothing. When you ask them what happened last night when you got into bed, they say I got into bed and then I don't remember. That's what it should feel like Dan when you start getting into bed and saying I. Don't know close. AM My getting there? Might not your way beyond already where you should be in terms of trying too hard. And of course everybody and their brother has a remedy. And when you start becoming fixated on your sleep, it is one of the worst. We called perpetuating factors that keeps insomnia chronic. Okay well, you just described my life. Sounds like I need to come. See somebody like you and so that actually is because we're going to start taking some questions from the audience and but. Before we do that. I want to give you a chance to say something that said to me before we started recording, which is. You'RE GONNA. Give General I sorry. My son is opening the door to this closet. Okay Hi Buddy. He has his pajamas on. That's awesome Alexander. I'm recording a podcast, so can you? Go Away. Okay, club be quietly. Okay. All of my meetings are like this. So he is five and has made a million appearances on this. During the pandemic, that's awesome. That's just awesome. Yes. He's coming in here to pet. Our cat okay so. Your point is you'll give general I. Hesitate to use this term but advice, but it is not the same as going in to see a doctor and having the doctor or the sleep. Expert diagnosed what your particular issues are. Right exactly, so let me go back again. How do we transition from acute insomnia? Chronic insomnia and we talk about we called perpetuating factors and those perpetuating factors by-in-large have to do with. The things we've talked about here today. I start to alter my sleep schedule as a way to compensate for my poor sleep, and therefore I throw myself further off. I will begin to work harder at something that I never had to work at before in my life, and by doing so exert more energy and tense up. which you can imagine is not conducive to a good night's sleep. and. This is one. We haven't mentioned yet, and it's a tip. I can give if you are in the middle of the night awake. And I don't care whether you're just thinking random thoughts or all the way up to worry. It's not a good idea to stay there. And the people who were staying. There are engaged in what I just talked about which is sleep effort for one thing right there? Holding onto that mattress for dear life. Hoping that sleep will come back. But the other thing they're doing night after night week after week month after month is associating their bed. With a place of worry and thinking and ruminating about stuff. So imagine that you can start to get sleepy while you're on your SOFA watching television and then go into bed and like Pavlov's dogs Boeing. You're wide awake because your bed is now a trigger for being awake. So my recommendation to people who are not sleeping well is that if they're awake, never be in bed when you're awake. Go somewhere else to something fun. Wait until you're sleepy again and try again and if it doesn't happen tonight, it doesn't happen tonight again in Psalm. Neha is normal. Don't panic and if you don't compensate if you don't stay in bed if you don't over, think don't. Work to hard at it. It's going to rectify itself as I said and usually within a few nights, so yeah, you might lose two or three nights, and then right the ship and you'll be fine. But people got to get it right away and they caused themselves more problems. And the other thing of course people do is they start to worry about this? Oh my God. I'm not getting enough sleep. What is this going to do to me? Imagine what that does to your sleep so going back to your question there number of different perpetuating factors and any given individual who's not sleeping well might be exhibiting some or all or others of those factors and what it requires to get well is A. A. Really Good assessment, a good evaluation of that process by somebody who knows what they're doing and then knows how to fix those things. Because fixing up right now I can tell somebody look. Don't stay in bed and you won't develop a problem once. You've done that for six years. You ought to see a professional to help you get beyond that because just getting out of bed for one night isn't GonNa do it. I want to prevent people from getting there. But if you're there, you should go seek professional help as I always say for other disorders. We understand that the doctor wants an x ray before they cast your leg. They want blood work before they give you a medication, and likewise here I'm not going to give anybody specific ideas about what to do. Other than what we've already talked about and what? I would advise, anybody who has tried a couple of these things. Things, and it's not working to do is go get it properly assessed by a professional who is a behavioral sleep medicine specialist like myself so just to put a fine point on this the tips or advice that you're on general guidelines that you're gonNA share in the course of this. You've already shared in the course of this interview. Our basic sleep hygiene that we should all be sort of endeavouring to operationalize in our lives, but if we're finding ourselves with. Chronic or sub chronic insomnia that's time to actually go get an individual assessment. Yeah, look, even sub chronic. If you do some of these things it might work. But, if you've gone beyond three months and more often than not by the time, somebody comes to see me, they've had their insomnia for three years and thirty years. So once you cross that three month mark. You tend not to get better without some targeted treatment. And I'm talking about non pharmacological treatment, not medication. The number one I should get this out there the. Largest medical organization in the country the American College of Physicians has now done a guideline paper on insomnia, and basically made the statement that the treatment of choice for insomnia. Disorder is cognitive behavioral therapy for insomnia, which is a non medication therapy for insomnia, which goes after all these things we've talked about. On that you know if it were possible. Unfortunately, there's not enough of me out there, but if it were possible that somebody oughta almost fail this before they go onto a medication. Because medications are great for short term insomnia, but they were never really intended for the long term problem. Is it safe to go see asleep doctor right now I mean I. I've been under the impression that in order to really. Get the most out of a sleep doctor sleep expert. Do you need a sleep study? But I don't really feel like going into a hospital in the era of Cova. Is it fine just to you know, do a series of concerts over a resume and Gecko in that way I'm so glad you asked that question first of all when I say I practiced Behavioral Sleep Medicine that encompasses a lot of different sleep. Disorders and insomnia is only one of those and beyond what I do. behaviorally there are medical sleep disorders and medical things that we do. The most common of those would be obstructive sleep. APNEA, and many of your listeners may know about that and the most common. The treatment of choice for that is C., PAP or continuous positive airway pressure. In order to get diagnosed with sleep, apnea appropriately appropriately, you have to have a sleep study as you have noted. And yes, often that entails going into a sleep lab and sleeping there, but more and more frequently. Even those labs are now doing home studies, and certainly in the era of covid. I'm sure they're almost entirely doing home studies and diagnosing you for those kinds of disorders. They're. Coming back to insomnia insomnia disordered. That does not unless you suspect other Occult Sleep Disorders does not require a sleep study whatsoever for the diagnosis. And so somebody like myself could diagnose you online like this and we are right now in an age when telehealth is flourishing and state laws are allowing people to do more telehealth rather than bringing people in the office, so for the particular type of work we're talking about with regard to treating insomnia with cognitive behavioral therapy for insomnia. It can be done exclusively online through telehealth. House that. I love it figuring this out is now number one on my to do list, yeah. More of my conversation with Don. posner right after this. Ten percent happier is supported by better help online counseling. We're an extraordinary times, and if you're struggling with stress, anxiety or depression, you're not alone. Better. Help offers online licensed professional counselors who are trained to listen and help simply fill out a questionnaire and get matched with a counselor in under forty eight hours join more than a million people taking charge of their mental health with better help, better help as an affordable option, and our listeners get ten percent off your first month with the Discount Code Happier. Get started today at better help. Dot Com slash happier. That's better H. E L P dot com slash appier. Before we dive into some of these questions that we got from listeners who called in and left us voicemails. Is there anything else any other points you want? A macro points micro points anything you want to say before we start getting into these specific issues. Yeah, this one that we haven't touched on which is one of the interesting things and look. There's no question that everything we've talked about I. Think is true and by the way there's people. People all over the world right now doing research studies and getting grants on covert and sleep and looking at all of those issues, so we don't have all the data right now, but we will eventually, but anecdotally no question. Some people are becoming more stressed and therefore at risk for acute insomnia, and at risk, therefore chronic insomnia, and some people may be altering their schedules in ways that are making them at risk for acute and chronic insomnia. That said one of the things that I'm definitely hearing within my field is that at least some subset of people are sleeping better now than they ever did. Interesting and I wanted to get that out there because I can only speculate as to why that is, but I think it has to do with things that we've been talking about but I did talk about this idea that we all have sort of a proper sleep number if you will asleep need. Having nothing to do with sleep number mattress. We all have a sleep number I'm gonNA use the number seven because I hate using number eight everybody somehow things. All of my patients come into me and they're locked into an eight hour timeframe. I'm going to use the number seven. Suppose you're a seven hour sleeper. The other thing that we all genetically have. Is a preferred sleep phase meaning winning the twenty four hour. Day am I able to get my seven hours. And we all have an intuitive sense of this. This is the effect that we have when we think about somebody as being a night owl or somebody being a morning person. So when I say that somebody needs seven hours. They can probably get seven. In a fair range of sleep, but it may be that they can get their best sleep between ten to five, and not between one to eight and somebody else is GonNa get their best seven hours between one to eight, and so on and so forth. What I think may be happening during covid for people who are working home. Is that if in fact, they are getting up with some structure in their lives, they're doing so but it a different set of phases than they did when they were forced to work. When you have to get up in the morning at five thirty in order to get showered and dressed and shaved or make opt, and then into the car and commute for an hour and then get to work on time. You, don't have to do any of that anymore. And now maybe you can afford to get up at seven o'clock instead of five o'clock or five thirty, and it may be the just that slight shift of an hour an hour and a half allowed you to sleep a little bit better because it's closer to your preferred face, it also may be that people are feeling better because they're not being shorted again. I'm not saying anybody can sleep any number of hours I'm saying if your sleep need seven, you should try to. To get seven and if you're getting six, you're gonNA feel a little shorted, and it may be that our work schedules for many people are forcing the burn the candle it ends, and not getting enough sleep. That's a message. My brethren have out there that they're right about. We should try to get what we need is the way I'd like to frame the message and cove. Maybe some people to get what they need in the proper phase, and so if you're finding yourself sleeping better I think that may be the reason. That's so interesting. I know I said when it gets the voicemails, but there's one other point I want to let you make. Because you kind of made a nod in this direction, but we're talking about the importance of wakeup time you then talked about exposure to daylight or sunlight and. I actually think and I know in your talk you expand on this. What does that look like? Should we be if we can getting outside first thing in the morning? Why is that important it? If we can't get outside, should be sitting by a window. Why is this emphasis for you? Again light is what entrench trains the Circadian Rhythm it is essential to that pacemaker in the brain. And so, the timing of that light is essential to keep us in trained into a twenty four hour schedule. A controlling when you're exposed to that light is a good idea which means two things. It means that when you get up in the. You should open up the curtains and get as much light exposure you can. If, you're not having a particular problem with sleep. Sure sitting by an open window is good enough. Try Not to sit in the basement. If you could it all help to do it if you have a very dark place. If you can get out for a little while. That's a good idea that will help to strengthen again. If you're already sleeping. Well, I'm not telling people boy. You better do this or else. But. If. You're not sleeping well. Definitely, you want to get light at the same time every day and try to get either by a window. Or get outside if you're not getting exposure to that light, and frankly the other thing that people should be doing. Is Controlling the light in their bedroom before that we don't Wanna get too much light exposure before are destined time to wake up or that can predispose you to waking up earlier or resetting circadian patterns in Waking You early so asleep mask is a good thing if you can afford it room, darkening shades and putting shades on tracks I, always like to say that the rest of the world has gotten the memo and we missed it. We seem to have missed it and a lot of things now with the rest of the world got this memo. Memo and the memo is we were born in caves, and we should have stayed there if you go to Latin, America they have what we call. They call Percy on. They have food metal sheets on tracks. Come down, and I feel fairly certain. You could survive a nuclear blast behind that thing, but for sure you're not getting any light exposure if you go to. Europe you're going to see the shutters that they close and you kind of have a slap that comes down and closed them off, and there's no light come in in the morning. We have window treatments. Blinds and drapes that let a lot of light in the morning relatively speaking. And so I always tell people. It's much better to keep your bedroom as close to really dark as possible that what I'd like is to be able to develop film in your bedroom in the morning before you wake up. Okay this has all been incredibly helpful, so let let's somebody other than me. Ask some questions here. We got a lot of questions along the same lines There was one really big theme that I. WanNa hit I. You've already. Hit It! It's going to require some repetition, but I think it's worth it because I. Think this is a big issue that a lot of people are dealing with which is the middle of the night up, so Samuel our producers just GonNa play. We got three messages along these lines. He's just going to play them for you. And then you can fourth okay. Thank you for taking these sleep questions. Mine deals with how to break the cycle of waking up in the middle of the night, and not being able to get back to sleep. If, there's anything that can be done to break. That cycle I would be interested to hear what the tips or suggestions might be. Thank you. What can I do with? My anxiety is waking up in the middle of the night. This is the question regarding sleep. It's Kathy calling from Palm Springs California. And no trouble getting to sleep on usually tired and sleepy before I'd like to be, but inevitably anywhere between. Oh two, thirty and four I wake up. And start ruminating and one time start ruminating. Forget it, and you know no matter what I do I can't pull my mind data that. Constant trying to figure out this thing or that thing or whatever anyway any any help on that would be appreciated. Thank you. Okay, so I suspect you're hearing a lot of this during the pandemic, yes. I've heard a lot of this for thirty years I. Mean You know you don't you don't require a pandemic to wake up in the middle of the night ruminating. So yes, I mean look a couple of things. Let's go back and reiterate some things I said one is that if you're having trouble sleeping in the middle of the night, the first thing to do is not lay there in bed and ruminate. If you're going to ruminate ruminate somewhere else at the very least, take it somewhere else, but a better idea for ruminating is do something fun. If you occupy your mind, it's less prone to rumination than. Than a know, an idle mind is the devil's playground as they say, and it's very hard to flip a switch on our minds, and just turn them off, and frankly the more we try to turn our minds off that sleep effort. We talked about the more we try to turn our minds off the more energy. We're expecting to do that, so it's A. It's a vicious. Do loop. We can't get out of that as people are noticing. So, give that up. Get out of bed and do something fun and wait for sleepiness to return if this has been a long term problem though my sense is that alone. Is Not GonNa do the trick that there's other issues going on here with regard to why somebody's awake in the middle of the night and they really ought to get it properly assessed. And I know I gave. You blinks to that people can kind of find somebody to help them with this. Another thing that I wanted to say is. We have now talked a lot about how people get this message when they're looking for problems when they're looking for answers to their sleep problems. Where they start to hear, they need to sleep a certain number of hours. One of the things that can wake you up in the middle of the night is being in bed for too many hours. If your six hours sleeper seven hour sleeper and you start being in bed for eight hours because somebody on a podcast told you. You need to be in bed for eight hours. You're going to open a hole somewhere. And eventually refi that, and so you're just going to open this hole in the middle of the night. It might be that you're getting the proper amount of sleep, but you're just got a hole in the middle of the night. Because you don't need all that sleep, but I can't say to any particular person who just asked us a question whether that's their particular problem. I can just say that these are ways in which those holes can open. Open Up. The holes will also open up. Remember as we get older. There's lots of things that cause us to wake up in the middle of the night. first of all waking in the middle of the night is not unusual. The average sleeper Wakes fifteen twenty times a night. If we were studied them in the lab, it's just that they're each of those. Buildings are so short that you're not. You're mastic for them. You don't remember them. As, we get older. We start to remember a couple of those awakenings because they get a little bit longer, maybe once or twice or even three times a night. And if you can roll over and go right back to sleep, that's really not of concern. That waking up as we get older, I can't make it through the night now without waking up and needing to use the restroom. It's not happening, so the question is not did I wake. The question is can I re initiate sleep? I'm and that's what people with chronic insomnia problem need learn to do and again. There's many things that they need to do to do that. But many people will hesitate to go get the kind of help I'm talking about. Because? They will attribute the reason they're awake in the middle of the night is to some medical problem. Is it true that hot flash from menopause will wake you in the middle of the night? Yes, is it true that a full bladder or a urinary retention? Problem will wake you in the middle of the night? Yes, is it true that a AH prostate problem will wake you in the middle of the night? Yes, is it true the chronic pain will wake you in the middle of the night? Yes. But most people who have those problems will tell you whether they're avoiding in the bathroom and then coming back to bed there now done their blotters, not keeping them awake for forty minutes at that point or an hour. Something else is, and they can get help with that. So you have a hot flash if it doesn't last all night long, and you get cooler, but then you still can't go back to sleep. That's something else, and you can get help with that, and it may be the difference between waking three times a night for twenty minutes total or waking three nights three times a night for ninety minutes total. and. That's the way to think about that one last thing about waking in the middle of the night or early morning. The thing we haven't touched on at all. Is what I'd call general sleep hygiene. This is the kind of stuff where people are told. Oh drink less caffeine. What I do about exercise. What should I do about alcohol? Perhaps, the biggest one on that list is alcohol. Alcohol's an interesting substance because it will. I cause you to be more drowsy and sleepy. And in some ways therefore might help you to get to sleep. But it is abysmal. Sleep aid because it lasts very. And wears off in the middle of the night and can produce fragmentation and cause you to wake. I'm not talking about substance abuse issues now I'm not talking about alcoholism or any of that. For some people and I don't know who they are for some people just having a glass of wine or Beverage near bedtime might make you both first of all sleeper than you WANNA. Be before bedtime, so you're falling asleep inadvertently on the couch earlier than you should. which will wake you up in the middle of the night and the alcohol wearing off itself in the middle of the night will wake you up in the middle of the night. And so, if anybody out, there has a doctor that says Oh. Maybe a glass of wine before bed would be a good idea. Don't listen to that. It's really a bad idea to use alcohol to help you to sleep right now. And I now said do any of the people that called in. Is it alcohol? It's causing their problem almost certainly not, but it's a good jumping off point for worth talking about that issue. Let me. Ask a question on this waking up in the middle of night. Thing this plays off the very first thing you said which is if it's going on for a while, you get out of bed. Do something fun. One thing that might be fun for some people that I would imagine you would say we shouldn't do is play video games on your phone or do anything on your phone. Then you're bombarding yourself with the kind of blue light that might make it harder to fall back to sleep. Is that correct so yes, and no I mean remember yeah, we don't want to get a lot of light exposure in the middle of the night, but please for those of you out there who are taking this to heart? Put Out Night Lights and things like that. Don't bump into walls. Don't fall and. And break your hip. Don't do any of those things. It's okay to get low level light. It's okay to watch television if you're watching television. That's all about the light you need right. If you're reading a book, You WanNa Book Clip Light, or you want you know a source of light from behind you to the book. That's fine, so then we come to devices like ipads and phones and things like that and what I will say there is you touched on the idea that it's not light per se, but the spectrum of Blue Light. That has the most effect on the Circadian Rhythm. and. Most of us now, almost all of our devices have a blue light filter so download the blue light filter. You can set it to say I want no blue light between ten PM and eight am and your screen will take on a little bit more of an Orange Tint. And that should do better. There are blue light filters that you can download off the Internet if you don't have it built into your machine. So that would make it better. It depends on the person. There are people who have what I would call real. Circadian Rhythm Disorders. That's different from insomnia. You can have people who have significant circadian. Rhythm disorders which is beyond scope of of today's talk. For those people, they need to be much more careful insensitive about light, and I would be advising those folks to stay away from hand held devices with light sources close to the eye, but for the average person who is does not have a significant circadian rhythm disorder. They can probably get away with it up, but if they're concerned again. Yeah, do something fun, but do it at a distance from your eyes. Do the television you know. Plug the computer with some device into your monitor screen, so you can sit farther away from it and download a blue light filter, and you should be fine. Great so the next batch of questions actually two in this category that we're gonNA play for you, but I think this is quite a common question. It has to do with sleep AIDS. My question is ready to sleep nothing pills, but not addictive asleep things that gets old. which I used in the early days of the pandemics, pretty religiously antihistamines really and equal and I didn't know how safe those actually were I'm not using them as often now because I'm. Gyms are back open. I'm able to exercise and that kind of tires me out and helps them sleep better but I still do use them on occasion and I know they're. They're supposed to be not addictive, but I suspect using them kind of as a crutch I did for a while was less than healthy, and I just wanted to know what your expert had to say about these not addictive sleep solutions. Thank you. Hello. This is Aaron calling from Portland. Oregon I have a question for the sleep expert. I'm wondering what their thoughts are on using marijuana to help you sleep especially if you're in the position of trying to avoid taking pharmaceutical drugs to try and help you sleep. Thank you very much? I love that the we'd question came from Portland. That's just amazing lowest. Isn't it person much and it's it's the. Is it all right for me to take drugs to avoid taking pharmaceutical drugs? Question. Okay, so there's the We'd question. And then the antihistamine or with that caller was calling sort of non addictive sleep. AIDS, so take it in whatever order you would like. Yell. I'll start with the order. You're headed. Let's start with antihistamines and over the counter sleep AIDS. Most of them are antihistamine medications which have as a side effect. Drowsiness not necessarily sleep. Mom and there's no good data. Although there's not a lot of data whatsoever I mean. They haven't been studied. Is the basic answer, but what little there has been done, suggest that they are not as a class of medications all that useful or helpful. That doesn't mean that any individual might derive benefit from taking an over the counter sleep aid. But, again I would argue that all sleep AIDS are designed to be for short term problems. And especially if you can define the problem, so as I said a night or two of bad sleep. Is Not anything to think about, but you might think well. Yeah, but I always get my night or to a bad sleep before I have a big test. I always have a a night or two a bad sleep before the big papers whatever it is, there's a place for medications for sleep. Whatever we're talking about. I would prefer if you're GONNA. Use Medications for they do use prescription medications. They were designed for this. And that you have a cutoff point you saying. Yeah I will use this for the next two nights. I will use this when I go to Europe a jet lagged and I want to get myself to sleep at the proper time. For a few days, and then I'm done, but when you have a chronic insomnia, the idea of having to use those things for years and years and years is really not what was intended, and ultimately can provoke more problems than otherwise now over the counter medications is not my big would not be by big thrust. Again if somebody's having severe problem, even right now, really anxious, really troubled, and they need just need to get some sleep for a few days off again under an advisor or a physician's guidance may be taking some medication under those circumstances to get themselves back on track would be a good idea, but that's in the acute phase. In the chronic phase when you take those medications, they can work. They can work very well, but they don't tend to fix those underlying perpetuating factors that I've now talked about so much today, and so the problem is when you try to come off those medications. Those problems are still there. The worries are still there. The conditioning is still there and so the insomnia comes back. Which is why we say look the better way to do this is. To start the right way and knock it on medications for chronic insomnia for short term insomnia. They were made for this. Also there's this sense of dependency. There are certain classes of medications that are physiological Lee habit forming. And certainly some of them are sleep medications. But understand I had said to you that there's a system of for our sleep which I call sleep regulation between sleep, drive and Circadian Rhythm. And that will, if you let it not compensate for poor, sleep will regulate your sleep and get you back on track eventually, and we've done some research and there is a bit of a rhythm of insomnia. And the rhythm of insomnia goes something like this. Nobody has insomnia every night. Almost no INSOMNIAC will ever say to you seven nights a week. That's why we defined it as three or more nights a week. But the rhythm of insomnia is bad, bad, bad, good, bad, bad, bad, good, bad, bad, bad good, which means after every third or fourth night. You're bound pop off a reasonable night of Sleep K. It's just going to happen now. It won't stay that way if you're doing everything wrong. Which is why I don't want people to develop chronic insomnia. But if you're just in an acute phase and you just wait it out, you're bound to have a good night eventually now if you start taking things. On an intermittent basis like I wanna take medication but I. don't WanNa. Get addicted, so I'm GONNA. Take it every three or four nights. You can see what happens. It's much more easy at that point to become. At least psychologically dependent on those medications, and it may be that they didn't do much for you to begin with a lot of my patients. Come back to me. I'll say well did that over the counter medication work? Did that thing that you tried work? Did the doing whatever you do in bed work and what I will hear inevitably is well. Yeah, sometimes. and. I can say that about everything you know what works for Insomnia sometimes everything. Including Magic Pajamas. Okay, if on your third or fourth night you wear the magic pajamas. You're GonNa Sleep, you know. Why not because of the magic pajamas so do you understand what I'm saying? I do understand and I want to get to the weed for a second, but let me just ask a question about sleep medications the sleep expert. That we had on previously strenuously argued that there is a big difference between sleep and sedation so that if you're using something like a benzodiazepine or and some of these. Are In that family. I understand it so like what's the famous one? Ambien Ambien is a Oh, I believe it is not oh. I thought it was related to valium, or in all know the newer class of medications like Zolt them, which is Ambien? Sonata Lou Nesta. Those medications are what we call benzodiazepine receptor agonists. And they are much more specifically targeted to sleep and non sedation, and they are while again. Anybody can develop a dependency on these medications psychologically. Imagine you take it every night. And it works for you, and then you stopped taking it tonight. What do you think's going to happen? You're going to get into bed and start thinking Oh my god I wonder if we're going to be able to sleep without X. Y. and Z.. What do you think that does to your sleep? So basically anything can do that, but those newer class of medications are not benzodiazepines. Hasten to say that I would definitely agree with the idea though that there's a difference between sedation and sleep. And so again I'm not I. Don't know whether he was advocating medications for sleep. I do I was not. Not a long term solution I don't think they're a good long term solution and I think people should work to get off of them. Where are you on, we'd. You got some. Where my on we'd we know about marijuana. Is that it works a lot like Ambien. Okay that is, it will in the initial phases. It will work to put you to sleep a little faster. It may wake you more in the middle of the night but I, but if you wake, you'll get back to sleep faster and so like ambient. It will do both of those things. But there is a tendency a possibility like with ambient in any of those medications to become more tolerant to the medication, which means that over time it's having less effect. If that happens, you then may find that it's taking longer to get to sleep in your longer awake in the middle of the night if you use weed for. A long time and then decide I don't want to do this anymore. You again might have some significant problem trying to get to sleep and get back to sleep now. I'm not saying at that point that cannot be fixed just like everybody. Else's INSOMNIAC just talked about. It can be fixed. If you're using marijuana again, I would think of it like any other sleeping pill. I wouldn't use it for long term. Fix. I would use it if you wanted for short term fix now. The other thing to Kinda hasten is some people are using it for other things. We need to remember that some people are in various kinds of medications. That might not be great for their sleep, but they needed for other reasons. Then, that is a struggle to then get to a person like me to say. How can we make you the best sleeper you need to be on marijuana because you're using it for Glaucoma or on marijuana, because you're using it for pain or on marijuana, because you're using it for cancer and we do that all the time, so what? I don't want people to run away from here is saying that's it I better stop. Now that I'm using for other things, but as a soul sleep aid I would think of it like any of the other sleeping pills. It's wouldn't be my first choice for long term management of insomnia. Okay so. I think we have time for one more little set of questions here. These both have to do with something that the psychology that I see at play in my own mind about bed times. This is easy from Connecticut and my question is about. TO STAY UP SUPER LATE SO in my normalize I'm a night owl, and I bake myself. Go to bed around eleven, but now that I have no reason to like. Get up early anymore I. Find Myself being up till about two sometimes to thirty, and even then I don't even want to fall asleep just wide awake. So how can I bring it back to eleven? How can I get sleepy again? How should I retrain my body to not wanNA party all night. Thanks bye. From the subject of sleep one thing that I struggle with not so much with the of falling asleep or staying asleep, but I find myself every night whether it'd be doomed scrolling on twitter or watching TV too late at night I kinda just. Want to keep it going and just won't allow myself to go to sleep at a reasonable hour. Even though I always wake up in the morning, feeling very exhausted, and not well rested and Boeing, that I should go to sleep earlier and have a more calm nighttime routine. I forget that by the time night comes around and I just WANNA watch Netflix. And throw on twitter so wondering if you or the experts have any advice on how to. Kind of switch that knowledge to wisdom, and just because I know that asleep would have a big impact on my life. Thanks again. Yeah these are people, S- Ten o'clock at night and my wife are like. What should we watch another episode of whatever show watching and you know it's like rebellion time. So, what do you say? Yeah, that's another thing that you should keep in mind. Is that I I said marriage is a time wins insomnia starts because people have different preferred sleep phases. You know the people of the same sleep phase tend not to marry other, and so there's always this argument over you know. I WANNA go to bed earlier and I want to go to bed later. And somebody's GONNA lose that argument, and that can precipitate insomnia going back to the caller. General question here so I. Want to address it in a general way again. Not necessarily her problem, but there's a whole class people what we're talking about. Here is preferred phase. She used the term night owl. Lot of people are night owls, and all that saying is my preferred internal phase, the best time for me to get my good sleep number is later than the average bear. There's a whole class of people that tend to fall in that category. There are always exceptions, but tend to fall in that category and we call them teenagers. All of us go from childhood into adolescence, and into young adulthood and children sleep long. They need more hours than down. Adults and they sleep early an eight year old. A seven year old is tending to wake at five or six in the morning, and waking their parents to their utter consternation. And then like. My son turned into an adolescent, and it took dynamite to wake him up in the morning. Okay, that's a natural change in preferred face. Your sleep number doesn't change that much once you get to adulthood, but you preferred phase changes a lot during the course of the lifespan and in younger age, the tendency is for what we call a delayed sleep phase for later, and that has nothing to do with all the activities that kids are doing if they had none of those if they were living in a mennonite colony and they haul, we're living a highest life with no parties and no late night. You know keggers and any of that stuff. They would still want to go to bed later. It's just a natural shift that takes place genetically. I already mentioned to you that some people are sleeping better because they are being allowed to sleep in their natural phase and I think that's nowhere going to be more true than with our teenagers and young adults that they are going to be finding that. They're going to bed later, and they're sleeping in later because they can and because they're doing it. They're getting more sleep. We are doing a terrible disservice to our teenagers by making them get up earlier than the young kids to go to school. Crazy okay, absolutely crazy. For the human animal. So with regard to the question that I get a lot, which is well, should I allow my person to do that should allow my team to do that. Again if they're sleeping well and waking up in the morning, and they feel like they're doing great. The answer is I. Don't see why not. It's more their preferred phase, and if they right now have an opportunity to get that, they're going to function better and more efficiently in the hours that they have awake when they do that. What we still want to stay away from in that class is irregular hours. I still don't want that teen getting up some days at nine Sundays at ten Sundays at eleven Sundays at twelve and. And so forth if their natural phase is like from two in the morning to nine in the morning or ten in the morning, then do that five days a week now. The question was also about transitioning back. The question is how soon do have to transition back as you start approaching a time when you're going to have to get up earlier in the morning again. Yeah, you may WANNA start transitioning. How do I learn to fall asleep earlier? Was the question again I. Go back to you. Set that with wake time. If You keep getting up at ten o'clock. You're not going to be ready to fall asleep at eleven, but if you start getting up earlier and earlier and earlier, you'll start to become more and more prone to be ready to sleep at eleven unless again. You're so delayed. Your clock is so off kilter that that becomes a problem and all of that can be fixed with a with a specialist. Speaking of specialists. You referenced this earlier, but it bears repeating. You have links that you provided to us that we will put in show notes yet. That will allow people to find specialists. Should they need one right? So one of them is a site that epic, sleep, education site that sponsored by the American Academy of Sleep. Medicine and it has a little bar in there where you can put in your zip code and it will give your. Your nearest accredited sleep centers, but that's four other kinds of sleep problems if things are going strange and bump in the night like you're, you're sleepwalking and you've got night terrors, and you got you think you have sleep, apnea or other kinds of problems like that. That's what you really want to sleep center for. If there's nobody else close to you asleep, center might also be able to direct you to a behavioral sleep. Medicine specialists like myself. Myself But, if you have insomnia and you WanNa get I to a behavioral sleep, medicine specialist. The side I would go to is the other one which is the Society of Behavioral Sleep Medicine and when you go there, there's a place that says provider search, and it will give you a map of the United States, and you can click on your state. They'll give you a listing of all the providers in your state that either do this. This, regularly are frankly certified or have diplomatic status to do this kind of work done. This has been a real pleasure. Really I love salty guy from the Bronx. It's been really fun. We didn't get to your other question. Guy Didn't know if you wanted to go back to that one, but we don't have to doom scrolling on twitter and the net. Flix Yeah I actually the answer is I'm a little bit more flip about that? Guy was basically saying I know I should be going to bed earlier but I don't into which I had. The answer is that you know there's an old joke that says a guy goes into the doctrine, says doctor. It hurts when I go like this and the answer is. Don't do that anymore. You know more seriously. There are some people with various kinds of problems like attention, deficit, disorders and obsessive compulsive disorders that really do struggle in a way that it makes it difficult for them to just to do it. Again I'd say they need to get professional. Help and get that assessed if it's not that. than a simple trick, you can try if you Kinda blow pass the time you wanted to go to bed is. Set an alarm on your phone. And have it go off at the time you want to get ready for bed and then do so and see if that works, but the same advice you gave to the female caller of. Setting alarm in the morning and you'll be paying the price for that twitter. Late night dooms growing on twitter. That might strongly disincentivize you from doing it the next night. Absolutely, that's absolutely right so I must have done a good job here because I taught you the stuff. You definitely did a good job here. I'll tell you some bad advice. When I was a little kid, I would go to my father who was a Jokester, and I'd say Daddy. I can't fall asleep and he would say. Bend over and run as fast as you can into the wall. Yeah. Yeah I know those treatments listen I've seen it all. Magic Pajamas yes, well. I'm going to buy an investment, some magic pajamas just remember they work sometimes. Don Thank you again? Really appreciate it. Yeah, my pleasure. Thanks for having me. This was a blast. Big Thanks Don. I really enjoyed that. Also want to thank the folks who worked so hard to make the show. A reality Samuel John's is our senior producer Marissa's Schneiderman is our producer. Our sound designers are met blatant, and on your Shoshee of Ultraviolet Audio Maria were tells our production coordinator. We get a ton of wisdom and input and Guidance and oversight from. Ph colleagues such as jen point nate toby. Been Ruben Liz Levin also big. Thank you to Ryan. Kesler and Josh Cohen from ABC News. We'll see on Wednesday for the sex episode. Don't want to miss that one. Streaming July thirty first exclusively on Disney plus can follow the journey of a young prince in search of himself, Gruber trail, love and self identity with black is king, the new visual album from beyond say with music from the Lion King. The gift is a celebrate Ori Memoir. That reimagined the lessons of the Lion King for today. Lack is king streaming, Jalal Thirty, I only on Disney plus.

chronic insomnia insomnia Dan Harris Behavioral Sleep Medicine founder and president Adjunct Clinical Associate Pro Don. posner Don psychological stress ABC US Disorders Stanford University School of partner Los Angeles American College of Physicians
Discharge  the gooey taboo

Ladies, We Need To Talk

22:51 min | 1 year ago

Discharge the gooey taboo

"Hey ladies as a warning, this episode contains adult material, and we talk about discharge a bit like the episode is cold, discharge cert- get amongst. All right. I K. My husband and I were talking about NAS debate unloving already. Okay. Sorry. My husband and I were talking about masturbation and during key accused me of being a chronic masturbaters. What where did you get this idea from, like spying buying me? So I asked him where he is idea until he's head and immediately through his across the room point, the duty, washing basket and was like go, and look at the crush of your onto it going look at the crutches of all of your underwear they're all just like smelted in what he could as lady ges. That's not lady ges, that's just. Agile discharge let's face it. A lot of people think discharge is Iki. It doesn't always smell nice. And it is secreted from your vagina. But, you know, the policies, the more uncomfortable, ease the mole, we need to talk about it. Women spend lots of money trying to deal with discharge pharmacy, shelves are stocked with intimate washes feminine wives and it's estimated that between twenty to thirty percent of women throughout much of the western world use panty liners every single day. That is a big mental loan again. Your underpin. I'm Stein's ladies, we need to talk about vegetal discharge. Absolutely nothing. This is Shannon, and as you might have gathered her husband had a huge gap ease knowledge about how vaginas work, and she kind of did to. She says vaginal discharge didn't come up her six classes, Ivanka. And when she was growing up. No one was talking about it. I always kind of grew up. I thought like I just had fresh. I just figured it was that no one told me that like discharge was just a normal everyday thing that women have. Ah did actually out of high school when I was eighteen I did actually get Thrush. That was a real funny experience because I'm like holy shit. Like this is actually what it is what I've experienced for all of my childhood, I guess that's normal. Then you thought you'd had Thrush that entire time until you really got Thrush ES. Never talked to anyone talks about these things. Agreed, I know it because before this episode I reckon, I'd had a total of ten minutes of discharged by entire life. It's a shame because this is fascinating. Doctors recommend secrete almost one teaspoon of the stuff every day, and it can be pretty fluid. Get it, it fluctuates throughout the month depending on where you're at in your cycle. But how much do any of us know about discharge because it's true. We rarely do discuss it actually I just met up with a friend yesterday. I told her about the story and she is. Oh, like the stuffing your undies unlike. Yeah. Talked about that to anyone before she goes, nor like never even consciously thought about it. I said, there's a name for fashionable. This charge my best friend calls, it goo goo get good Brit, discharge is a basic bodily function, that not only cleans the vagina, it provides you with lubrication, and it actually helps to protect you from S T is Dr Deborah Bateson is a clinical associate professor at the university of Sydney, and she's medical director of family planning, New South Wales. Shea spent a big pot of her professional life fuelling questions about discharge. So John discharges is mixture. It's, it's. Fluid from the Jonah walls, and I'm not in combination with Nukus from the cervix, as well as healthy bacteria. So the collect overseer and they produce something called lactic acid. So the Jonah's actually that discharges, slightly, the environment slightly acidic is a healthy ecosystem, healthy, micro buyer as we call it. But that's what the discharges made up over and normal amount of John discharges, produced every twenty four hours is somewhere between one and four milliliters, so that's a little less at the top. Endless a little less than a teaspoon. We're not seeing that, that, all at once go some of that discharge is going to appear on Arend whereas normal part of life. Did you hear that discharge is normal part of life? A got it. Good guy. Good. So Deborah says that you start getting discharged around puberty and it happens because we start getting more estrogen, which causes more bacteria. To colonize, your vagina, just what we need. More Cohen is I see many women in my in my clinical life in a so anxious about this. They haven't really gotten benchmarks to work out. What's normal? What's not? But it's very normal to have this John discharge keeps allows us to have comfortable sex instance, in allows us to walk around comfortably actually, will, we know after menopause, that amount of, of lubrication decreases and that can be incredibly painful for women. They walk around feeling very uncomfortable because of that sort of lack of lubrication. Yes. Yes. So I never knew that really interesting just generally walking around just for walk at not I'm not everyone is grow Dacians of everything. But sometimes we going to women after menopause. And, you know, I see some women sometimes who have early menopause, for a variety of reasons. They can have very, very difficult times with what we sometimes call vaginal atrophy. I hate that word but is John l- dryness? It's really and so we need to give good advice around lubrication to additional lubrication. But, you know, we know that for for young women, the body is doing its bitten, and very staff thing, sometimes the way where the body's doing its natural thing. All these good is healthy, but women can feel very anxious about that for Roddy reasons. I've noticed the discharge changes during the menstrual cycle. Can you explain what goes on with it? Yeah. So the discharge does change because of the influence of start the vaginal discharge starts offers dry sticky, and then as we approach ovulation, so there's an increase in eastern and the discharge changes consistency. It becomes a little bit like an egg white as we always describe it becomes stretchy and slippery. And then after the ex-pm released we passed the fertile phase, then you get a decrease in the eastern increase in progesterone, and the mucus changes again, becomes thick and sticky. So again, what that's doing is actually optimizing. The ability for sperm to actually swim through the mucus. The fertile time. That's really interesting. Never thought about it or heard it described in that way. So that sperm can swim through it. It's right. Wow. Wow. Amazing amazing. That's cool. I that's that's what changes around relation time, of course at totally makes sense. Tell me about Cornick Thrush and recurring bacterial. Badgen ISIS, those can cause a lot of discharge what's going on that happened. A lot of women have come across Thrush in their lifetime. But we know that sometimes it can be hard to work at is this normal naught how it presents. It's like a sort of cottage, cheesy type of discharging, it's usually associated with niche inflammation, so that can be redness, real soreness, sometimes on intercourse, but sometimes just daily life and it's caused by overgrowth, we've all got a little bit usually little bit of yeast hanging around, but it's caused by the overgrowth of the yeast, and it's often caused actually by wearing hot sweaty clothing. We know that wearing tight, Jim clothing, for instance, can create a hot moist environment. So there's not enough air circulating non enough breathing off until the young young women that I. I see L say who sometimes we'll have recurrent, recurrent traditional safe. Tell me a couple of things you wearing underwear. Not. And they'll say, of course, I'm wearing underwear night. Don't we all say, really that is not a good idea? Because, you know, allowing that whole area to brave and to circulate and keep things light an area and decrease the risk of Thrush and also Oscar, you wearing panty liners. And we know that many women were penalized and some every day. And again, that can actually create a perfect environment for Thrush to thrive in was that keeping things dark and hot and overly moist can mean Thrush will grow in those sorts of environments, so Pantalone those very thin pads that you wear on the inside of nNcholas, and that they actually helped create Thrush if hand I can. So this really what we really, really compaign against his actually against this daily wearing penguins, often the vicious circle because women will actually notice they've got discharged over very anxious about it. Very why. Are you about it? And they'll start to use panty liners and sometimes creep to up to wearing them every day. And that can actually have the paradoxical effect of actually increasing the chance of Thrush. Also, Tyrian veggie noses as well. So what's the difference between Bitel veggie very distinct so bacterial Genova, it looks different sort of tends to be a greyish greenish, more frothy sort of discharge and this generally doesn't cause an H, and sometimes we do say, look at ease a little bit like a sort of fishy type of odor? And I certainly see women who sometimes can even be in a housebound. They can have great anxiety going on public transport often. It's been just from throw line from a sexual partner for instance, who said, oh, what's that? What's that odor? And it's been incredibly challenging often it's taken years for them to actually come up. Come and see me. Wow, that's so full on about people getting housebound by they're in fear of their bodies. They're reluctant to inflict the smell on someone else. It's a shocking thing isn't this and it really is. You know fed by well what I'll call. Inverted commas, the feminine hygiene industry, there should be no such thing as an industry associated with feminine hygiene. But it's you know, the for profit really shifting the gnomes about, you know what? What normal whereas? And so, in fact, you know, many women will feel very anxious about something that's very normal, and feel that in fact, you know, we should all be smelling of rose petals or awesome vanilla pods or something. Some of the different smells. I guess there's that classic fishy, smell yoga's before your period, yet that sort of Omni bloody sort of snow coming through sort of wells that sometimes it didn't smell like anything. This is Amy. She's into thirties, and she's being anxious about her discharge since she hit puberty, but she's never felt able to talk about it not even to her. Doctor says of conscious about discharge for also to reasons of Italy smells, consistency though were changes so minute a watery the next, it's cluggy stuff meek, ac- stuff, I guess, any never know what's normal. And, you know, you could go to the doctor, I guess, an us, but we've one day you've got nothing in the next day of something else dot e can't really go. The doctor say on this day it was that was that going through puberty Sundays, I'd have liked very Sobe undies during. On that. I wasn't on my period, thinking what's wrong with me? What what's going on with these is normal that sort of thing, or you get, like a new Kosice sort of showers, thinking, lock wise, this, not in my undies and being voice of conscious about that. I think that's what it all started when I started to get sexually active, of course, is starting to show those parts body to somebody else who also had probably doesn't have a great understanding of what's normal, like many women when Amy started having oral fix it made her feel even more self conscious about her discharge, you didn't know what was discharge or normal shot. And what was saliva say being a soggy huddle on the bed, and instead of enjoying what he was doing to me. I would be worried about is whatever's coming Adamy, normal thinking that the saliva was what's coming out of me. When really it was probably just a mix. So I was I was not able to enjoy him going down. On me, and I'm still not able to enjoy him going down on me 'cause I just don't know what he's gonna find down there. I don't know if it's pleasant unpleasant. Normal, not normal is still brings me a lot of anxiety. I would love to be with, that this sort of hang up. I guess so I could enjoy someone going down there, or even sometimes getting undressed, and having them CB in my underwear luck, I'm differently six in the docks sort of person 'cause I don't want to say my underwear, which is could have anything in there. You know what getting it on? And we're getting in the mood and will be in bed. And then I think, oh my God. Do I have not the John in my underway? That is not sexy. And alongside navigating things -iety. Amy also noticed a change in the way her underwear looked just after I had my daughter, which is straight years ago, now even during the pregnancy, I discovered a whole new thing that freaked me right out, and that was that my discharge was bleaching underway at first, I thought maybe I was maybe bleeding a little bit. And even after I watched them, I had these orange Blake side lock when you brush up against some late in the shower with your black close. This was happening to my underway, and that book back all the self-consciousness all the things out had a didn't us by doctor about it 'cause I thought I think I was not. I asked my mom about it and share on, I was not. So it got to the point, where again I was high. Hiding my underway for my partner. Having six in the doctors. In case it's been on for years until it was Elliott. We put this question about where the discharge can actually bleach, your underwear to Dr Deborah Bateson aware of Asia, obviously best explanation. Is that it's a mix of slightly acidic discharge and swit- that's the most likely effect. So it's that combination and you know, that ph is we call it the acidity of the discharge will vary. So and sometimes the discharge becomes alkaline, and that's normal. But these all of these things can have an effect. Well, there you go. You learn something new, every single time you bail up vaginal discharge group. I, I notice it's about ten years ago. Amy wasn't the only one with peroxide pants. This is Wendy, she's forty six and her discharge was never a big deal until she got older. I didn't think much at first, but then after longtime, it's still there hasn't changed by is to always buy dot colored undies, but I found that they bleached the worst. So now I usually buy skin colored undies much this toll event, notice, the bleaching as much it just continued, so probably more worried about this smell than the ching windy was also too embarrassed to speak to her. Doctor about it. I never told my Jay, but I did make tour friend wants a post girlfriend, and she just said back at being shock with no words, and that's. When I thought, oh, maybe a shared experience. I've never really brought it off. Debra says she says plenty of women who are ashamed of the discharge a lot of my job is, is talking to women. Examining women just helping them work out. What's normal for them, and it's normal to have a bit of an odor associated with that? So it's getting to know your body can come along and talk to someone. But it is and see someone just to check in, because we don't talk about it enough at school, and we don't share experiences, so it can be very challenging, basically normal healthy discharge it. So it's a slightly yellowish color. The odor is just a gentle, vaginal odor. But that conveyor between women as well. The difference is often to do with the, the sweat bearing plans on the Volver infecting the hair bearing areas of the genitals, so, and that, that can sometimes be associated with an increased ODA. So it's important to kick the outside skin clean, but it's just a yellowish discharge and it was going to change during the month. But if you do notice an increase. Greece in odor, an increase in the amount. So it's noticing any changes. And sometimes it is well, then, do go along and see your doctor. Where we told listeners that we were going to do an episode about this charge and put a call that you wanna ask questions and the feedback we got was pretty overwhelming that women embarrassed about the way they've adjoins smell, and they're super hung up about it. I think this view, as you say that we should smell great all the time and not have any kind of animal odor about us at all. Is there a line that you can cross, like, okay if you go any further beyond this line of douching and washing and so being in perfume ING, you're gonna make you soci-? Yes, we're look, we would say no to any dish after say, so luckily Austrailia, we're not big Douches. So they're certainly in the states, many other countries and that means spraying. It's usually a mixture of, of vinegar, and water with a spray into the into the vagina in actually in. Luckily, most of us, don't do that. But some some people do we know that, that is, does disrupt the John microbiome that that ecosystem and it can lead actually, even to, to more serious infections up in the uterus as well. So we really don't need to do that. But anything that we put in the Jonah and somebo things we want to be there. Of course, the putting things menstrual blood will change. Have a temporary effect on the vaginal microbiome having intercourse but of when those that gets disrupted, and that's those, those centered things. So the feminine deodorizers you know, really no one should be DD to use a feminine deodorizer and as I say can build up a vicious cycle, where in fact, it can have paradoxically the opposite effect, and that she create troublesome discharging sometimes potentially also decrease the body's resistant to, to sexually transmitted infections, for instance. So we're both fully clothed. Would you ever be able to smell something coming from a woman sitting as close as I not, not? No. And I think obviously, if someone does have a condition such as severe bacterial veg notice look NAMA trained. China doctor is my is my work, but, you know, women are talk to women about the executives about sitting on the bus, and often, we know I'm sitting next to them. No explaining their describing, you know, the, the smell and I always come in, when you've got it coming when you got it, and they'll come in. And of course, there's nothing for me to, to notice is different in, in all its overwhelming majority of cases. And we know that it's just about women. Their body is controlling them and they need to take back control of their body him and, and feel empowered and often it is just a matter of coming having that discussion. I feel I now this is a question I should be asking my mom when I was five. How do you clean your vagina because I eat? So I have a years, is that okay? So it's a really common question botany to say we need to think about Jonah, and then we need to think about Volver. So it's really important to clean the over that's the outside bit and using soap, but generally using unperformed soap that's not going to cause retations important, but we don't need to be putting any soap inside the Jonah. We need to steer clear of that nothing inside because of Joyner and she cleans itself, they have Maris, so ladies, do you Jonah a favor, don't wear underwear to bid, aim to by cutting undies, or at the very least make sure they have a cotton Gusset, if you're into washing them, you can use soap around the vulva, but you don't actually need to clean inside with anything. You're Jonah doesn't need a steam clean. Intimate wives and washes our waste of money and think carefully about what you put in your vagina. Which let's be honest is pretty good. Life advice anyway. I'm you means don's it's been really awesome talking discharge with you. And if you know someone who needs to hear these podcast, please web phone and show them how to subscribe, you can find ladies. We need to talk on a podcast app all on the ABC. Listen. Ladies. It's produced by Cassandra state, supervising, producer is meddling Jenner. And our executive producer is Justin Kili. This series was created by Claudine Ryan. The manager audio studios is killing bid.

vaginal discharge Thrush John Dr Deborah Bateson Amy Jonah menopause partner Cornick Thrush Volver vaginal odor Iki Stein Shannon Ivanka overgrowth ABC Sobe progesterone university of Sydney
1317 Minimally Invasive C.E. with Dr. Abdi Sameni : Dentistry Uncensored with Howard Farran

Dentistry Uncensored with Howard Farran

1:19:32 hr | 9 months ago

1317 Minimally Invasive C.E. with Dr. Abdi Sameni : Dentistry Uncensored with Howard Farran

"It was just a huge honor today to be sitting in the podcast broadcasting with everyone's a mentor Dr Abby many Diaz. Fa your ears were burning on the last episode on twelve twelve. Ninety with Dr Kim right she just thinks the world of you and she's doing a lot lot lot. You're doing building a continuing education center. And and I'm I really am all for the the see. I think it's the biggest variable to success watching Dennis for thirty two years. The ones who took one hundred hours a year they sold all their problems and the ones who took ten or fifteen they were they were always. They didn't seem happy. So Dr Abdul many DDS FA CD is a a clinical associate professor dentistry and in Nineteen ninety-one graduate of Herman Ostrow School of Dentistry. USC He has been a member of the clinical faculty since Ninety Eight. He is a former faculty for the aesthetic selective which emphasizes a biometric approach to restorative instead of care he was the original director of the UC advances Mansa studied dentistry continuing for the portion relating to indirect porcelain veneers. He's the former chairman developer. The international restorative dental does she symposium for the Ostrow School of Dentistry. USC In twenty nine hundred thousand founded the Los Angeles Dental Symposium Dr many lectures nationally and internationally on topics topics related to interplanetary dentistry digital photography and its applications for dentistry and various aspects of biometric and aesthetic dentistry. Dr Many money is the past president of the USC Dental Alumni Association past President Yossi Century Club former member of the board of Directors of the Pan Pacific Center for continue continue or a health professional education and a member of the board of counselors. UC school dentistry. He served for six years on the Board of Governors. My Gosh you're just Mr. USC is a former CO chair of the ostrow school of Dentistry. Scholarship Selection Committee. He's a member of numerous professional organizations societies which include the American College at Dennis the American College of Dentistry. Okay you National Dental Society and the peer for Short Academy. He maintains is a private practice in West Los Angeles California. Now I get a bunch of websites is your private practice. West Los Angeles California is that the La Away W. L. A.. Donald Center. Yes it is and that's Inter- west. LA IN WEST LA. And thank you for having me Howard and thank you Kim for getting you here. I don't know how things what's happened but this is probably one of those spontaneous. You could have never planned that this good and here. We are so thrilled to be on your show. You just made me tired listening to that. Go stop working. We'll we'll tell why you were also come down here and this is Friday and this weekend is the dental influencers alliance So if you go to influence dental antle DOT com. You're going to that coming in for that instagram. Yes okay now. I thought that once you hit fifty. You're kicked off instagram and had to go back to facebook. Well you know I. I'm going to start instagram. Because it's so much coming out of there but what what I have the privilege of is I'm mm around a Lotta Young. People have graduates. That work with me and I've been around students for a long time. So this is where they're looking and as a program director her it is. I feel my job to scout people really well before I bring them onto programs so this started a year ago in Los Angeles. It's just very different than I had to come see it for myself. There's a few people that have my eye on that that I'd like to scout and see if I can find a way at some future day to bring into la and your email came literally the moment. I pressed by on my ticket. So you're going to work L. L. A. Dental symposium. I mean I'm you called called the international restored dentistry symposium or what what is let me give you a little history because it's a little unclear. How the legendary you program it was at USC for you said twelve years now they Now you're taking it over to two thousand eight at the time of program director her a gentleman and a good friend by the name of Dr Ilan Rothstein who was in charge of CE approached. Me and said look can put something. Together that would be restorative surly oriented and he could be a two day program that you could sort of find the speakers for an I gladly accepted and it SORTA started on his first year. We had about eight people that attended the first one is sort of became the annual meeting for a lot of our partner faculty to go and we allowed access to a lot of students. One one year led to the next and so on and then when are unanimous I sedan joined to being a prostitute honest and somebody who was just so popular under C. Circuit He. Who is this address? Dan Our current dean at USC. Oh so I wish. I introduced me a different times to different the people because he was running the ceramic symposium on Jerry Sheesh was running at an average show was working with Jerry and an I got exposed to just unbelievably a good dentistry and I kind of wanted to bring those people so that the are group who would not necessarily go to all these meetings and experience that that went on on for about twelve years and you know as the Times are changing and I think you kind of see that. Ce's changing quite a bit. There are even hands on courses that are online on line on the resource has changed on your outreach changes you and I are sitting here talking to NEPAD gas a lot more people will be able to hear and see this as opposed to if you're just sitting on. We had thirty people watching so I think they have big dreams to restructure and make their programs more available more online more streamlined. uh-huh very supportive of but I had invited all these people on some of them Louis. Barataria is not an easy person to bring to lecture for you and the the date was set. I had an option of cancelling or taking your over. I kinda went to our school and I said look. If you guys don't want to do this I don't want to lose lose. The opportunity and base supported me in decision and said you know you can privately do whatever you like and I discussed it with my team and the La Dental final symposium was born. No because this had the name international restorative symposium of Dentistry of USC. We have to sort of take a year that those people know that this is not changing and as of the coming year. It is just going to be known as the La Dental Symposium being that this will no longer be a university affiliated program it allows me to bring business into this. It allows me to have side programs that may go on so it's unwritten written but it's very promising us to what we can hopefully bring so where do you Again I figured out in eighty Savon Savon that Every time we went to see course it was always the same people. You're in the big city and it's the same people over and over and the all the old ones who were my age age back then. They all had their F. E. G. Meiji and I put together very quickly that that when you go to. Course it's the materials GonNa Change It's it's the people you meet. You know if you're five you know your summary of your five best friends and if you kept your vibe buddies from college he dentistry and and don't do anything that they can take down and I thought the neatest thing about the AG d. n. c. e. was the people that like even on the things like the the the Six weeks of the paint suit our seven weekends with Carl Mesh. My biggest memory is so my buddy. I met their course And how how and and so funny. How sometimes all went to a course on Ortho with Brock Rondeau the pickup something about adhesive dentistry? And you know just So I it's it's just the secret formula and that's why I'm a big fan of this podcast. Because they got an hour commute to work A lot of these speakers are never going to go to slide Kansas US and they get it they get to listen for an hour and I I was open. I'm you know if they listen to politics on the radio for an hour by the time we get to work they'll probably just You know you go shoot themselves But they always get one good idea but when you you've year. Did you graduate from dental school. Ninety one ninety. One one eighty-seven where do you think the need. The most seeing now is placing implants as it clear. A liners facility. He said Dentistry Veneers workday. So now you're hitting a topic that's just changed for me over time. Okay I think if you you look at the c. e. and as someone who seek speakers so in order to make fees reasonable for meetings we need sponsors. The things that are most important are not emphasized. Now we talk about implant dentistry we talk about major aesthetic dentistry yet. You take a look doc at University of Geneva and I've had the privilege of working with some of these other people just through the companies. I've worked with and see what they're doing. There's a guy over there by the name of evoke crashy who is essentially the director of their minimally invasive program and what they do is they in their program teach their students how to seal into proximal carries an hard to diagnose differently so that that beginning lesion never curse re just implemented that icon process into our programs right so the education is contemporary. Then then people get out and work with quite a few dentists who graduated. There are four or five ten years out depending on the environment that they fall in what they teaching in dental school is unfortunately not what they're able to practice and what that turns con GonNa comes down to is. It is all the bud. How do I do it faster hardware faster? There are certain things that you just cannot do faster now in a bigger scheme of things and when you look look and see how things have to be done and why is it fast is because of the influence of the third parties that dictate. What an office? Cannon cannot do and the paradigm shifts I think is different so when you ask me where should see be a think she should be not educating the people that before the cycle of death of a tooth begins a there must be a process that you can prevent it the granted. There's a whole group of people that have have restorations. That needs to change all the time. But there's a whole bunch that are getting new ones every day and there is really no consensus. The technologies that allow you to be specific are not utilizing this country. and that's a pity. I think that whole endeavor needs to get redesigned of. How do you decide to enter to for the first time and do you It's really come a long way. So I if you're young and in school and you think it's Bad I remember when I got out of school. I mean the the cause. Many dentists were just people who would file down a bunch of crowded teeth. Papaya fountains and I mean when they got them. prepping the lowers the all the race. Colonels how how could that'd be good so then eventually key more minimally invasive. I love the fact that nowadays before someone does veneers unravel everything within visible clear liners. It's getting much more conservative than it was used to be just a wholesale Crazy but do you think it's going is is rapidly becoming more than enough to say. Yes but the reality is that no because if you look at at least in America or in California I should say if if you look at the direction dentistry is going more and more. DSO's are being formed and less and less sort of specialize officed justin to exist and and when DSO's with their business plans they try to work within third party paying tech all the PPO's they can etc so in order to for example do ceiling of the proximal lesions. They are not going to encourage that. Because that's not something that's covered with the current air system so where I see dentistry going is a group will continue to work within the paradigm around exists and find ways to make it faster and have more centralized ways of dealing with it. And then there's going to be the groups that are going to take a different direction Shannon and a good analogy potentially at least what. I hope I can contribute to is if you take a look at the organic food industry you know. I moved into I immigration into the United States in nineteen eighty-three you couldn't find organic Polidori and even three sixteen so was that stressful to change. Countries are sixteen. It's when you're from Iran where I left when I was twelve and that was a time that I had to go alone. Lived in a boarding school until my folks could leave the country so I lived in Europe for about four years and then we all emigrated into the US from twelve to sixteen with no parents in a different who of the years without parents. That's where learn how to speak English. And you know I'm during my and not drive so it was kind of fun and it was hard at the time going through hard times next you prepared for others being in an environment like that makes me comfortable whether you're from Sierra Lanka or America or Ju I don't think in those terms because I'm just comfortable we'd like whoever and I'd like to get to know you for who you are at Cetera that was instrumental instrumental for mere young age. To just you know despite the discomfort to get along with everybody you know. Have you heard of the company Intel. Tell the two founders. That are two brothers from Iowa and I was just asked the one time at dinner I said you know. You're you're just to normal guys from Iowa from Kansas. How how did you come up with this? And I mean it's a massive company and he said and they attribute all to being army brats. They said you know we. We grew up in every two years dead transfer to another country and we would just lay there in bed and think well. Why was the last country so rich and this one so poor and they look at the different things things? Is that same people same house. Same appetite same plumbing saint. Everything's so these started to understand the small little nuances of economics x and they said Yeah we couldn't have learned that going to Asu and reading books and they lived so you know what doesn't what doesn't challenge. You doesn't change you so there's challenges probably made you the person you are. So so what are you so again back to the question. I'm would you think the major areas that I'm you need to be addressed Vesey. I mean all of it I mean ce is when you finish what I like to call somebody. Somebody who finishes dental school is a qualified beginner. Somebody who is just not Jimmy Safe and if paid attention than they know the basics six and hopefully with some mentorship kind of grow and so on so all of the areas you can get better at the question is if you sort of change the perspective of the public and what is offered to the public and then you look at what we offer and the reasons of what we do what we don't do. I think the reasoning that we sorta justify some of the things that we do is is not appropriate and really think and I think this thirty years into this because if you ask me this I don't know twenty five years ago I genuinely a newly believed. I'm doing somebody a big service by taking those teeth and crowning them and getting rid of an interference an oak loosly making them fit what I was taught as the best way to go. No but I think at his dentistry is a game changer. Right because adhesive dentistry allows you to sort of keep the toot biologically for a lot longer longer and as dentists. We were trained that if a restoration fails a- that is embarrassing but if the consequence of restoration and having a patient lose a tooth that's a consequence that we agree and not that I am at the stage that some of the cases that are beautifully reconstructed are failing. It's disappointing and the ones that have their natural teeth may have needed a little more care a little more hygiene. Some of the composites was this may have been redone. Five six times bear better off is that minimally invasive. I posted that yesterday. We ever seen something anything. Like that. Is They I posted that on a just exploded on dental town so all on for you know everybody. He talks about preserving bone growing bound saving bone but on four. You know the you have to make a lot of space for the inner archer. Now some of these surgeons are just with the teeth in and everything just doing a what is a A term not used very often oeste awesome and entire dentition removal for an all in four Dylan case. Maximum mandibular ridges were removed to allow enough bone ability. But man a lot of people he posted this picture at all. That was to think about it. If you are a dentist and your commitment is to surviving a dentition for a lifetime right. Because you're really good dentists and I can't remember who said this I think is Ricardo metronews. WHO said this? But you're a really good dentist if your patient gets worse at the slowest rate possible right slow down the rate of death so if you trace all of that back how many unrestored teeth does one lose unless a severe Perria. What are your implants coming from? Mostly teeth that have had a crown post under ruth fracture does look the number one reason. The number two reason our TRAUMAS and accidents number one teeth that were restored to that is unrestored. Rarely is lost I concern member dental school. I Azima Saddam. which tooth lasts longest and he says the one that a dentist never touched? That's right whoa one of our Clinical professors guy by the name of instant she actually wrote an editorial wants India Kademi of American Academy of Aesthetic Eric Dentistry and he called it. A enamel preservation fee. That a dentist should actually be paid an enamel preservation fee V. as opposed to procedures that you do because once you take it away you can never replace it now talking in two thousand and twenty honey. This is a viable conversation because adhesion prior to adhesion. You couldn't do these things when you needed mechanical retention Shen. You needed to do the thing that you need to do to satisfy that requirement. But you look at a Boeing aeroplane today and you look outside. The wing crews do see holding. The pieces together is primarily adhesive bonded together. Adhesion works great when the environment is controlled control and as dentistry sorta take the posture of yes laboratories. Get great results but really in the mouth you can control that you just have to make the commitment to a rubber dam so adhesion is not complicated. Rubber Dam can be difficult now when you work in an environment. Does you've got to do something that twenty minutes to do something and the rubber dam maybe takes forty minutes to place on an isolated in multiple different ways than the first thing that you give up and I think that that the awakening needs needs to come from the fact that it's not that the technology the slacking is creating that environment environment. That allows you to do it. Yeah I mean it's I come a long way. I remember when I was in dental school. I was so amazed at the The ADA held the patents for. I mean that bonding benefits Of Dr Michael Bonaccorse back in Nineteen fifty five that all these patents on it and Irwin Ruin smuggle ran out with it with the American Society of Journalists Sakes so when I look around the globe. So you know America's only you know I hear things all the time say now you're big in USA. America only has only four and a half percent of the PD students. Well America's only four and percents population. which you're well Muslim governor major lose a hell of a lot more people in Asia Little United States America but when I look at the dental industry there's in two hundred eleven thousand Americans license? One hundred fifty thousand Gerald thirty charges weaker more thirty thousand specialists. Three jars work are more. They're billing on out about one hundred nineteen billion but the planet's got two million dentist and they're billing out half a trillion dollars but most of all the growth is is pretty just like the advanced economies. You know your was one and a half works. Who after so the only thing double digit with is IMPLANTS UNCLEAR LINERS and they're in double digit growth Will that affect a lot of your programming decision. for your your Let's analyze that. La La Dental symposium. I always confuse. La Dental suppose him with a W. wwl a dental center west. La Dental Center so is west La that that's a tougher part town now. No actually west. So don't say is very close to. UCLA is summer between Santa. Monica and in Beverly Hills I would say an upper middle class community of been there for over twenty years now and I thought it was more like Hollywood no doc Hollywood north and but you know. La's just so spread out but you raise the really good point you said the double digits. Are Implants unclear. Liners what what do you think that as well I mean at the end of the day the you know there's what life the biosphere popped up about. What three and a half billion years gum in your only goal is to reproduce have offspring so anything to make you look more attractive? I mean if you're missing her front tooth they're always gaming trying to look better because in their unconscious they want to attract a mate resource. Yeah that's what the patient was right when the unconscious owner and I agree with you. If you feel better you look better. Their studies that show that you succeed exceed more. You'll work longer. You'll be more efficient all of that. What I'd like you to sort of think about is the average person today day knows about implants right someone from TV's billboards Joyce clear choice? So those people have gone to public click right. I think one of the people who who really maybe ten fifteen years ago brought cosmetic dentistry to the mainstream and he deserves a lot of credit for that that is build l.. Dorfman Okay Yup that extreme makeover show right What it did is it allowed the universe To be aware that there is such a thing that I can have and then people started asking for right and then the education started about that because it became a demand. Now I can sit and argue and say some of the methods and methodologies may not be what I would agree with but this is not about. Thanks he deserves the credit for bringing it to the Public Hakam. The majority of the dentists in the United States are unaware conceal. proximal allegiance for the world for that matter. Well it I'll I'll go. I'll go really brutal because I I like to go back in history. I think when near in the president you can get so confused and tribal and miss the point but when you go back to America They started dental insurance About what was about nineteen Forty eight in California Seattle or it was the Longshoremen's so there there's a union that solidified anything coming in and out of the country had to go to the long-term reunion it was the perfect Chokepoint of labor deal bill and One of the first things they Started was dental insurance and those dental companies in Seattle Washington and Portland Oregon got in California eventually turned into Delta Dental and the wind did When was the radio often than winded? Why rent can Rankin Invent when when did ranking event. The radio probably sometime sometime in the thirties. Now and then radiographs so x-rays discovered eighteen ninety five. So here it was fifteen are here was nineteen fifty eight and nobody had an x-ray machine and then in Delta started covering xrays at one hundred percent and it was a domino effect across the country. Okay and and the hallmark of economics is that people taste incentives like when I was getting my MBA program. It was really sad to hear the the people from hospitals. They say you know we only spend our grandma and we get a twenty L. earnings. We lose money on everything. So we have to do a biggie. And a biggies anything fifty to one hundred grand like a hip or knee me a bypass and if we do four big day we can run everything in a loss and cover. And I'm just like how sad if you don't fully eight GRANDPA open and Redo a knee or if you don't do a fifty seventy one hundred thousand procedure You run everything I lost. But incentives matter and if there's there's no code for it it's dead on arrival to what eighty percent of the planet. Are I kind of feel that the public it doesn't understand insurance. Medical insurance has no cap right. If you get sick you go to hospital. No matter the cost you covered you have a deductible that sort of truly pay as an insurance right. Dental insurance is a discount club that you pay premium premium and you allow decision making on some other person and the influences. Your doctor us to to offer you or not. Two thousand dollars is what they pay and to to get that two thousand. If you're going to do it legally for the major stuff you have to pay two thousand to get two thousand. How can you ever be comprehensive comprehensive tech that a step further you are somebody who who is like a young person and you've got these Inter proximal areas that you could potentially eventually seal that you would never really get that initial mo feeling that you would get that today's mostly composite and if there's a way way to sort of protect you against that what is that worse? What is keeping that marginal and you know to get cosmetic work and Redo your whole mouth or implants on four or does twenty thirty one hundred thousand dollars depending on? Who Does it if you took a healthy hourly profit after your expenses and you started doing some of these? These works like other professionals. Do if you're a lawyer if you're an accountant you basically have your fee and whatever else is on top. Don't don't you think that most people would opt for it because they don't have to pay tens of thousands of dollars pay a thousand dollars two thousand dollars get it protected because what happens to that class to cavity that you get the first time the first that you get it. If you get in an impressive let's you just go back. How do you decide which lesion you enter you look at an x ray right and you take a look at that x ray and and it is generally accepted that if you see it hit the DJ you enter? How do you enter? Co- musial most people you can go in and when you start looking right well you can translate and if you translated you know where that is and if you translate and you capture that image you can try as has luminaries later and see. Did it grow. How come some of the people that never did it? From the time they were twenty. They still have that Inter proximal lesion. The same thing you've experienced that or you offer a patient to do something and they don't year after year they come and you're really trying to fight to see. Oh maybe you should because it's a little more twenty years ago you didn't have translation today. You can translate and look at that way. There is a lady who has her. PhD Her name is Marwat Abdulaziz Aziz. She went to University of Geneva. She spoke for us at the symposium. She's no working at. UCSF on a sabbatical she has a PhD and part board of that was to start analyzing what you see in an x ray and what you see once Trans luminated and then once you open the teat. How accurate are you? And many times you enter. And you're like okay. Where is the decay? And sometimes you enter and decays rampant. So our our diagnostics for initiation initiation are not being used properly. Because it's expensive right. You have to pay seven thousand dollars unit but you could get an advent light. which is what I use currently and that ad that led to sort of show you where it is and that light is? I don't know three hundred dollars and that gives you some. I'm sort of an idea. Next is photography right so if you have a photograph of a tooth and that person comes back five years later three three years later you compare photographs half of the things that you think we're going to happen doesn't happen some an others things. Get worse where you didn't suspect expect. No it's not perfect but when you read your notes and you sort of say this was under observation. What do you do with Dad? I know you've had Kyle Stanley here talking about Ai. Let's look into the future. A little bit cool is it if the judgment judgment doesn't have to come from you because the technology can tell you something changed and you know as a dentist we kind of feel unless we took something away and we built something we inserted. We haven't worked and we don't deserve to get compensated well whereas maybe the thinking should be the opposite. Look at dermatology right for a second dentistry. There metrology is one of the most popular areas of medicine because they rarely have emergencies. Most so what they do is elective patients. Wanted because they understand it's good for them and the media and they have invested in letting the people the public now with the drug companies. There was a time that the doctor would give you whatever today. You'll know what Lou Nesta is an you'll ask for it and your doctor will have to learn so back to what started this tangent that we went on implant companies have double digit prophets Because they have taken it to the public they're investing in educating the dentist and teaching them how to do it. Well the cosmetic stuff started because of Bill Dorfman likes that sort of put it out there and frankly is rewarding when you do it. Well because it's like something you see right away it's it brings the artistic part of dentistry out etc and that's kind of fun to do so it's it's pleasant for the people that like it. Why does anybody showcases ten fifteen years later of these big makeovers? Have you seen one absolutely. But but all humans don't like facts like I'm I mean I I on dental town since nineteen ninety eight every single day. Almost the smartest artists that is you know you say well. How long do you think your poster composites less competitive album go? I I can count on on one hand. How many of my feelings showings of failed? I'm like well you know when I talk to insurance people and they have hundreds of millions of claims that they're seeing like six and a half years semester. Then they say they say well. We'll we'll those are yours. I mean obviously on my hands look at my hands. Obviously I'm gifted I mean I don't think they like facts and I I think I think is going to blow their mine because the insurance companies are using it I than right now they arrest girl out by you good submitted the same x Ray Sixty Times to Ramallah ruby now and she's going to go to jail for a long time and so they're they're fraud. I'm glide we'll next to you. They're using to read impressions but But I think I think the next phases are going to sit there and say wow I'm going to give you a thousand dollar. Benefits are Muller Root Canal. And if you do it at five years five percent are extracted you does it ten percent or extracted. Howard does the twenty percent extracted? We're not gonNA subsidize Howard anymore. I think I think and I can tell. Dentists are not GonNa like this because they can't even he didn't even tell you they're they're filling fell today but you know let's talk about standard of care. We sort of agree that there's a certain certain level or evidence based dentistry even better right. How would you define evidence based dentistry that means if the average person sort of follows the general Enron guidelines of something and you look at it in multiple different ways and you look and see what worked and what didn't you draw conclusions? The this approach procedure. This material is good or bad. Then you pass that Gospel based on your experience to others agreed. What about the person who took extra care reduced less isolated immaculately and did something and took three times as long unless just for argument's says charged three times as much which is still less than the cost of a crown root canal? Okay and and would that patient be better off or worse off that. That's really the part. So I used to do aesthetic reconstructive. You know one of my heroes is Franks beer. Because he had a very probably wouldn't even know me by name but he she showed me that you look comprehensively involved in implant dentistry number one. It was quiz inspire where actually the just recently certainly separated the two big ones I'm Russell and Yup and you're right but you know but not to sidetrack trek but the whole concept of Endo I mean we should leave decay. That's deep alone and seal it and wait for symptoms before we take the pout. We don't think that way. An x-ray goes to an adjuster and insurance and gives preauthorized the Endo Endo is approved prior to caries removal. So it's a some of the paradigm of what rethink and change and you know. There's a guy who's a harvard. Mba His name. Is Michael Porter and read anything absolutely so one of the things I've taken out of that he says there's basically two ways to succeed. One is if your cheapest whatever if you can be the cheapest and your focus is to be the cheapest. You will always be busy the others you have to be different. I see dentistry going in a couple. Different directions. I understand that if I'm a young Grad today and I or a half a million dollars someone's GonNa come give me a 401k. Give me all of my C. E. in create an environment that I'm not committed possibly pay some of my loan off it's attractive financially and for my life the other way they're not gonNa make as much money those places don't really exist then you take a look at the practice at this and look you know you've met my to sor associates here with me. y'All who is one of the most brilliant people I've ever met. That really started just just like this for for for training purposes and she just finished her masters in. Hr She's just that kind of a girl and we've tried to redesign are suspended. Percents Taller and shorter. One is Rachel who really in many ways in t sued. Dentistry knows a lot more than many any other people. Because she actually just follows all the protocols and you know when you start teaching something you start understanding it a little bit better. Why I'm I'm sort of going there? Is You look at our office and our office about thirty percent of you pay. Goes Tours. Managing Your appointments managing managing the schedule. Having somebody to answer your phone calls preauthorized for insurance right so I could be thirty percent cheaper and make the same money if I could control the front desk costs. Add to that that today you average person who is in their mid twenties of red read that they will not stay at the same job more than four years it constantly. Move around right now. So if that's the reality and I just have a lady who's been with me more than I have been with this practice. Her name is Nancy Rosenbloom. She's retiring at the end of this year. She's given more than forty years to this practice. That is just not going to happen in the future. So so the process of this. This dental approach is is a hindering. You know you make tetons for golf. I don't talk to anybody. I basically go. There's a scheduler I kind of schedule. It and I think if we can take some of the things that we get from other industries maintain costs of things that don't create better patient care emphasizing the technology and the education of the patient as a profession. I think the CD and the ADA Ada. They should take the lead of informing the public that you know. Implants are great if you needed but hey if you seal your teeth you may not even need the cavity. How come that's last night popular and why can't why is it the same fee whether somebody uses rubber dominant? Wouldn't that encourage you to user if the build up is included in a restoration or not wouldn't make you be like why should I put a build up of heard that the most profitable restoration for restorative. Would've dentist is a single tooth implant in terms of the money that you make a dentist right when you're doing a single tooth implants. Isn't that kind of where you've failed that saving a tooth and that is your most profitable thing. What if the smallest class to was the most profitable thing in dentistry with more Dennis? I JUST WANNA learn that well it goes back to what I started in the beginning What two things? What are the only two things growing double digit implant and clear liners and they're the most was profitable as the insurance companies will be private or government? Don't set the fees for those so when they when I'm in the United States for example when And Johnson signed into law Medicare. And when Medicare you know I it was a relationship it for years it was like well. What what codes are using then when they start group coating but after ten twenty thirty forty years they finally figured out your business and then they lowered their reimbursement to so there's almost no profit so when the insurance company gives you say one hundred and eighty dollars for a filling? That's probably your cost so when people So people gravitate tate to something where they can dissect the fi in the province zone. And that's an implant and clear liners and so I mean dentist will do you like. I think the hardest thing I do in my office is when I see on the schedule I gotta go in there and I gotta do quadrant Emo decomposes to I mean that's just an hour of sit down. It's it's my there's no shortcuts. It's just you're going to be in there for an hour but You know that that that you're you're probably just breaking even depends on charge. Well I mean if you're participating with the insurance but ninety five percent of US tennis take Delta according to Delta Attack Delta says degrades for Delta terrible for ninety five percent of the dentist because it it forces you to do things things that you know is not better to make diagnosis. That is not the most conservative. How do you think your patients would feel if they knew that when you're giving them their options that's even in your radar filling here and if I were probably work a little hard to do and I'm basically going to break even but some of the emotional Pushback we've had on this show with Silver Damian floride some of the young pediatric dentist. They liked to you. Just paint on the Silver Damian chloride and kill the decay and do that every six months and some of them feel like some of the pushback from the older guys are like well. My God. I'm Bill Bailout Papa. John's and chrome stole crowns. Eight of them and you paint this stuff on there for you now fifteen bucks or there might not be insurance showed so so. Yeah incentives matter. I mean if you went over to the NBA program at USC until the incentives. Don't matter they they'd laugh you out of the building but going back to cheapest or different front a movement is necessary here right a movement of people who are going to get out of what's normal and accepted an easy that are willing and I am part of that of started. This along time ago I gave up Delta Dental the day that they would allow me to do a crown but are not only. Wow what your account of the year but basically re-sent Somebody's principles buddy now abstract because I now my homies and they're gonNA say come on. I'm in Salina Kansas. You're out there in Hollywood you. I wish I was in Salina. Kansas being able to do this the the overheads is probably less. They pay US rent to get in and out of their offices easier. Okay the concept that Insurance enables people to get the best thing. Take Your family and I'm surprised nobody has done this. Or maybe somebody who's done this or you go find the person who's done this and bring it on the show pick a family and look at twenty year projection of family of four. How much did their employer or company or day contributed attributed dental insurance? How much out of pocket did they pay to subsidize what they receive and what procedures were done for them in a twenty year span? Dan then see how many of those things to be redone because they were restored of failures are inevitable. Tell kids because the kids might not see this but you asked me a question really like like we gotTa School Eighties Earl. These legends out there doing all these full Malfa near case and I I was a little uneasy with it because I knew a lot of them and when their daughter was sixteen Nass for that she had to go get braces and bleaching but when someone came in with a debit card they they build out but if someone comes in and got the traditional upper ten veneers done the typical lv way. What would those look like? In ten years. Twenty four the tissues would be always inflamed. You know you can't bond sub gingerly if if you accept that as a principal apple you can't bond sub gingerly if you don't see your margins you shouldn't want the worst restoration. Duration on the planet is a on bonded bonded restoration. An Amalgam is better a glass glass. I honor on a lot of older patients right. Where if they don't have the temperament to really get it isolated? It's better for me not to do ending. It's better for me to do a full crown. Crown is better for me to do a gold crown. That's not the discussion. The discussion is for the two that has not been invaded at some point the arithmetic mythic of this is that there's somebody who dentists have not touched. Why is it touched for the first time? Are there alternatives. And how'd you make those decisions. I I look at our charts. My patients are extremely unique because they grow gum and they lose gum. And that's because the head my own probings and it's like three millimeter recession. A look at that and look back and it was two millimeters there's and then it becomes three millimeters before I had photographs and everything and we make decisions and when you're off a millimeter in three. You're thirty three percents in error based on that you may make a recommendation. You don't know that you just emotionally decide where I see the future and I'm in the building process process of this. I do not have the workflow to tell you but if there's one thing I want to contribute I want to contribute a way that you come into office you get scanned and your first visit three d. where you really see where everything is. That's get saved you if you're young and you have your own in apple and et Cetera et you you city and radio graphs and you look with tries elimination and you capture that data and don't be in a rush to get in there which proximal caries became a root root canal in a year. And you know I have friends that spent ten thousand dollars a months to try to be on top of that Google page for patients to come in what is wrong with you. Re repairing and redoing some adhesive dentistry like resin dentistry. That you did ten times in a patient's life in one hundred eight years. Do you need that many new patients if that was what you did you don't so we don't concentrate on the ones that that trust US already. We go outside and then try to get more patients to come and and like you know there's this thing out there that says that the new patient will do thirty thirty or forty percent more of your recommendation than your existing patient. The how much effort you put on your first patience and how much effort you put on a recall. All ten years ago I stopped doing exams in the right after a prophecy. Because I miss things I pushed this just as my my Phone was ringing ending and after I posted this I'm which one was it. Oh check out this this is I I posted. USA Essay Three year trial by professor. Nikola Lines I n any Shows no evidence to suggest fillings or more successful intruding to decay. Okay three year trial. I mean I'm forty three percent of those for just being assay experienced toothache or dental fixed regardless of the Truman They did and it's funny. Because because this is on the pediatric forms and I mean I I mean. Can you imagine being Piatra Dennis saying. Don't do that. Just being Silver Damian Florida and And then people saying that You know the pediatric study that these fillings. There's no of suggest they are more successful missile. So if you think of tooth decay right. He's a pediatric dentist teacher and researcher. Her work is focused. On improving the way we manage the disease dental caries so so so let let let's look carries it is an infectious communicable. Untreatable disease agreed. It's a bacterial infection shun. That can go from two to two percents of person you do not have a vaccine and we do not have a medication for it right so if you look at it in that perspective by you you doing your restoration and leaving margin. You're always vulnerable to that. And the bigger that margin the more vulnerability and the closer to the tissues or below the tissue the higher devan ability so if there is a way to get the tooth to sort of heal itself. That would be a better solution. John Unfortunately is not easy to do because we have patients that have to comply. And that's where we fail most of the time because when you finish a restoration nation is in good. Shape is some patients that great care. And some. Don't but my issue with with just excessive restorative stored if care is that initially it seems really good but almost invariably you when you look at it to three decades later the ones that that have been more aggressively restored of the bigger problems. So have you been following that That fiction dental trial trial. No it's pretty cold fiction dental trial and it's it's basically researchers. Just you know you said Oh the cavities Easter. We needed to have felling. And they're all sitting there looking at the data and likely say they a lot of these professors who are pediatric Dennis Research. Or whatever they're saying man you you don't have an argument for the filling. It's the surgical model is a certain amount and you know the surgical model becomes extremely important. When it's about replacement of other things you know? I learned a resource for you. Go check out maybe already know about this place called style Italian. Oh yeah he's on this on the sound. Don't work that gets done there right. And that's in Italy and that's like you you telling me a guy in Kansas is going to here and say well discussing Hollywood there people in Morocco and Iraq doing dentistry like that. It's not like nicer offices. Better equipment better materials is dake sort of bought into the philosophy of keeping Super Gingele. And I think that that adhesion is brought that to the game and you know one of the hardest things I think is to unlearn. Learn something it's easier to learn for the first time to unlearn and good different direction. And I think that once we get comfortable just comfortable right Yeah this is a This is a very interesting deal I was Liz. Very excited about Tough the other day Tops at a doctor kill you Nair. Ms Phd Developed Bacteria Korea. That would make a low calorie. Sugar called Taegu's that will not cause cavities. The the actually made a sugar. You're it tastes like sugar. It has thirty percent fewer cavities but the bacteria canton and in house decay from. Yeah I mean Xylitol can have the same concept right the sugar. They can't metabolize. And but you know looking at all of these things is great things things because it's like thinking maybe the first approach should not be surgery. You think of the medical world right if they those sort of do your blood pressure and those sort of get a plaque index and and there's a whole series of things that you could do and the first thing that they would tell us. Let's just do a bypass because you it may get clogged up later. Just for me thirty years into this and look at the stress to a dental world when you do a case that somebody spent fifty sixty thousand dollars with you and that case is failing. That's not a good day at the office and the management of cases. Difficult when you have a case that you do the class to that failed are you. That stressed out that you have to do it again. Probably not as much and I know you probably know who don Fischer is right yes. He's join Dan the man Fisher there. There you go. He used to invite to people from school once a year before the Sunshine Act. GonNa you know complicated that and I had the privilege of going there and and one of the things that I kind of wondered is look. Here's a guy who's got this amazing material. And and he doesn't make anything for porcelain ORLAND. He doesn't do indirect materials except impression materials. Soy Ask them and he says you know the majority of the world can't afford indirect dentistry so this focus is to sort of help those people and then what he said is if every office learned learnt to charge by their time. Then you make the right decisions because it makes no difference what you're doing and if you look look at other industries the law industry if you look at accountants if you look the contractors most of the world that hires professionals was hired them that way and as your skill gets more your hourly rate goes for more and this sounds weird but we've implemented in our office successfully if I take Delta and somebody wants to front tooth that looks really pretty without lying and cheating about it. I can't have them pay for a better lab lab is that is that if a patient knows that is good for that and I'm not trying to bash the dental insurance companies unease because the intent is not to be bad but it's an agreement between the patient and that company and if they understood more maybe then they'll choose to use the insurance things that make sense and and go outside it so so have you set the date for your your next Next year yes okay. Okay and also I'm a little confused So I know the LA dental suppose him just la a dental symposium yes the West La Dental Center. That's your dental office. You have another website. E Point Inc e Point Inc.. So that's a whole interesting story. We had a couple of people that sort of moved out of the area and and we wanted a front desk person to help us and we just couldn't find it so I went to recruiters and through recruiters we found somebody that. Actually I found your that way and restarted making all these training manuals so that as we bring people in we can sort of show them what we want him to do for us because we are a little the different as far as insurance girls and all that kind of stuff and somebody needs to explain that well to a patient then we thought we have a business opportunity and e point was meant to become A recruiting agency specifically for fee for service officer. Because a lot of my friends are suffering from not having the good front desk helped helped they need what required right. NASCAR assistant purpose was front desk when we've forum that but then we discovered that that's not an easy thing into actually feel. There's not a lot of people out there who are willing to work for the salaries that's paid for that. That would have that level of skill and that level of customer service because because a person like that could work in the hospital industry can work in the food industry they would basically have easier lives on make more money. So we've kind of failed at Creating the talent the demand for us to find it is there but we can equip. So now we're sorta rethinking et and rethinking. Maybe we should have some training that Redo for other people so that they can go in this direction and when the USC continuing education programs stopped. I needed an umbrella of a different different company than my private practice. DISORDER RUN THE LA dental symposium so it went under there and and you know very Kim was so helpful to us and aged edged sorta became a partner to sort of help us with the C. e. part of it an and these things were not pre-planned there were just too mean if you will so so. Have you set the dates for next year. I believe it's November six and seven the the weekend after the election the weekend rush. I love how on E. Point you spelled it. E. P. O. exclamation mark in T-. I've never never. Actually you start you you twice. In one area. You do the smalley then P. O.. Exclamation Mark Andy. But I love the way. I've never seen that before. Where you through a And it's been so difficult to actually get a right registrations for that Sino creative and then many times you're creative and then you get roadblocks. That definitely definitely was one of those situations. I was telling you before you night. Out of the country tomorrow and Just having that Roman numeral two after my name my dad named me the second aiming half half the country's it just stops the whole system. I I'm still going to the cemetery yell at my dad because but yeah and Crazy crazy names but yeah you put an exclamation mark in their. This just lost The whole Microsoft backbone of the Internet so so the La Dental symposium you. It's not on your website when this when the data's or six and seven we haven't really. It's I'm scouting for it it currently and we. We probably are going to continue after some of the highlights of last year's. So if you're so I cannot. Six and seven of November is the date of thousand and twenty November. Yes so one. This election next year election always the first Tuesday of a return. Dobie twenty two hundred and twenty twenty. We'll finally see clearly Louis Gateway you know it's funny. I can't believe we're doing that election. I means lots me because The last election is what made this podcast really. Yeah I mean I am the last election you know Talk Radio and social media and these Dennis had our commute to work they said. I can't listen crap an hour each way. You know even like me. I I kind of like my news summaries on Friday night you know you can watch a couple news programs. They Kinda sums up the week. Some people there watch at breakfast lunch and dinner I mean is tonight the NFL game now. That's perfect you know. I had a game Monday night. I have one game Thursday but I can't watch it three times a day and they were all emailing me saying well. You started dental podcasts. At now What I'm most proud of is not the not the this podcast? Ask the fact that now there are sixty people in Dentistry uploading a dental podcasts on dental town and the views are crazy. People do a podcast. They uploaded items. You can upload it for Free Dental town there's one guy on there who has six hundred thousand views just on dental town and And then my vice any podcasters. Because I know there's a lot of people out there you know I own a media company dentistry. So I've been a dentist but I owned a media company. Since ninety four and media is only medium and a lot of people they do too much you one medium. I mean there. There's printers instagram. There's I tunes audio. Oh youtube vigil but all the podcasters like we're doing this on video even though I have a face for radio you look like you were made for video or Bertha roofing you have that Dorfman luck on but by Gosh. They're they're human. Say they want to watch it. I can't believe all the people that do these audio podcasts. have nothing on on Youtube and I would rather angle video on that but So yeah that election means lots of me so so the next election is on November Third AH and your you'll be the weekend before averick enough. They're six and seven. We just seven where you're gonNA be simpler the Biltmore Hotel in downtown downtown Los Angeles and what. What does that mean something to you? Because that that's where you're having every year used you have really has a great room. People are familiar is centrally located so that a local people can come. And you know you're getting more and more people that are coming from outside of Los Angeles and frankly my goal with that. Symposium is to let the audience see some of these people that ordinarily would never cross paths unless they joined these big academies where they have a lot to offer and and and Hopefully I can leverage than bring them back on for more like a detailed one or two day. Course that we're GonNa do and what do you think okay so I was trying to get address. The address is right here So the address of that is the five. Oh Six south Grand Avenue Los Angeles California -fornia. So where where's that at bet is right in the heart of downtown Los Angeles her down a mile away from the Staples Center in California. Yeah I mean it's ten percent of America I mean it's it's what the ninth largest economy in the world. I I totally fill thing out without ever even even leaving southern cal. You're getting international people. It's what I would love is to get somebody WHO's in Chicago. Somebody who's in the suburb of something. You went somewhere and we didn't quite finish their. If I worked in an area that I had a little more time and I wanted to have a little better time and I would sort of see they. They ease of doing that type. Dentistry does not as stressful. Life would be better. My patients would be better. And they're not exposed they don't see some of the things that you see an icy and then you know I'm not saying transform your entire practice do one case due to cases some of the best dentistry I sees from some of the most uncommon places and the because people that typically go to become a dentist. Want to do really well. You know another thing. I've noticed over the years like say some arm Saturday. I'm blind you know you know it's international when your time's thirteen eighteen and a half hours on one leg but one thing I e Oh so much is changed like when I started lecturing international nineteen ninety. You always had a translator. Now there's no translators I mean because thirty years ago parents realize told a little kid you know. The International Language of science is is math in the the international language of Business and everything else is English and So now there's no translators just amazing now that doesn't doesn't mean they can all talk to you because you know in. La You have a Hispanic friend. Sure can understand his her grandmother but can't speak it which always blew my mind. How can you understand grandma and I just heard back? But it's obviously it's obviously a separate issue but I have noticed going around the world especially places like become like Singapore Tokyo France. A lot of people say yeah you know back in the seventies. I did that American way running back and forth for Tories. I felt like I was born. Just to provide jobs for assistance in receptions on this stuff and I got rid of it all and went down to one opera Tori the and my iphone and my overhead drop down to one hundred thousand a year and now I do three hundred thousand take home two hundred I I used to do. A million take home one eighty now I do three hundred take home two hundred and not stress and then I also coach that. I'm you know so much of our stress. Stress is just by design in dentistry. There's so many threads on stress. You know what just slow down and the way I was just fight is because I want to be treated in a lot in dentistry. When you're really really stresses because you only got seven more minutes to finish his well throw the clocks way? I mean who decides that for you who you're should be who decides how long you should schedule you do. And you know I don't know there's a movement in Europe right now. It's called slow well. Dennis right and to have a very specific protocol that they're trying to create a defines. The Basic Minimum Guel right is is that his movement Maguire L.. I know Mark Resnick and I know that he was featured in there. I don't know the name of the person that actually started at but I kinda joined their social media. Yeah and I watched some of the things that they do say an. It's an interesting concept. This is like no. There's always this should really be less than an hour and that that that's just not that complicated to understand yet when we put three or four things and you know I. I have done that when I finished school for about four years. I worked in a really busy busy clinic and I felt exhausted every day. And it's just really hard to finish something and no you didn't do your best I want. I can't believe we went over an hour but I want to explain something because there are some old people whenever I say. Almost a quarter mile quarterback emails. You're still in middle school and the Russell there. They're all under thirty. But I get one from fifty sixty seventy year old every once and for those older guys out there are a lot of them. Tell me I want. What's your huge on instagram? They don't get what facebook and instagram. Wha- What do you think instrument what what do you think Mark Zuckerberg son of the dentists. Edberg Edberg why. Why do you think his son pay a billion dollars for instagram? And why it's a big thing in your in your world so explain to the old till you. I'm more with the the old guy than the young guy. What I have is a team who understands instagram? And I'm trying to get better at at my social media personnel. Social media stuff is not that good mix accept students family friends etcetera but what instagram does is it allows you to broadcast something and show what you you have done or what you can do and people can pass it around so quickly and best a good part the bad part is UC. See a lot of stuff that could be misleading as well. You see before and after you don't see a prep you don't see anything like that right so I think in our area. INSTAGRAM has Laura teaching opportunities that you could do. If you standardize it the senator we're talking about re re re think sort of toying with the idea of starting something Michael I preserve which basically becomes a group of dentists that dedicate themselves to a particular practice. And and don't let the million reasons of why you shouldn't don't think that way think of why you shouldn't find a way to do it. So we have like a five year goal in that in that concept but rethink as you should make available to people in detail how you did something I think. INSTAGRAM can be huge that way with the instagram. TV's and so on And I think the younger population gets that a lot and the meeting that I'm here for the that I'm excited to see what they're doing. Yeah just born. Learned that way you know. We didn't send violence influenced dental dot com the dia founders are Blake McClellan founder of implant. COMPARE APP DR. Dr Nouri Sonata Process It on us. Dr Peyman Pay Ray Razi General Dentist Dr Benjamin Johnson or Mexico facial surgeon. Dr Brian Boas General dentist. And you know you look at a from year one to year two. This changed its dramatic attic. John Koi is keynote speaker. This has to mean something for John to agree to do this. And I'm thrilled to see it. Because because that's the population that needs to sort of learn how to diagnose better how to be conservative. If that's what they choose find the things they like to do not do the things they don't want to do because we live in an interdisciplinary world and I think this is what he does better than any anything. I mean it. Sure he's a great world class process seconds on all fronts up but for young kids. He's such a great mentor. Because he's not GonNa make you feel bad. There's no stupid questions in then he's GonNa he's he just has a great. Is that the green. He's just a tease him that His secret talk kind of bridges. He sprays windex on him before. He's cements member. Greek fat wedding. Remember that windex thing. But he's just he's just such a mentor and and he's with Pecos does Michael PECO's same thing. These are guys were. I mean you can just I say there's no stupid questions at take under the thumb and they're just saw aw there just so world-class and Joel Moreno far. He and he teaches right here in a in town. Zero surgeon right. Yeah Western and on my Gosh. Brian Harris whose local yeah. He's a talk about his dad's a dentist knee that had four sons and so forth. And so I I what I found out There's Denison town. We had four boys and they were ten years older than my boys for boys. I call them. I said I gotta be your friend. Spend the night with you can i. And he said well. I'm going to L. V.. I and I said well can I share a hotel with you. And he said Sure I I figured since he knew I had four boys I would hit me on them because it was great winter. Lv I in the day that night we go in the hotel room and he would just tell me all all the advice of raising four boys. Three boys turned out to be Dennis in one a laptop but my God what an entrepreneurial Brian is Greg. So what's what's the takeaway from that influenced dental. You're asking me about three days too early. He ever been to my main purpose like I told you. I WanNa see what it's like and and I'm really excited to go see. Amanda say of heard so many good things of never heard her speak. So I'M GONNA go watch her speak and some the other speakers and see who I can work to bring to our symposium and expose their good work so those are all the all the speakers all those many more all those are speaking. Yes yes and who. Were you looking forward to Amanda. Say Say yes she she. She actually has joined John Choice. I believe and they're doing a big hands on on direct resin which I think is so needed. And the country's big so the more people that get to get exposed them more will become interested in at a symposium. You're not gonNA leave it and go do it and be an expert but it gives you the resource to maybe go take coys class and in and learned that and and become better and abandoned say she's a From Mount Pleasant South Carolina. Yes of matter at a number of different meetings we sorta both belong to a ED. And I'm really excited to go see what she's presenting and then some of the other younger people that I know oh like Sky Adama of never mad never really seen much of his work. He's very good photography. And you know it's going to be exciting to see these younger people April who nobody knows about presents and let me tell you about photography. It's it's the your Po. Danny Domingo's 'em denting dominique is he. He's Sir too but I mean it's it's amazing how Patients go to your website. And you tell me that you're a member of the American American Academy of Cosmetic Dentistry Implant Dentistry. Your choice spear whatever you told me all this stuff and you your website and you just look like Joe Harry and in my gosh patients are so visual. We're talking about. That's what we do the podcast on Youtube to my gosh the people that get a digital camera and commit to it now some way no can't commit to it but they got an assistant that committed to it and that was the last I wanted to point and then we'll wrap this up is the fact that on the e point I was lecturing to like a hundred guys in Scottsdale the other day. And you know the big dilemma with anyone with associates is employee turnover. Of course how do you. How do you keep your employees toys? And and it's like well I hear the other end What was the tipping point? Of course people don't like their job. Course stay in bed and eat donuts all day but you know But what was the tipping point at a really big day. They didn't sleep well last night. They were doing that big Muller Endo and they walked in there and they're they're joe Friday dental assistant She's gone on now and then here's some temp that he couldn't pick out of a police lineup and I told her D.. So guys menu. You can't have the region have dentists turnover. Turnover is because you have employee turnover and stop the employee turnover and once that dentist like a rule my assistance. Once they've been with me fifteen fifteen twenty thirty years. I always say you know. If you'RE GONNA call in sick lease have the courtesy of texting me first so I can call in sick and I don't want to go work with the temp and I'm me my gosh when I have to go in and it's going to be a temp you should see the sweet tax dig- at you know the I mean because they know I just can't stand and so you want the uncensored answer to why we have a problem and remember we tried to build a point and and we can't staff it you don't take care of to them. You do a parallel. A twenty five year old person that gets the job norstroms good employees responsible person smart ext things up follow that career for ten years see the growth pattern and what they get and benefits and everything that they get in that world and the the stress that they would have to go through compared to if they make a mistake in dentistry. Much more dramatic right in any good person would feel bad if you nick something but what when we make a mistake someone gets hurt right. That's stressful for someone who cares so if you look at it in that paradigm I mean just going to say stuff that probably is going to grow issues with a Lotta dentist and they may not like what I'm about to say but why should a hygienist ernest be paid more than a dental assistance. Your Prophet on a hygiene appointments is about twenty to thirty dollars when you take everything away. The time that you to schedule The patient that part of the office. That's rented for them and what they get paid and I'm not saying they don't deserve to get paid but a chair side. Dental assistant is what enables you to your best and really when you the plateau is like by the time you hit twenty five thirty thirty dollars an hour. You're right. There's nowhere to go practice. Consultants advise you to get rid of them and get new ones. So that whole dynamic is is unfortunately Florida and I try to keep mine interested is maybe I can't pay them the same as like you know some of the things but you saw me come. I'm here with two of them right now. How many dental assistants go see what you see? The could get inspired to be like. Wow look at that rubber dam and how much users to work for them to take the initiative to actually go an support what she learnt so just in case you swished you at me Sony. The only people that come on the show and said that they you know for thirty years. You're going to see in this side of the room. Every row is an office dentist receptionist the whole teams there air and it just you know every row is an over here. It's all the dentist coming along to save. And you look you pull the tax returns on this group. This group makes twice as much as this group. I mean they don't come to your office because they have a problem with some person in there will. You're only one of five six seven people in your office and My Gosh the the the people who take all their Tamara influenced so those. Dennis came to the influenced incidental DOT COM in Phoenix and they came by themselves and say okay measuring majority. Yeah so it's like okay. Well you came to Phoenix. You got all fired up. You're all charged up that you walk. Walk back in there Monday morning. And your staff's like an out the stop feeling it so on. Well I WANNA thank you for all that you do for dentistry and it's a I mean you have some big fundamental lofty goals and I. I'm sure you're more than anyone. How difficult they are? I mean it's so so hard to turn around a train that's been going the same direction for seventy years but if anybody can do it lets you thank you so much for so much really appreciate being on the the show. I know. I can't turn the trainer on. I'm just looking for a car to God different direction.

Times United States Los Angeles California USC Kansas America California Delta La Dental Piatra Dennis Ostrow School of Dentistry Hollywood L. L. A. Dental symposium director Los Angeles Dental Symposium University of Geneva National Dental Society Herman Ostrow School of Dentis president
Usability, Satisfaction, and Usefulness of an Illustrated Eczema Action Plan

JCMS: Author Interviews (Listen and earn CME credit)

23:39 min | 1 year ago

Usability, Satisfaction, and Usefulness of an Illustrated Eczema Action Plan

"The buck. Amac Jason mass podcast. Kirk Barbara, the editor of the journal cutaneous medicine surgery. And in this episode of the podcast, we're gonna speak with Michelle Ramian lead author of an article that was selected for team e credit in the November December twenty eighteen issue of our journal. The article I selected for seamy is entitled usability satisfaction and usefulness illustrated. Excellent action plan, I selected it because I think this is really going to be helpful to conditions when we finally see validated and reproducible action plan as you were call in March April twenty the first phase of the action plan was brought four with yellow stray shins. The article was authored by Dr Ayman out of the Jones hospital of eastern Ontario with a group of co-authors. I'm very happy that Michelle is with me now to speak about this research. Welcome shell. Thank you very much for joining me. I really appreciate your taking the time out of your day to to walk us through your your publication. An exit plan. Whatever got you thinking about wanting to do that sort of thing, I think virtually any dermatologist who has been in practice for long enough, and particularly people who see children would see the unmet need for a more efficient way to provide effective care for patients who have eczema, and that was really what led to this project. So at the children's hospital eastern on -tario, we have a huge population of eczema patients much like a lot of community practices in a lot of other academic centers. And we were finding that these patients were making up over fifty percent of our visits. So we were trying we with our act exam action plan. We were attempting to provide the same level of care that they would get in tertiary center. Visit in a more efficient and more durable way. Renew. Started this. It was a number of years ago. And it you've been four or five years. Putting this together I understand in our our first introduction in the journal was in March of twenty seventeen when we published the rations of this. And and when you start using these eggs action plans, I I read read the literature. They say they work. What was your? What was your thought? Did it really improve the ability of people look after themselves and their children. So I might clinical feeling is that yes, the evidence also points to the fact that eczema action plans improve outcomes and also pro patient satisfaction with care. But I I think going back to you alluded to the fact that we published it previously on the on the validation of the pictograms are the images that are are action plan about a year ago, but the work on that actually started many years prior because we. Went through a very rigorous validation methodology to ensure that the action plan was something that would be useful. And understood by patients on that is what makes our action plan unique as compared to the existing action plans. It's really the fact that patients were involved in the development of the plan from the very beginning. And we did we also sought input from for example, pharmacists, emergency doctors who also see a lot of patients with eczema to see what kind of information, and what things could be included in the action plan to make their care more comprehensive and also officiant so. Do I think that these action exam action plan helps patients I do? And part of the reason I think that our plan is particularly helpful is because we got input from patients on went to put in it. It wasn't just so for I can give you a good example of actually we thought that one of the when we were does designing the exam action plan, we had key concepts that we wanted to illustrate and for example, one of them one of the concepts was about taking cream out of a small out of taking cream out of a vial or out of a out of a container using a using a clean method, basically not sticking your hand into the tub of cream. So initially we thought that the easiest method for a patient to do this at home would be with a spoon. So we had a pictogram that was a patient who was holding. A tub of cream and taking cream out with a spoon. But obviously this was interpreted by most patients as eat ice cream and your exam will get better. So we had to adopt some of the images some of the concepts that we felt that I think as physicians we think might be very clear dermatologist, we think might be very clear that don't make sense when you try to translate them into a single image. I note the painstaking detail in both articles and and the duration of time. I mean, I can't I can't wait to see it. You gotta get published soon. Because it's with great anticipation that we're all looking at because those pictures were fabulous in the fact that get the pictures to to wear a hundred percent or very close to people actually recognize what to do based on the pictures. I would have never thought that it took that kind of effort. But clearly it did. And then you're reading level, you're reading levels. I I read with with a bit of humor, you you're doing it a great five level or below a great vibe level. And then one of the limitations you say in somewhere in the discussion was the in Ottawa, they have a very high literacy level, and I I sort of have to smell because you made it for a great five level in in this high literary or literal area if you will. So it it won't make any political comments about that the present. But it did strike me as a bit odd. But I understand why had to go to five and then you said. The better the reader, the less likely they were to not less likely, but they also needed pictures. Even though you got it down to a great five level, the pictures are really appreciated. So will that be the centerpiece of the of the X action plan? You mean that the pig? Picture the restrictions. Yes. The pictures so the with with images there's the picture superiority affect which has been well established. And so even patients who are patients or caregivers who are very good readers. They benefit from that additional reinforcement with images. So the kind of cornerstone of developing this exemption plan, I guess one of the cornerstones was that we had patient input. But the images are what really make it acceptable. And also tool that functions as a memory aid away to reinforce the need for treatment, and the concepts of treatment of us this in the clinic as a as a teaching tool to to write out what you want the person to do and or their caregiver, and then they took it home as a reminder. What serve the best markers are where they both useful. Yeah. So when we first developed this action plan there was there was not a lot of 'em. So five years ago EMR's were used a lot less than they are used now. And that was when we started working on this exam action plan. And so in fact, the eczema action plan was designed as four carbon copies that would be distributed to the patient when patient one copy would go to the patient as a they would take it home as a reminder of what they were supposed to do for what level of Exuma, for example, in the general measures another copy would go to the family physician as documentation of their visit. And so that we would have coordinated care. Everyone would know that what specific instructions had been given the third copy would go to the pharmacist. So that the pharmacist instead of providing their own counseling based on their knowledge of the medication would hopefully be able to adopt their counseling for the directions that we had given. And then the fourth copy would go. To medical records remain part of the medical chart. So it was also meant to be it was meant to be a tool that improves education in prescription processes, but also increases your fishing because you wouldn't necessarily have to write out everything that you had done in the medical note again five years on. Joel this. Yes, we are looking at ways in our. So we are currently doing pilot study to look at objective outcomes exective Zima outcomes using an exam action plan compared to routine care in the dermatologist clinic and in differ this project what we've been doing is using a pedia firs in that's scanned into the Marin can be checked. We are kind of check boxes or boxes that need to be initialled. And then it can be printed out in multiple copies and distributed in the same fashion. But it probably the technology may need to be improved going forwards to envision in a busy community practice. This being incredibly useful tool that you would you would use as your teaching somebody how to do what they need to do. And then you will give it to them, and they would leave and take it home those. It'd be the principal bits. The pharmacist and the and the referring physician would be less important in this because they may be I may not have a pharmacy that go to regularly or to them any member physician that go to regularly. So do you are you envisioning electron version of this plan with the pictures and somebody could go home, and you know, Google it or look it up somewhere. Yes. So I think that what we had planned for this Exuma action plan would be that it would be available to be available free of charge to dermatologist or other health care practitioners who wanted to use it. But I I guess patients could print it at home and bring it to their appointment haven't completed, but it it does meet all the criteria to be used as a prescription. So in terms of translating it into an electronic form that is probably a few steps down the line because we would need to verify with our pharmacy. We have clobbered in pharmacy that it would still meet the requirements to function as a prescription. Because I think one of the strengths of having an action plan that goes out in multiple copies to different people different. Members of the circle of care is that you get a cohesive management plan rather than for example, the patient going to the pharmacist. Who tells them only to use the cortisone cream for two to three days, and you know, makes them very concerned about adverse effects? So it's a back door into education. The pharmacists about about the medication. And I think it is a broader it can be used as a broader education tool. So it is helpful for patients. But also, for example, family doctors or pediatricians who are less comfortable prescribing medications for eczema, the they have check boxes so they can choose options that are appropriate for for example, mild moderate or our mild, mild flares are severe flares of eczema. But they have pre they can kind of preselect amongst the options. They don't have to write out what exactly what they want. So it's also a learning tool. I think for community providers not necessarily dermatologists who might be less familiar with treating and prescribing for eczema the burning question, I have is when do I get to use? It sounds. It sounds like it's an ideal thing. And I'm I'm as I said earlier, I'm fearful this is gonna take another two or three years before I can get my hands on. Oh, I hope that it won't be two or three years. The val. Dacian process. We were very fortunate to have collaborations with the pharmacy division or department at the children's hospital eastern on -tario, and they really insisted on this rigorous methodology. So that moving forwards this would be we would be using an evidence base or validated plan. And that is part of why what led to the I guess long run in time to having an a complete exemption plan available. Our pilot study is actually mostly complete. I suspect it will be done by the end of two thousand nineteen and after that we had planned just to make it available with a few adaptations based on what we see in the in the pilot study. So you so I can see this being version one version two version three one as as as people start to actually use the tool in clinical practice a final. I would I would once again urge you to get it out there because it's something that. Is so needed in our community. Right. And I think patients will really benefit because they'll start to use it in and and teach the pharmacists, I think that's one of our biggest problems mature, you would agree. But a lot of the times the pharmacies. The stumbling block to effective care. Because they scare people with his third full bay. This stuff about cows and earn inhibitors and all that sort of information. So well by providing I think by providing the directions on how to use the medications that also takes a little bit probably for the pharmacists that makes them feel more comfortable with our prescription practices. And in some ways, I probably removes the onus our responsibility off of them a little bit some perhaps they'll feel more comfortable filling our prescriptions without providing all of those scary warnings. Will what else do know you've learned a tremendous amount about doing validated research in creating validated tool? And so now we understand when we do any kind of research. What it goes what goes into really, what sounds very simple stuff in order to to dwell validation. I mean. Do you think that this thing will have a life? Is there somebody that's going to carry on after you decide? Okay. I'm moving on to other things this somebody in charge of it. I hope not to move onto other things. I I really eczema therapeutic education for exhibit is one of the areas of pediatric Rheumatology that I'm very invested in. And I feel like we can make a big difference for people who have eczema. And this is one of the ways that we can make a difference as part of may be a more comprehensive approach, but I can see I can see future spinoff projects coming out of this exe- match in plan, for example, validating it in different populations different in different languages and possibly in different countries event. I mean, there is some interest through the foundation for a topic dermatitis, which is based out of France in adopting are exempt action plan for use in a broader audience as well as though I think it should be static eczema action plan. It should evolve to meet the needs of the of eczema patients. As treatments Volve and as our technology evolves as well. Because like I said this was designed as a carbon copy prescription. And it's not going to come out like that in the end. I'm thinking, maybe we should explain what carbon copy is because it's been so long since I since I've seen one so this. So it's designed for for uses at their -peutic tool like to treat patients. Right. It's not it's I'm assuming is not going to be designed as an outcome to. I mean, right presently, right? This is to make people better. This is the help people's lives to improve people's it's so I think that we can improve outcomes with it. But it's not the primary objective of the eczema action plan. I think when patients are better educated they can be they can take ownership of their condition. They can feel empowered to do to note with the knowledge that they need to care for themselves better. And even just that feeling of having some control over a condition, that's chronic and very. Fluctuating over time can improve patients quality of life. But ideally, it also improves their exam if they follow the directions properly or an end, adopt them to their particular situation view made any advances towards the home group is harmonizing outcome measures for Exuma group that meets the multiple times year from all over the world to try and figure out what the best outcome. Measures are going to be there been any interest expressed. Yes. So when we when we designed our pilot study, so I I don't know that the home initiative aware of our action plan. But when we designed our pilot study, we reference the home the home proceedings from two thousand seventeen and we selected the easy in the score at as our combined primary outcome because those were felt to be the best measures for grading Exuma severity at. At the time of their last meeting. But there is obviously a lot of a lot of work to do promoting the exam action plan and bringing it to a broader audience and hopefully improving along the way. Once you get it out it will promote itself. I'm quite confident that the amount of work you put into this has been outstanding. So thank you very much from my patients already that will that are benefiting from these pictures. I I do use the I do use the pictures now to show people in there, there's language issues. And so the sooner I can have a look at your at this work, the better. So I'm the end at twenty nineteen couldn't come soon enough for this. Thank you for saying that I I do want to knowledge all of the people who contributed to this project. You know, MAC solder who initially started this as a resident project brought on Atlanta McEvoy who was at the time a medical student now a dermatology resident to and Alanta brought on Catherine MacDonald who is now. Dermatology resident in Toronto. And Amanda, Shelly was the most recent medical student working on her project. I think she's applying for Matala g now. So maybe there's a bit of a plug for her. And then and then and who were the the you had pharmacists involved too. Yes. So. Reaches. Vion core is the head pharmacist, Chico. And he was involved in the development of the asthma. And if Alexis action plans at she oh and was a natural collaborator for this project. He also had any pool yo who is a clinical pharmacist working with him at the time. And our other major contributor was Rogers democ from the emergency medicine department who worked on the asthma action plan are also reach out to Nordahl Canucks. Berg who I see list of you trained me when I was also so wonderful group to work with. I'm sure and and it's nice to have that enthusiasm. Isn't it? The people the medical students in in particular, really drives some of this stuff. Well, Nordahl nor was really the father of this project. He he is the person who promoted it from the beginning. When max a resident and o n has always been extremely supportive. But. Also provides this clinical realism, for example, when Biro when we were looking when we're agonizing over the semiotics analysis of the different images. He just said we need to make this good for the patients. He he never lost focus of what was really important, and I have to really give him credit for that. Because it has been a long process and he's been there since the beginning. Good for you to carry on the legacy. So thank you, Michelle. I know we got you it to work and out of the clinic to join us. Oh, a let you get back to that. Thanks again. Thank you. Thanks so much for your interest. In our action plan were excited to bring it out to everyone. Michelle Raymond is a clinical associate professor pediatrics at university of Calgary. The work. She described to us today was worked that she performed when she was innocent socio Ernest rather professor pediatrics at the university of Ottawa and practicing at the children's hospital of eastern Ontario. She's the co author of the article entitled usability satisfaction and usefulness of an illustrated excellent action plan team makes reference to her co-authors is it is a collaborative group of medical students. Dermatology. Residents and pharmacists period, and we also make special recognition the fact that Dr Nordahl Canucks Berg from Ottawa is really the founder and father of this clinical project to my mind is a connection the key. Takeaway from our discussion was the fact that we will have a validated. In sounds like a very useful. Exa action plan for our patients for clinical use in in our patients. I'll start again from to my mind. To my mind is a commission the best thing. I heard from the talk was that the end of twenty nine will probably have an action plan to use a refer you back to our March twenty eighteen issue Jayson s where photographs and rather illustrations were reviewed and dominated. And so you can start to understand the utility that this project will have for us. I think this is another instance where Canadian researchers and clinicians are impacting the welfare of patients everywhere in the world. That's it for this episode of JC mess. Author interviews podcasts I'm Kirk barber. Thank you once again for listening, and until we meet next time be good to each other.

Michelle Dr Nordahl Ottawa eczema Michelle Ramian Kirk Barbara Dr Ayman Jason mass Jones hospital of eastern Onta Google editor family physician university of Ottawa Toronto Kirk barber Michelle Raymond Joel university of Calgary Marin -tario
Episode 4 - Let Us Take You to CanRIO  -  The Canadian Research Group of Rheumatology in Immuno-Oncology

Around the Rheum

25:32 min | Last week

Episode 4 - Let Us Take You to CanRIO - The Canadian Research Group of Rheumatology in Immuno-Oncology

"We I think one of our strengths is that were national network We have sites all across Canada and very keen people who are interested in collecting this. Another big strength is that we've already collaborated with other countries who are doing similar things. That doctor Shaheed Jamal talking about the Kaneria network she is joined by Dr Kerry on this episode of around the Rim Canadian Rheumatology Association podcast. I'm your host Daniel Ns. Today, we'll be talking to Dr Kerry. I ever you wind my name is Kerry. I'm rheumatologist in Edmonton I'm a clinical assistant professor at the U. OF A. and I'm a member of Cameo. Doctor Shaheed. I everyone. My name is Janine Jamal. I in. In. Vancouver British Columbia and the clinical associate professor at the University of British. Columbia. and. In adverse events of immune checkpoint inhibitors both are founding members of can Rio, which is the Canadian research, group of Rheumatology in. Immuno oncology while Katiba. Thank you. So. I think can really really interesting and I think we should start by defining some terms, I so she can you tell us a bit about what the can Rio network actually is. So they can radio network is a group of. People, clinicians, researchers, basic scientists across Canada, or interested in some of the adverse events that occur as a result of the nudes immuno therapies for cancer So that's what we are a group and we are studying right now one of our main focus is studying prospectivity patients who develop these adverse events clinically and linking it to their bio data. Carry to Sheen started telling us about the adverse events. Can you actually expand on that? What what is an adverse event with drugs? Are we even talking about here? Okay. Adverse events are like side effects basically. An Immune checkpoint inhibitors are this very exciting new class of medications used to treat cancer, and actually predominantly used to treat metastatic stage four cancer, which is the extra exciting part about it. So in some ways I, think of it as almost opposite of chemotherapy. So chemotherapy kills a bunch of thousand. Cudi immune cells. At chatwin headers actually activate she sells which immune cell and allows your immune system to kill cancer spouse. I think actually expand on that as rheumatologists we ought to forget that our immune system is also very part of cancer surveillance and you know we think of it as our immune system is important for fighting infections and that when our immune system doesn't work, it causes autoimmune disease However, our immune system also has an important role in cancer and the oncologist have really tried to harness the role of the immune system for cancer surveillance, which is why they are targeting drugs that actually activate the immune system or inhibit the inhibitors of the immune system. And therefore allowed the immune system to fight cancer which has carry says is opposite of traditional chemotherapy, which the approach there was just kill everything including immune cells and hopefully cancer cells at all died, and so that's where this is super cool because it's really activating our immune system. And this I think is going to help us to learn a lot more about our autoimmune diseases, which is the exciting brought set camera. Can. I yeah. Okay, I don't need any. Excuse. Gopher area. Great. Yes. I think the other great thing about immunotherapy is that you can develop one drug that fights all types of cancers because it really isn't the drug fighting the cancer it's asking are super complicated super sparked immune system to fight the cancer why one drug now be used to treat so many different cancer and with her two cancers are we actually trading with immune checkpoint? Inhibitor Semaine wants right now are melanoma that was the original disease that was approved for, and now I see a lot of non small cell lung cancer. What else have you seen? Should he? There's lots of genital urinary cancer is a lot of the t cancers sarcoma low falmouth on some types of pancreatic cancer or some types of breast cancer and I think. Some squamous cell cancers, and in fact, the FDA a few years ago had given almost carte blanche to approve these drugs for refractory stage four cancers that had no treatment. And some of these patients who had no other options and were you know had a very high mortality from their cancer have been treated with immune checkpoint inhibitors and some of them have had a good response of their cancer. So they're being used for all kinds of cancers and I think if you look at the data, they save fifty percent of cancer patients in the next ten years will be able to be treated with immunotherapy. So it's very, very exciting exploding area. So with one drug or multiple drags but on drug at a time treating multiple cancers, what are the general targets for the immune checkpoint inhibitors while the two main ones right now that are approved Canada for use are basically monoclonal antibodies against detailing four and then either p one or p l one which both breaks on the immune system basically inhibitors of t-cells. So currently were targeting those chew inhibitors, but there's many other molecules targets eating tested right now, how many drugs are now approved for use? So currently held candidate has approved seven checkpoint inhibitors and so many people with. With many of our patients might be eligible to get treatment for their cancer with one of agents. So rheumatology, what do you guys have to do with the these medications? In the first place they're being used to treat cancers why do we need rheumatologist in the next while if you think about it, if you're going to basically take breaks off of the Immune System Kinda, give me a free rein right now there's a lot of inhibitors in place to prevent auto immunity. That helped with south tolerance basically, and if you break that, then you basically can get inflammation directed to self antigens and can cause matic diseases. Were clinical spectrum are we looking at here? I would say this is what I told. My residents think of any Oregon Adam is to it and that can happen. What are some of the common things that we're bumping into Shaheen? Maybe you can take this on. I think the communist thing that we as rheumatologists are is inflammatory arthritis. Commonly we see threats that symmetric that mimics rheumatoid arthritis or mimics polio algebra Monica. But there's a huge spectrum many of his many of us have. Quite, Asus particularly large vessel vascular access. myositis is the other big. So those are the big categories but then there's everything is curious said everything in between and the other interesting thing that we're seeing is this sort of rapidly progressive osteoarthritis or inflammatory osteoarthritis and I think that's an emerging area. Recently, there was a publication at ultrasound findings are patients who have joint pain and it seems that ultrasound wise they have emphasized. So it's emphasize that causes there need paid not clear the innovators and so this is all emerging work just at the spectrum of learning about it but those are the big patterns. I think the other thing that we as rheumatologist. So you know most centers across Canada have a cameo person who's Interested. So if you have patients that you can refer to them but I think the thing that all rheumatologist are going to have to have some understanding of is their patients who have preexisting romantic disease because the patients with preexisting autoimmune disease were excluded from the clinical trials. But as you know, our patient also get cancer and so that's where the big question is going to be is how to treat our patients with Autoimmune disease. So there's going to be the denial arthri or to. Romantic events that also had a manager patients with the existing Kasese. Kerry how do we actually go about telling the difference between patients who have? Immune. Checkpoint inhibitor related inflammatory arthritis or just incident rheumatoid arthritis, for example. Good question and right now it's a little bit hard to tell I. Think for a long time we were under nine now same. Rheumatic immune related adverse events from immune checkpoint inhibitors. I also like the pendulum swing the other way, and we're actually blaming every little thing not occurs after someone who started on IC- therapy on their I see. So I think you have to look at is a lot of lakes tiki ca eat grading. So a lot of people have him before they start immune checkpoint inhibitors, but then I see of back raiders changed and so that my represented slayer. The other differentiating thing is if you get someone with. you know paulie arthritis small joint. If, they have been sero-positive. We learn out that most income tax right is from immune checkpoint inhibitors on So if I see Sarah positive generally think that's probably pre existing. Rheumatoid arthritis that baby was messed and maybe flared on therapy. And then other things that you might think about is like is this kind of a disease that presents in this age group normally, right this is the general demographic acute onset Holly Arthritis occurring in a seventy five year old male less likely. So sometimes, it can be hard to define the causation or association, but the negative serology, your inflammatory arthritis that might be helpful clue that it's immune checkpoint related. How do we actually go about treating immune related adverse events? Are there any principles of therapy that rheumatologist should think about? So I think my very first thing that we have to remember that these patients have cancer. And you know our responsibility to the patient is to help them receive treatment for their cancer. And a Lotta Times as I mentioned earlier in clinical trials patients with free existing disease were excluded and so when we add when patients developed auto immune toxicity, they were removed from trials and so often the oncologist wants to stop their treatment or halt hold their treatment and not don't know really how to manage it. So our responsibility, the the main principle is that is to facilitate their cancer treatment. However, that looks and and most patients are on board with that. Their goal is often be under report their droid sentence because they're afraid that their cancer treatment will be held if they report joint engines. So if a patient develops one of these Matic IRA's Do, they have to stop checkpoint inhibitor bushell one no now. If you develop a romantic IRA. Does that tell you anything about the prognosis of the cancer or the success of their treatment? I think there's conflicting? Yes. danger I think for a long time we thought that. If probably had a good Austin You of ribs to represented like a robust immune response Abbot of the contract but then. I think there's also been other studies that have shown the opposite and. I think that the jury still out on some challenges. So if you look at other auto immune adverse events, for example, in melanoma patients, if they get vitiligo that has been associated with a good tumor response. So if you have metastatic melanoma, get a checkpoint inhibitor and then you develop it, ally go those patients tend to have a good response of their melanoma and probably as. A flu to that suggests that the immunotherapy has turned their immune system on. So it successfully did what it was supposed to do, and therefore the patient often alive Oh. Of their immune system being. Active And but a lego typically, we don't immunosuppressed Riveta. Lego. The challenge in romantic disease often are patients because it developed arthritis or Myositis or sarcoidosis we have to immunosuppressive, and initially the initial studies suggested other people are a treatise that was also a pattern. Those patients had good tumor response but more recently at even can real we found we have a large retrospective review the largest in the world to date at our review, we found that those patients who received. Who are drivers and received immunosuppression had a less robust tour response and what we don't know is whether that's the fact that they had a romantic adverse event is a marker for less good tumor response or visit because we immunosuppressed them and I did the effect of the immunotherapy and that's why they had less of its human response. So again that. Still. Stop with learning about. So we're activating their immune system to treat their cancer they developer rheumatic IRA with the modern immune suppressant. which may sway things. The other way we're not we're not sure he'll now I said he said definitely. Show steroids can blunt the tumor response. but I think it's hard to apply that to what we know now because our retrospective cope included really high doses of steroids because that's what colleges typically do, and that's what setting protocol if tate but I think we're moving towards less steroid use earlier demar therapy so We might see. Yeah I think the challenge is because you know this yields changing rapidly every month or two months there's more more more case series experienced face literature, and that's really what it is or is not our C. T. Literature for how to manage these toxicities and as we look at each other's experience, we change how we managed song you know if you. Look at a retrospective cohort, we used fifty sixty milligrams of prednisone for joint pain. Maybe we didn't need to. We didn't use any arts because we were afraid. We didn't know if these would be chronic or not products always prednisone, and now we're starting to use D. marts earlier because we're learning from our mistakes and other people's mistakes along the lines of NOCES. why do you think is really interesting as there is a study that looked at Inflammatory joint pain and three days after discontinuation of immune checkpoint inhibitors and things that we learned from. That is one if entree detritus can continue to persist actor, ICI's are discontinued to the people who had continuation of their country arthritis have better tumor So is like they had sustained activation of your immune system would be my take away from that. That was one study breaking. That's a really interesting thing to think about. So, totally getting getting mixed signals and I assume not enough literature to differentiate vitiligo specifically good prognostic marker sarcoidosis, bad prognostic marker. This is data that we have to figure out over time I think the challenges every tumor is different. Every talk city is different because it's all different immune pathways that turn on these various clinical manifestations, vino types. So we can't necessarily say that because Vitiligo. Is a marker of a good tumor response or threat. This is also you know and that's the big challenge right and so that's again where we need long-term prospective clinical data to to really identify patterns Tumor Specific Drug, specific and today what happens patients get combination immunotherapy they get switched from one to another because they have one, they might get collided with something they switch to something else than the yet thyroiditis than they get switch to something else. So we don't know the chicken and the egg. And there's immune activation has carry said it's it's really interesting that those patients who ended up having chronic immune activation. Even when they're needle therapy is stopped, they seem to have a better. Cancer Response, which suggests that once their immune system is activated, it's activated. And that's for our treatise. It's been shown for scancen. Also, they showed that because people will often have ongoing vitiligo a worsening vitiligo even though they've stopped their child and not on the drug anymore, and those people tend to have a better tumor response. Abedin patients who? Have a pre existing rheumatic disease what you guys think about continuing or discontinuing their immune suppression before they start their immune checkpoint inhibitor. Also compensation. Know, what I? I have to say most patients that I've seen like this, their demands have been stopped already because a lot of them were tired on chemotherapy I and they progressed chemotherapy and then they're being is therapy so. I have to admit six months ago. I was actually starting them on d-mark preventatively because there was a study that showed. March didn't affect tumor outcomes. My Pot flares can because they can be to discontinuation Hulu by. Scott. Therapy. And then this is what we were talking about how we're constantly changing our practice three months ago or so city came out that said initiating demands at the time of. ICI. Therapy M maybe associated with working responsible. Now we undo that anywhere and again kind of the idea that like the artist blunting the immune response from the ICS. Right. But the same study also showed that if you started d. mark the D- marks, they documented in this study where methotrexate iron. If you started at after initiation of ICI therapy than it did lunch response. So now I sort of I'll let them flair and entry, and then they'll have better tumor response but this is based on one study and the challenges is if a flare so it's all about risk. So if somebody has a history of myositis and their myositis is well controlled and now they have metastatic melanoma. And there say they're on as alive or one hundred milligrams a day while cajoled myositis that patient I probably would not stop there as vibrant of withheld, we continue it. Because to have a fifty percent chance that they're myositis will larry what I start limited their off any gr start the Mata Martin's prophylaxis. No there's no data to do that. In fact, the date suggested Carey said the very limited data suggests notched to do that. But because the risk of flares fifty percent of their underlying autoimmune disease, I would probably not stopping on the same token. If you have a rheumatoid arthritis patient I, think it's less bad player. You know the the problem with myositis flares in these patients is that they can be associated with other. The highest mortality is recorded, which happens with myositis and we don't know if it's the pre-existing disease page the same noble that's the problem but. myositis would not watch clear laboratory titus. I'd be fine to have a flare treat. So we still have to continue allies the riskiness of their underlying rheumatic disease even though of course, like the cancer is. Perhaps, the most important consideration that's perhaps the most fatal thing. The romantic diseases also important we have to adjust therapies he's cases. Fatal there or high risk their diseases, and it also depends on the flurry. Civic rheumatic disease and I was kind of surprised when I was reviewing most improves this neon paper they had like I can't remember seven lupus patients or something only one of the lupus patients flared and it wasn't very mild. Compared to other ones where it's more like fifty percents survey and I probably has to do with underlying mechanism Lupus, which I think is more B. Cell versus cheese out. Activation with. I think we're GONNA learn so much more about this, and it's going to be much more. Disease Drugs Tumor specific. So, maybe, Kaneria will teach us a little bit about those things. So what is Kenro actually working on right now with the pipeline so can. We literally just got our central ethics approval like a month ago. So we're just starting baby network I. Think One of our strengths is that were national network. We have sites all across Canada. I'm very keen people who are interested in collecting this but another big strength is that we've already collaborated with other countries who are doing similar things. So even when we were developing our methodology, what we were collecting, how we're collecting it when we were collecting it, we allied with the a group in France and a group in Australia. So we're collecting similar data prospectively were linking that to bio data. So we're collecting serum DNA. And you know there's talk about collecting sandoval biopsy samples and things like that. Eventually, that's our goal in the coming future. Hopefully, skin biopsies another and we're also trying to start a separate sound protocol so that we can get ultrasound information on these same patients, and then we want to collect that data systematically prospectively and because I think that as Jerry mentioned, it really depends all of this depends on the type of cancer, the type of treatment, the type of the. You know the pheno Tikal there were other autoimmune adverse event an also how they're treated so. Patient get the diverse ticks, patients and expressions of adverse events. The more we're going to be able to answer some questions. So the other, the other Focus Cambio concurrent to the research art is the Education Art Kerry speak more about that. So Janet Robertson I another member of Carrio were putting together. See are right now to try and get some funding to put together a website that will allow us to house a lot of resources and information coming out a cameo, and we also want to build some learning modules that are interactive case taste. For rheumatologists oncologists CONCL- assistance anyone who is looking after patients who have these matic adverse events. I think a huge part of doing research obviously disseminating answer. So we're hoping this is one of the offerings that we can use. Shaheen. If clinicians have patients like this, where should they go for help? So at camera, we are trying to be ugly focused, and one of the strengths of Oh is that we pretty much have a cameo investigator at most of the academic sites across Canada. If you have a patient and you don't know what to do, a Sierra website will have a map of Kenro. So you can find your carrio champion in your area. WHO's interested in patients with dramatic IRA's, and you can either call them for some bone advice or you can refer patients to them. If you don't have a can real investigator, I'm happy to take calls and give you phone advice as our other carryover member service close to you. The other thing that we have are some podcasts that were not case rounds. This is a podcast gas. Out here on a bike them. No matter. What podcast. SATYRICON. Rounds Yeah, we'd like to. Start these case round so that there is a place you can go to. If you have a case, they'll be few can real members attending each one? So. We can discuss it offer aren't by we'd love to learn from you guys while so I think that'll be really nice resource for all of us to share information on from each other. So see h you should be coming at unsure will send out announcements. Rosario. That's such a great idea. Thank you guys so much for coming on the PODCAST is really great talking to you. Thank you. Very. Fun. Those Dr Kerry Assistant, clinical professor of Medicine at the University of Alberta, a Dr Shaheen Jamal Assistant, professor of medicine at the University of British Columbia. The Canadian Research Group of Rheumatology in Immuno Oncology is a new national research network focusing on immune checkpoint inhibitors and their rheumatic immune related adverse events. As these agents become more mainstream rheumatologists are going to start seeing these patients. Regularly, we're going to need research groups like can re educate us on how to manage these complicated patients. That's it. For this episode of around the rim. The Canadian Rheumatology Association podcast, we are produced by David mcguffin, Dr Docs Ramsey Heaven Beijing off an Errand Fonterra. We would like to give special thanks to the Communications Committee and the staff of the Sierra for their hard work. We're supported by funding from Scotiabank, the Canadian Medical Association and financial. If you enjoyed your time with us. Please give us a rating and subscribe. So you don't miss future episodes. Can also share this podcast with your colleagues and spread the word on social media. Daniel Ns thanks so much listening until next time.

cancer Canada autoimmune disease Dr Kerry Dr Shaheen Jamal Assistant Daniel Ns sarcoidosis metastatic melanoma group of Rheumatology doctor Shaheed Jamal Doctor Shaheed Vancouver clinical assistant professor Sheen Columbia. Rim Canadian Rheumatology Asso Edmonton inflammation
37. Palliative Care in Heart Failure with Dr. Rab Razzak

Cardionerds

35:23 min | 3 months ago

37. Palliative Care in Heart Failure with Dr. Rab Razzak

"Worldwide cardiovascular disease affects the lives of hundreds of millions dedicated cardio. nerds everywhere are working hard to fight this global epidemic. These are their stories. Welcome back nurse. It's I'm coil as we wrap up our high yield series. We are extremely proud to bring you today's episode. No discussion on heart failure is fully complete without discussing the role of Palliative care and the management of heart failure patient in today's episode. We discuss all things pelt medicine in heart failure with somebody who taught me a lot about palliative medicine, none other than Dr, Rob Razek Clinical Director of healthcare at university hospitals. In Cleveland Ohio joining us for today's conversation is a close friend Dr. our Salon Dereliction Assistant Program director at Case Western Internal Medicine Residency Program in the head of. Of the global health pathway as well as CO, host of the clinical problem solvers before we begin just remember, this podcast is not meant to be used for medical advice. The views expressed here do necessarily reflect the opinions or policies of our employers. The goal is simply to enjoy learning more about cardiology directly from expert palliative nerds. Also as you enjoyed this episode out, apologize in advance. Because of all you can hear. The footsteps of my wife runs after my son for anyone with a family. You know that the chaos of children is what ads the greatest joy to life happy father's Day everyone. Ed Hardy. I'm I am very excited to record this very special episode on the role of Palliative care in the management of heart failure patients as part of our heart failure awareness week series, joining me is Dr our salon. DIRAC Sean. Who for fans of met Ed? PODCAST does not need any introduction whatsoever. He is the fame co host of clinical problem solvers now. Our Salon went to medical school in the College of Georgia. He attended residency at Johns, Hopkins Hospital Oastler Training. Training Program and is now internal medicine faculty at University Hospitals Cleveland Medical Center, and director of the Global Health Track I had the honor of working with our salon last year when I was chief resident on the barker firm and watching our salon grow into the physician and teacher and person he is, today has to be one of the most special honors of my life Oh. Man, how do I even start talking after that intro? Thank you so much, this is. Such a privileged to be on Cardio huge huge fan I'm so excited to hear more. You guys. You guys are just absolutely crushing the game. I had the distinct privilege of introducing. Dr Rob Raza who went to medical school at Bangladesh Medical College in Internal Medicine Residency at Saint Joseph's regional medical, center in Paterson New Jersey, he worked initially as a hospital that Sinai in. He was grandfathered into Palliative Care He. He moved to Maryland to work at Johns Hopkins where he practiced for four and a half years. He is now a clinical associate professor in clinical director of Palliative care at University Hospital Cleveland Medical Center, and I absolutely love seeing him in the hospital he he makes my day every time. He's also devoted husban dedicated father in a stand up comedian in right before this interview. He was practicing taekwondo with his daughter. Thanks so much for having me guys. It's been such a pleasure seeing you guys grow because I think when I first met Ahmed, he was an intern and I still remember our salon when you're an intern to. It's such a Satam. It's been so fun to see the. Amazing work. You've both done on the impact. You've made on patients as well as other teaching you you've you've brought to Hopkinson and now to the US social media. Thank your arms united front. Get started. Just want to thank you for not recounting stories of us in terms. But then also I was wondering when we were making this intro for you I didn't realize that you had gone from the private practice world to the academic religions. Hockey's where you had just tremendous impact. And I'm wondering what What were the motivators for making that? Jump yes, so. When I was when I moved to California. Shortly afterwards I ruptured my Achilles twice actually back to back so sitting down, and just trying to figure out what I wanted to do with my life, and this was probably my. Second or third year in practice I just WANNA. Say That resume and Rob. Your Clinton problems was sitting somewhere making a Schema for bilateral. Rupture! I'm sure there is one. Too many. You WanNa Quinoa. I was I didn't have any risk tractors. I can't do the stretch. so I got to think back about what what were the things that brought me joy, and where I saw myself in the world, and and shortly after that I started teaching Ucla Med students in clinical skills and then work with a lot of dmed students where they rotate with me, Cedar Sinai and that was so so much fun, and then afterwards when we're moving back to east coast. I had this Opportunity Johns Hopkins to quits the Godfather. Tom Smith. and. Any took a chance on me and reopened up my world. We're glad that he dead. Yeah, absolutely, you know very glad you switched over to to academia rob because you're. You're phenomenal and many generations of learners are grateful for this and I'm very excited to learn from you. from this episode for you to share with us. The role of piloted Kieran Heart Failure I, wanted to preface or discussion by acknowledging how big of a deal heart failure is, it's global impact both epidemiologically and financially is is absolutely astronomical in continues to grow exact numbers vary, but around twenty three million suffer from heart failure, worldwide, approximately six million in the US alone. The mortality estimates are disappoint. Fifty percent of people diagnosed with heart. Failure will die. Die Within five years of diagnosis and nearly forty percent will die within a year of their first hospitalization. Despite some optimism from several advances in heart failure management, the realities of these numbers are truly sobering in despite all this engagement with cares lagging compared to patients with cancer heart failure, patients enroll with hospice care much less often in later in the disease course rob. Why do you think this is the case so I? Think I think the reason for that is first of all a lot of the data in Palo of care stemmed out of oncology, and so they're lot of the larger trials were essentially oncology, and then around twenty fourteen ish Dutch side bottom. Came out with a study on acute heart failure, looking at usual care versus specialty, multidisciplinary care, impact on quality of life as well as symptoms, and so I think that sort of set the stage for heart failure. Also you know I think conceptually heart failure is one of those chronic medical conditions that has a natural history, and of course where we see patients that have accused compensated staged like you may see for COPD and other chronic medical conditions, but the inter-korean periods they seem generally well and relatively symptomatic whereas cancer, the word cancer itself engenders a perceived prognosis that is different but I think there is a chasm between our perceived notion of the prognosis of heart failure, because it has his inter-kurd period wellness. And the actual prognosis, our salon talked about so well so I think I think that at least for me as a practitioner, I probably don't realize the prognosis. Sometimes because people seem the I can get them better when I come in with their compensated stage. Yeah, and so you know one of the things I recommend to. Doctors, unders, practitioners and other providers on a regular basis is to ask themselves surprise question of. Would you be surprised if this patient died in the next year? More. Would you be surprised if the next six months right? And, if you wouldn't than. If you wouldn't be surprised, said they would die in the next six months. They party me criteria for hospice. Right and if you think that they wouldn't be surprised if the dining next year than historically. It'd be good candidates for healthcare. I liked that question because I think it really does force you to think about who your patient is and framing their next year in the context of with past year, which I think is probably a nice way of thinking about what the trajectory of an individual pige may be like. Yeah, I think the other thing about this is quite. Quite often. many clinicians they. When you ask them about prognosis, there has intent to share that with you and often it's because they don't want to give up on on patients, and it's well intentioned, and so if you re frame it as would you be surprised if this patient died in next year, it's it's less difficult for a lot of clinicians to answer. Yes or no? In your consulted on patients with in stage, heart failure. How do you meet the patient where they're at set the stage to have these discussions? Because I think it's difficult, you know as providers inclinations. We want always treated in prolong life in for long the quality of life in in sometimes we don't easily convert that into being. Let's just focus on symptoms. focus on quality of care. We're looking to belong DVD's high. You set the stage for these discussions so. Actually like what you said I think the issue is I. Think when we see patients, the people that we care for I think for the most important thing for us to recognize that there are human being right, and they're not just someone with a disease. They're person with goals and objectives in enjoys and and figuring out what they want. What they what they hope for their main goals are what quality of life would be okay with them. What quality of life would not be okay? I think it's really important for Russia's to do, but oncologists cardiologists you name it in, and that's really primary care. Where he was, clinician will have basic skills on how to talk about goals. Of Care, Talk About Code Status How to talk about where people value and what the hope for talk how to talk about what people are concerned about. A really I like that I think conceptually. It's important. A frame is is that because you can keep a body? Live right we can. We oxygenated mechanically people, but at what point like you know. There's extremes to that point. Would your quality of life not be something you would wanna live with? I think teasing that out in a very patient Senate ways the which talking about here. Because I think we as clinicians certainly have our prime directives and goals based on God Linda Medical Therapy, but asking the patients with goals in value systems are in how we fit together can be very fulfilling for both parties, and it's really important for them. Take this information to to tease information out when they understand. What's going on right so I relapsed they. They have this communication checklist these here, so this conversation guide on there. They asked questions like. Hike Teresi medical information, and what's your understanding of your situation right? And then they tell you something in. They're not fully informed. Then you can fill the gap and when you fill in the gap, my recommendation is actually star broad, and because sometimes we provide much detail to people. They get overwhelmed. Taken down the foot view. To step back in and talk about the big picture. Seem assessing what they want out of the conversation. While sharing information also kind of exploring what understand their situation, illness and asking permission to share. Would it be okay for missionary? What I what? I understand now you like. You also made the distinction between primary specialty palliative care especially Paladino primary care being. Piloted Care provided by the primary clinical providers be at a primary care doctor hospitals with Hartford specialists, cardiologists, etc and Specialty Palikir being where you invite the services. The trained pilot, a specialist to help assist management. Now getting pelted CAIRN bawled at the very end stages when they're in shock in. We're discussing salvage therapies like durable ventricular assist devices or heart. Transplant is I think. Think a no brainer in and we do that. I think reasonably well. In fact, it's sort phone requirement. By the Joint Commission incentives for Medicare and Medicaid Services to have inclusion of Specialty podcast for VAT program certification, the first place that was huge. Is that right I was a huge moment back in two thousand fourteen Edinburgh the background to that story house Oh. I, think I think once you change payment, you can change shatter dudes. Yes, I believe that I think I think on a national scale there was a change then and and part to that there are many many folks who are very honecker friendly Ryan right, but I think he changed the ballgame for for. Heart failure and it changed the ballgame within the context of the most end stage heart, failure variants, but heart failure is a chronic disease with several hints, points the onset of the risk factors, the first diagnosis, the first mission in many more beyond the the crash and burn scenarios when we're thinking about Elvas and transplants, when in your opinion is the right time for us to include specialty Palliative, care, and what is it really have to offer to heart failure patient population. So I mean they'd looked at a what happens when you when you consult palliative care in acute heart failure, looking at life and things of that nature I think there is no. Consensus on what you look like right, and so as opposed to. Where Lasko the came out with guidelines for anyone who's diagnosed with weeks of diagnosis of cancer, who seriously they should hat powder council are, they should have care and knowing that we're never going to be able to me to meet the needs of those patients with specialty Palliative Care, therefore primary popped should be done right, and so there's nothing like that yet in heart failure but I. I think I'm sure. ACC and other groups are working on some of this, but in general I think that surprise. Question of your noses is one with in patients with class, three class or heart failure. So that's essentially what people go to then beyond that depending on your position, he worked with the amount of healthcare provider to have a lot of the other things are different. Specialty Palette of clearly has an important role in many time points within heart failure spectrum because the resources are limited, we need to empower the primary practicians taken care partners patients to engage more with patients in these in in the Serena. Yes, yes, certainly so I mean. We were Hopkins, the heart failure clinic. One thing I worked on was working with the nurse Practitioners Clinic. Teaching them primary powder skills and getting a sense of how comfortable they were with lot language, and with invents. You're planning as well as symptom management. You know such as using low dose opiates in patients with this. Knock out here. No, it's can be helpful. To. US A little bit of Noor of the traditional framework that I've seen is Palliative care versus cured of paradigm. It's an all or none it's been viewed as being mutually exclusive for a long time or the patience choose one or the other. He knew clarified the difference between palliative versus hospice care and help patients should receive palliative in in whether or not patients can receive Palliative in curative care simultaneously so when I when I think about of care I think of. People. Who are seriously ill right? And what does that mean that means people who? Have a higher risk for mortality and here quite life is affected, or there's some burden, some degree of burden on the caregivers right, and so whereas hospices is, it's more definitive. It's more where Nestle has a prognosis of six months. And the OPT for comfort care where they want to avoid hospitalizations and procedures. And so and it's it's an agency. Would I teach people about the difference I think it's really important to in terms of how you freeman so for example. When you're talking to some about hospice quite often, people say oh, yeah, I, think you'll benefit from hospice, and here's what it is, and my recommendation is actually instead of naming it describe it first, and how do you describe hospice for the patients? So the way I describe it as there's there's a service that's available to you. for someone with with the prognosis centers where we would not be surprised if you died in the next six months or less and majority of. Of this is done at home where someone's available twenty four hours a day seven days a week by phone, and they can send a nurse over at least once a week. More depending on your need, and they can have home, health aides, and other other services for you like chaplain, social worker sort of help you through this, and not only with you, but for your family, and it turns out when people like you have the service people better longer with them without it. And quite often I hear That's exactly what I what I really liked this approach because the words palliative care in hospice can be so emotionally charged, and there are a lot of misconceptions that go along with these terms in a lot of our patients had experience with palliative or hospice care from a loved one, then maybe that interaction was was good or not good and. I think describing it rather naming it probably leaves them a little more open to the concept, and then actor actor describing it then give it a name. Right and that's actually hospice enrollment in in some of the goals of care meetings that had been in the room, taking care of patients with you. Something I've learned directly from you that people who qualify four hospice care who choose ten ruin actually live longer than people who qualify for it. Don't use Tuesday. And when I describe it that way I think it, it relieves patients in their families assembled that that may be associated with maybe enrolling in something that could potentially shorten expectancy, but to tell them that you know what in fact it can actually lengthen their. In I've seen shifts in the direction of the conversation. We share them that fact here, probably take. It might be helpful for some of the audience. Maybe you WanNa roll, play on how you would start a discussion short. Let's say I'm a patient who was in stage heart failure, and you've been consulted to come by conversation Clinton. Vision so really depends on what the context is so for example if there is awesome on who's being evaluated for that. We actually have a checklist that we use so. Keith sweats. Mayo Clinic article that we use for evaluation, and some of that is sharing with them what to expect in terms of complications from that. things like hospitalization and getting those type of things and then doing advanced care planning who can make decisions for them with their power attorney is asking them about things like to feeding trick is some of these patients. It's difficult for them to get off the vent, and some the mainly trigon. If they need a trip through me, also need a peg. Right some of these patients develop Encino, disease. They many dialysis right and I mean I. Think it's really important for people to recognize what they're getting themselves into. Those are possibilities of complications, but that doesn't mean it's going to happen. Also sharing with them prognosis would the Nevada versus not in some of the data shows that patients who get now bad. They're likely gonNA live. The two years about seventy five percent survivor for another two years, and then it starts dropping after that. And there are some cases that live ten years, and there aren't many, and it's important for them to figure out. If that's something they're willing to go through. So for patients who are bad candidates, that's one of the compensation have and we also talked about symptoms, and and things like breathlessness and fatigue and nausea vomiting insomnia constipation, those type of things anxiety depression. Author overall wellbeing those cycles. Symptoms and then we'll figure out a way to help them through that. Right and so for me. I when patients are anxious, I. I actually recommend using a hand fan. Simple doesn't cost much, and he can actually help. People with the Irene Higginson is like the Godmother of power in the UK, and she's done this study with patients breathlessness, and they were either given usual care versus given These breakfasts support group which is essentially of care with respiratory therapists. and. There are essentially given a hand and little mantra own dressing right, and they actually had greater mastery of their offices. Another thing I talk to patients about is, so we're bioch- He. He wrote the four things that matter most. For conversations to have remember at Hopkins, patient evaluating for and in possible heart transplant. Who ended up not kidding either. And went home on hospice, but one of the conversations I had with him, and his wife was. About the four things. Please, forgive me. I forgive you. Thank you any love you. In one thing I recommend is for patients to have these conversations, and also for family members to have these conversations with other people and it can be. It can be a very difficult time, but it can also be a time for healing, and so this one patients wife Mlb but I'm slater and said you know. Rob Thank you so much for this conversation? You may not recover me, but I saw you five months ago with my husband and that was that conversation you had about the things that matter most. That was the most important conversations we've ever had in our fifteen years while we were going back and forth. A hospital in seeing seeing doctors and and it turned out. He didn't see his son for twenty years, and after that conversation, he went back home and had those conversations. And was able to heal that relationship, and so his son was by his side for the last four months life. So I mean these little things can be really possible. Please forgive me Africa if you thank you, I love you. Is Wonderful. Really. Simply this is nothing like these very intense moments in in a person's life that can give meaning to their entire life. You know and quite often we as we take care of patients will here's some people say we're hoping for a miracle. And what did you do then hurry and so Rhonda Cooper `promising for in two calf together who had cervical? That progressed. Yes to a very staged in looking at higher therapy, and trying to get transferred to the third center, and it was a very situation because they were looking for a miracle, and there's no rationale that we understood our language that could overcome the optimism of miracle. And so, what do you do? Surrounded Coupon Tom Smith in a couple of people wrote. This article called the amend protocol. So affirming what they're saying. Meet them where they are then educate them about the realities of the situation, and then and is for no matter what really non abandonment. You don't have to do this alone. We're here with us. And that can set the stage different conversations in review. The aim protocol is affirming with her saying a farming meet them where they are. Meet them where they are again. -education, and for no matter what or non abandonment. Well on that note you could do a conversation that you would have with with an Alabama candidate. Let's say someone had non vascular Ski mccart failure very low, Egyptian fraction very in stage with with not a lot of therapeutic option, advanced age, not advanced therapy. options for therapy had what would that competition will light so first getting a sense of how the Electricity of information, and as we talk about this? Who else would you want in the room? Right, and then getting a sense of the understanding. And so asking them what what they know. And telling them in broad terms. And then asking them again to repeat to. So that they can process right then getting a sense of If we had a sense of time or pregnancies that information, you'd WanNa know. Majority of people do want to know about ten percent or so don't. That's okay. They don't WanNa. Know who can we show the information? Right and then, and this isn't a serious conversation, Guide Harbor Program, but in that would i. also add is my favorite question. How Care? What brings you joy? Right because it's really important to build report. And sometimes those can be actually. Sometimes become so the goals right and then after that asked him about what are they hoping for? The keep digging. What else what else? And an explore more about what they want. And then asking about some of their fears at words, but the future help. or about the sentence. Right and then that way, you can actually like focus on some of those symptoms. and. Then after that figure out what functions are so critical to them, they can't imagine living without and when when I think of that. I think like cognition. I think about and being able to eat on your own or being able to take care of personal hygiene and being independent. So. Those are classmates our full. Actually it was a questions I told my pieces now. On and then what what what are the willing to go through for the possibility more time, maximum burdens and finally Asking them if they spoke to their family about their goals in wishes from there, you can talk about things that convinced you're planning right and then also getting a sense of symptoms. Talk Toss Dot Beth, fatigue, nausea, vomiting constipation. Depression appetite, those type of things your framework is, it reminds me of a demonic that one of my residents Cooper Loyd toppy. Spikes. Yes, so everyone who's listening to this? Please download the vital talk, so there's a vital talk. TIPS APP I actually like that a lot in a believe. They have spikes in there. They're the one that created this. Along with re map in guide, Alice very cool battle talks by Baio. Talk tips APP. And then they also have a vital. Todd conversations leave dot, com. And he talks about very nuanced ways to twenty is like one of the masters of Communication Greenwich really thoughtful. It's helpful to have these frameworks structured ways off approaches topics. Couple, yeah, and so you know what I recommend is using the Ariadne lab Susan's compensation guide. As well as some of these vital talk tips. So using spikes or re map and I love rap I live by and. And reframing expecting motion, so the thing is, we don't quite often. We're not populous. We're not taught about how to how to respond to emotion. 'cause like eighty percent of communication is nonverbal. Right so when you share news with people they can be. Upset or shatter address it. Right talk about the elephant in the room. And once you're able to talk about the shoes you're you'll be. Everything would be so much more fluid and you build report. And it's really I mean. People People say Oh, my God. You know we need to be more empathetic. And it can be taught using these tools using nurse statements for example Rob Thank you so much for for all these teaching points out of respect for your time. What will your message for providers taking care of patients with heart failure be? So I. Think I think number one. Don't be afraid to have these conversations, and if you aren't experiencing this, you can always ask about of care provided WHO's near you to say? Hey, by the way I wanted to? Would you be able to just see me do this? And the and then get feedback, right? And if you're gonNA refer someone out of care, I think there's a way to do that. Because quite often. What I hear people saying is the way rob I was trying to refer a patient to you, but they didn't want to see. How care I'm like. Is there something on my face or Did you see my home, i. He's scared them right. And it turns out. Of Framing Ham and so we're concentrated service. So when someone has a heart, attack does Internet. You know. What would it be okay if I got the cardiologists you is? You've had a heart attack, but that'd be okay. Right say something like that. Heart Attack Reagan. Get the specialist to look into this ENC-. If you need procedures of what other many need Yada Yada Yada. Similarly without care when you can say. You've got a serious illness. You've got the advanced heart, heart failure, and what we WANNA do is get the specialist who can help you feel better and talk you about what's really important to you. In any full circle what you were saying earlier, you know, describe what you bring to the table. And I want to get them involved. And you'll see a big shift in terms of their acceptance of that. I think you can also direct him to get healthcare dot org. Lots of great resources there, that's awesome. Robin I asked You. What made you shift from private practice academic? You said time to think in your thinking what brought joy to you? But I think for many people when I say that we are so glad that you made that jump because you've brought joy to so many other people. In just the impact you had at least when that was hopkins. Just tremendous your when you left, your loss was felt so deeply among medicine program that it was like we're losing our bigger brother advisor Tean new you also smart. You brought you so much for team morale team building the health when he helped bring the the the in terms of the nurses together with a team building exercises and together started a program where we had small groups of entrance. Sit Down and do reflection sessions which I think it alive so powerful. It wasn't Wyoming. I think to see these strong Brillian hardworking young doctors. Usually didn't have space to talk about. The the meaning of the patient kid were doing Break up in tears in be thankful for the experience that we're having in being able to process some of the loss of the experiencing. I think just added so much to live and I think you've touched so many people and I just WanNa play an example of the impact that you had. Hi. My name is Amanda. Mole and I'm one of the medicine. Residents at Johns Hopkins, hospital. Dr, Robert Stock has actually been my medical and life mentor for six years now he was not only the first person to introduce me to palliative medicine during my first year of medical school, but since then has really inspired my daily practice as a doctor, how I approach palliative care and my future greer and I really got to learn all of this alongside his daily dose of humor in various accident, so to say he's played. A special role in my life is truly an understatement and I know he will continue to touch the lives of many patients and colleagues. While the that was so special. Yeah Amanda I feel like I've known her since she was a baby. And here's the thing I think I've I've had the privilege to me like incredibly smart people her really passionate in who make a difference in people's lives, and and just to be able to make a small dent in their. In a positive way that's that's a huge win for me, so thank you so much for this out of those released touching. Thanks for being you rob. Will also post our show pages. The upcoming venues for Rob Santa Com-. That brings us to our show so to make like enough to split. You can follow us on twitter at partners and please share white made your heart sweater sweet. Send us a clip. Two Cardi nerds gmail.com who enjoyed the show, the narrative and spread the word.

Johns Hopkins acute heart failure WanNa Dr Rob Raza US Ed Hardy private practice Clinton Rob Razek Clinical Director specialty Palliative Care Johns, Hopkins Hospital Oastle Kieran Heart Maryland College of Georgia University Hospitals Cleveland California Cleveland Ohio
Bob Ross | Liz Kolb

OnEducation

1:06:01 hr | Last week

Bob Ross | Liz Kolb

"The presenting sponsor of Education is participate lately teachers from. have been working together to find new approaches to provide quality remote education participate sister company participate learning presents united. We teach a global gathering place for educators to share distance learning resources as we navigate these strange times for these resources and more visit participate dot com slash on education. Weapon Weapon of choice MS paint. Big Red Art. Welcome to on education part of the on podcast media network. My name is Mike Washburn and I'm Glen Irvine Friends. We have an awesome pod for you today we would discuss what are the best ways to teach face to face and virtually at the same time whether Mr Rogers and Bob Ross some of the greatest teachers of all time and our guest. This week is author and professor Liz cold. I love Bob Ross. I. Know He. Said off area he so it's so mesmerizing. I. We have our kids. I clicked on it to it's actually if you were going to watch something with your family or whatever it might be to kind of calm everyone down before you get ed before you go to bed. That's it. Exactly why I watch it. And in the context that I, watch it and. Always. Almost, always watching it later at night just to kind of relax calm down. It's exactly what I watch it. Now I am like the least calm person. In the world. So you can I watch a lot of Bob Ross what I'm saying? so He's helping, it's helping out though. Else's much as a kid I was amazed at the end. Mike. Though like the beginning of the thing is this Palette or usually white or whatever one solid color. And then we'll clear at the end you're just like. My God how the Hell did you do that? I mean. It's like here here. You know and he doesn't. It's not most of the time he is giving. He's he's giving the the audience permission to do their own thing too. So it's not like he's very super technical or whatever may be just talking it through whatever might be of got their amazing happy little trees. Yes. So Great. Friends we need your help. Yes. we are trying to get the attention of Lin Manuel Miranda We WanNa Talk Hamilton on the PODCAST WE WANNA talk about Hamilton in educational context on the PODCAST and we WANNA talk to Lin Manuel Miranda which is a very hard get obviously. So let's say if anyone's listening and has any sort of like I know a guy who knows a guy knows a guy sort of thing. You know help us out hook us. Up Yeah. And you know. tweeting. About it police re tweet those tweets so that he gets So we we're GONNA, try to get his attention there. Someone's attention WE'RE GONNA try to go through the normal ways you you have people on podcasts like pr people in publicists and stuff like that. Bite. We just need some help friends. We have I have a target list. That's that's just one of them. That's the biggest one. Give us on the target list. Yeah. I would love to talk to him Buddha judge yes. That's that is the that is someone I've actually wanted to talk about for for Glenn would know for at least a year since since we kind of met him since the world met him you know when when Mayor Pete ran for President Chess Oh, chazan is Pete Bridges Husband. and. He was a teacher I think still is a teacher. Book. So the book is not even out yet I don't think. So it's perfect timing with you of it come on a podcast. So. Also. I'm actually, I actually might know a guy who knows a guy for chest and Buddha judge believe it or not so. I'm I'm working multiple angles on that one. But if if if you know a guy who knows a Knows a guy or girl you know what you know what? I'm saying. Let us know because that's another one You. Know we've we've done like the other stuff that you know the other longshots like send a we sent a message to the Biden press team to see if you can get Joe Biden on the podcasts that's not GonNa happen but you know. We tried to get any Klobuchar on. We could still try you know somebody there's a lot of Minnesota listeners. Here we have. Somebody someone who knows the senator we ribbon and also. How could there not be? I would be actually stunned if someone does not know someone in the office of in the like a local office for Amy Klobuchar. So come on people. Let's. Let's get it together. Let's do this for the team. So we are about to start school in. Southern. Ontario. The first day of school is tomorrow. Today's Labor, day Monday. So school starts for a lot of kids tomorrow. My son Isaac is in grade seven starts class on Thursday they were doing a bit of a staggered start Jacob starts kindergarten this week Cheryl's back at work tomorrow so That's how. She actually though she did get. She. Did lose her her kindergarten slot because they did. We thought they were GONNA. Do they collapsed classes all all across the province so she she's not teaching kindergarten this year she's teaching Special Ed and. Good landing time which I mean she's a twelve year kindergarten teacher So I mean it's it's a little bit of a weird. You know. Yes. You're looking trying to look at it as an opportunity because I, think I think it should be viewed that way especially because of the lines with some of her more recent interests. So thinking of it as an opportune but we came across a really interesting resource earlier today that was so good that I just wanted to make sure it was in the show notes to four today this This group called responsive classroom has written Guidebooks for lack of better words ten days of mourning meanings to start the school year In the context of being culturally responsive talking social justice but also talking corona virus and just how we're all kind of in this together and they're they're made for each grade. So you can go to the website we're going to Lincoln in the show notes and there's a holistic. Kind, of which range of kids you teach and there are ten you know as they get older, they get more. Complex and they're kind of their tone is different but there's this whole bunch of covid nineteen resources made by this group responsive classroom, dot, Org that are pretty impressive. And and I was I was shocked at how well put together they were So check that out. It's in the show notes it's really important to and and really I I. Don't know. I hopefully, districts are doing a good job of helping their teachers out as far as how do you approach the beginning of this year? What's how'd you begin the conversations? You know we left last March. How do you? How do you get back? Into this and and then do it in a in a way that really takes into account. What's actually happened, which is a lot and like we've said on the PODCAST, the students know what's happened so China ignored and just moving on to just content or whatever it might be. You know kind of passing over. Yeah. Probably not the best thing to do, but a lot of people don't know how to approach it. So the resources like this are fantastic forgetting those conversation started in a responsible way of being able to go out and have. Have those dialogues inhabit begin the year as far as building that climate within your classroom and that's relationship so that the students know That you are the person that can have those conversations and you are willing to go in and do that. So really really important and we'll keep passing along any resources we start getting him so. About Resources Yeah. There's a lot of you out there who are going to have to start the year as many teachers are doing it right now already. Teaching both distance of virtual students. So online learning. And students that are standing or sitting in front of you also at the same time. and. That's a really complex. Environment. Let me just say. I mean. And I'm not talking about know. We're going to provide another resource or a link to a twitter feed. by Jennifer, Gonzalez because she's amazing and she put out basically the question out there and said, hey, this is a really unique situation. Let's pull some ideas of how do we do this the best. and. What's amazing about this thread as far as on twitter is that? It provides a lot of great ideas. Resources people are sharing their things, and it also starts that conversation to Mike that. Some of them I would say it's about fifty fifty right now that are talking about. Pedagogy pedagogical stuff, and it fits perfectly into the interview that we had with Liz cold. In some people are giving technology solutions and we kinda need both. We do need both solutions obviously and we should already have them in place. I would hope that by day one starting tomorrow that we have some things actually in place whether it be zoom or Google me, whatever it is how you're actually going to do it with the technology but then you need to know how you're going to do it do the teaching part. In a really. Great way as far as the pedagogy concerns far as the teaching component is concerned and so there's a lot of ideas that are being shared in the thread both of those ends. So I actually found it fascinating that there was some answers like, hey, people are using swivel cameras and someone that talking about. Hey. Here's some advice you know talking about chunking the lessons, breaking them down since for the students make sure that you give clear directions do these things. Blah Blah Blah, you know what I mean so. It's an interesting combination of the two important aspects but a lot of time we hyper focus on those tools. Yeah. I'll be honest we have to be done talking about tools. Like we we got. Twenty twenty. You. Now let's move on from like I. It's funny when you when you pull up a tweet. It brings up like a couple responses and I'm not sure if it's randomized. Everyone. Sees the same responses when they click on it as I do but it's funny that I'm looking at the the first response of the ones of seeing is like a pretty weak. You know here's some tools to use type of response and the bottom one is a great answer. About centering the students in that experience yes and It's just like you're getting a mixed bag with these things. Lease stop thinking about tools we know would exist you know like I don't know how many years you have to go to conferences and and just you know we know it exists. Let's start talking about the experience because you know in the end that's what actually matters here and So it is it is. There's tons of responses, three, hundred and fifty over three hundred and fifty responses at the time of we You know that we're recording here but that's not all that was on on twitter this week you know the nonsense was rampant as well. You would expect. And this I'll tell you I'll tell you this conversation is so dumb. that. Just I completely ignored it. I didn't even I didn't weigh in I didn't jump into it I. didn't even respond to lake our conversation about it really in our in our group. Is just because I'm just done with this. Stuff. Yeah. So there's a there's a I don't want to call it a mean because it's not. It's not meant to be funny it it just an info graphic. Got An info graphic. Graphic has Lavar Burton of Reading Rainbow but more famously. Jordi laforge of of the enterprise. Bob. Ross Mr Rogers, of course, because there are some some of these that exist just with Mr Rogers I've seen some of those where he's sitting on his chair and it says the exact same statement and this one has fever when which I thought was interesting. And and. The says. Some of the greatest teachers of all time top virtually. That's the the the headline, this the splash graphic there. And it's, interesting. It's interesting but there's like a movement was first of all. This been shared and and versions of this have been shared through facebook and twitter whatever might be in a lot of people. have offices you find feelings for these TV, personalities. Of Their Childhood and at some of US still have those fond feelings of like Bob Ross actually. These guys, figurines. Six I love Bhadra. Yes. Yes. We still have fond feelings and we. Would like to share those. You know share this as yeah. They were great teachers of my childhood. You know we grew up in a time Mike. And you're around my major you're young a little bit younger than me. Quite a bit younger than me but we grew up in an age where where we came home and we turned on the TV and then there was a limited number of you know some of US didn't most of us didn't have cable I mean some people did most people didn't we turn it on and we had a few channels that you could see an Saturdays. There were specific cartoons that came on in the afternoons. There were specific shows that were on. Your age range you you gravitated towards certain things. Mr Rogers. Obviously is one things like sesame street reading Rainbow Bob. Ross is interesting because I think it is not only it's a kid thing. Just many adults in that era were of were positively affected by his amazing not Lee talent but is his way of being you know. Also more popular now than he ever was. I would say so. Yeah, yeah in a Steve Irwin someone more recent. I would say it's interesting that he's in this to about you know we. Found all these people to be endearing at at minimum. You know word they some of the greatest virtual teachers of all time I. Guess That's that's my first question number two someone actually went out made another graphic and just crossed it and just said, this is the nicest way could say about how I feel about this. Awful meam you know as far as they put it on there 'cause they hate this this discussion about having Mr Rogers, whoever else might be? Where they great teachers. Were they great virtual teachers. I don't know. I. Mean I. Don't I don't know if they were. I know that they were they had a huge impact on our lives I think on a lot of our lives because we. A lot of us and maybe some of your listeners out there too are old enough like me to remember when you came home, your parents actually weren't home but you turned on the TV and then you watch some TV you know Canada's and these. People were there. Spreading basically positive messages, you know that's all it was is like these positive things you know whether it was on reading, Rainbow Rogers neighborhood where even Steve Irwin and his funny antics with animals, and whatever may be obviously Bob Ross. It's there's some positive things. Obviously some things that are being toddlers lessons sure. There's there's even lessons I. I remember that even in Mister Rogers neighborhood, there was a specific. Anecdote something that was being taught. But I don't know if they're the greatest virtue. Of all time but I don't even know why we're getting. So pissed off about dumb stuff again, like this it's kind of like the the. The Bit Mogi classroom conversation we decided to get pissed off about this week. Yeah really. It's again one of those distractions that's really getting us work the. And we want to just get mad because. Teaching virtually is difficult. It is. Yeah good. Can we redefine like? The word teacher yeah as opposed to the word. Educator Are. Those are those two different things in my mind they are. I refer to myself as an educator. But a lot of people can be teachers. True and the word teacher isn't necessarily someone who teaches in a class or is an educator by trade or fashion points right so we're headed with this so. I have no problem referring to these four folks and a bunch of other folks. As teachers. They definitely taught us things. Yes. Hey. But they were professionally trade. No they're not educators. They're not educators I get chain K. People people who are offended by this frustrated by this or mad at this are just having trouble. With the feeling that they have to live up to the standard that that they're not Bob Ross, mister, Rogers, Lavar Burton or. Irwin. Whatever's for as I wasn't a I wasn't a fan of that guy. I didn't watch that show whatever saying what does the same seaver? So. Yeah and you didn't have a television studio or a staffer assistance or a budget you know and all of that stuff in certainly education budgets are slashed so even You know in the context of these people had like. Lots of money. In some cases to do their work as as. Teachers. and. You have very little money to do your work and certainly aren't getting paid very much in some cases due to. Their like you know what screw you. And I get that I get that but. I think that I think that the. I think that the images are being taken out of context. You know you know and I mean just everyone is so raw right now. It's only September and people are offering this angry. I don't know what's GonNa Happen later. But it's true. It's like. You know. The, the reactions are just over the top These were great teachers. We don't need to hold ourselves up to this standard and they weren't educators. No. And I don't think anyone is saying like like this. This image is dumb because it's it's it's pudding. Educator? Work in the context of their roles and they weren't educators there. You know they're not in a classroom. So you know it's not that you shouldn't compare Bob Ross Lavar Burton Steve Irwin and Mister Rogers. To what's happening right now now so it's a, it's a dumb image deaths. The reactions are equally dumb. It's interesting. Just the concept I mean just putting it there and. I mean ultimately. These were and are TV personalities. And, I mean I want to say you know what to say. How can we trust TV presents but we have a president that's a TV personality. Obviously that's you know that's led him to be the actual president of the United States and he was a TV. Personality. That's the best way you can actually put it. And for us to. I think we do this often too with people that are on television or movies, and we even athletes. You know that this happens all the time and I think we've had a similar conversation that this I don't know if on air or off air but when we want to attribute. Something that is in real life mic to these people that are living in a completely different separate entity and and they're things that are going on either a are fake. which are most of the time or be they don't really there they have zero to do with our daily lives. So we want to tribute these things like these. Great. These awesome attribute whatever might be the messages that were sent at I believe as far as on all of these shows. were. Awesome. Were Great. Positive things and and an uplifting you know messages. But that doesn't mean that they were educators. As you describe Mike has a great point there that they are great teacher because they are. Sending messages and you don't want there could be teachers send out evil things to I. Mean That's you're still teaching things whatever they might be. But in this case, they were very positive things but there are TV personality so. Could they step into a classroom and teach year first graders or whatever might be? We won't never know for some of them because they're not here anymore. Obviously but. Why? Why why are we even comparing that far as us it's more like, Hey, and what that's a interesting thing I did find it interesting though this masters specifically the one that we pulled has a educational. Entity it's the curriculum for agricultural science education, which. In that context that sucks I mean if if that entity is putting this message out there as far as for educators, you know that kind of thing. That I don't know that doesn't jive with me. But as far as the message itself. It's okay and we could put a little light on it or just ignore it on our feeds. We don't have to get super. It's. It's like you don't have to do the rage machine activate. and. would. Get, Microsoft paint. Weapon of choice MS paint. Big reports. It's just over the top. I love that uses Microsoft paint too. Take. xactly exam. You know we saw a little bit of this in the spring but I think I I've seen it seen stuff like this a couple of times already whether it's the kid putting up a poster of himself in front of zoom camera and then sleeping behind the poster. which is so funny or or this this article on on the verge. which is a student who figured out how to figured I. Figured out that his high school teacher was using a software program to great things so even reading. You know gusting the the the content that their child the child was was creating. And then learn how to game the algorithm in order to. Grades By. Determining, the proper words that the system was looking for to indicate that you knew what was going on in whatever it is that you were reading and then you know just word salad they actually refer to it as a word salad it's totally these words. You know it's funny in the image in in the article at the very bottom, there's like two sentences and then the the very last line is profit diversity. Spain. Gaul China India Africa. Like. Bailed it. It's so funny like. There there are. There are situations I totally think this is one of them where you have to give kids credit absolutely more for just like not only throw in their teachers under the bus but like being so. Smart to figure out what the Hell's going on and play it. It's so funny. Yes. So some of these auto graded. In this. In this case, it's genuity. It's a website, a whole curriculum basically that you can you can use either for e learning or distance or use it actually in your classroom is actually. Scanning the contents of A. Open response question which. Already right there. It's like there's not going to be good, but then it actually evaluates the contents in their get assigns it a great you know and so this kid I thought it was a it would have been something that would have happened. Could have happened to easily to our kids where they feel dejected where you you in the missing a couple and you get seventy percent year at a C. already in your like what would just happen the way I can ever get an a. in the class and again just assigning signing that point value to that learning instead of just actually showing the learning and then having this A. Read through that. But the best part was what you just described not only do they give the answers but they? Let's pull every key word. From the reading and just put it right at the end with the word salad and. Then make sure that it actually gives us the one hundred percent and they took good snippets of this and. I think the twitter comet was. ALGORITHM UPDATE HE CRACKED IT Glenn Glenn. There's also some solid nuggets of life lessons in this article. and. I know there there are some. Listeners who are like pre service teachers. So yes, you know friends you still have some tests in your future some essays to right listen life lesson for Mine Education to to you. Any. Good cheater doesn't aim for a perfect score. You gotta go faster. Cheaper sets. Got It you WANNA get on a roll, but you don't want to be perfect because you. Red. Flags. Just like you know ninety to. Ninety two. Sometimes goals and get. A really good grade. And it won't raise any red flags you'll look wicked smart and. and. You know. So any life lessons friend that's you know you come for the deep educational content and you stay to learn how to cheat So that's the service that we offer here. On Vacation The bit classroom is back in. back in our. Zeitgeist. I guess and You know it's funny because it got brought up by LIZ conversation. So. So you know I didn't I haven't read this article because I just don't care anymore in my my heart is dark. For the Bit Moti Classroom, I've just I'm just done. Many things, and this is the thing I've done with the most. Utopia weighs in on the. Education has wade into it. And then they basically are laying out the conversation that we had last week Mike we're playing both sides of the coversation. I think if you just listen, we didn't even prompt her. We thought it was awesome as you brought it up we didn't. We didn't say anything about it with even ask a question, but she brought up the Boji classroom just as far as working with pre service teachers and you'll have to listen to what what she thinks about it as. As far as what her opinion is, but it's it it is interesting that this conversation has has. Continued, and it'd be interesting to see where like when it just dies off and we should we should make a little note. You know this was the day. That's bit Mogi classroom was still very hot in the. In, the eyes of the education of news world and then it'll just slowly off and we wouldn't even know what what what were. We even concerned about why we're even talking about this in the end do this if you want again like this is like I don't give a damn. Make your. Classroom, but please. Please, do not go and ask your instructional coach. Your Tech leads your technology integration specialists. For Help No. It's a waste of their time. Save so many other things to do including not dying. That would be good. Right Don't bother them with the bit Mogi Clinton do it if you want. By. You know I saw where do we see? That a district made people come to like a Oh. Yeah. A training. Element session and I'm like. This is that's when the jump the shark. Like, it's just. Know. What a waste of everybody's time don't we have way more important things to do. Than talk about how to make like bit Mogi like fancy. I don't know what this is. This is graphic design that is total graphic design. That's. it's all it is and. Why this matters? Yeah. It's fine if you're into it and that's kind of like what you do. You know as it if fill some void or whatever it might be her something where you're like Oh, this is cool I actually have been joying this time spending this fantastic. Don't let it get in the way though of the teaching and learning number. One. Don't expect someone to teach you how to do this. Do It do it like you're watching Bob Ross? Right I go just to. Look. At this full circle I circle right this restart and we end with Bob Ross. There's no better way to do it listen do it if you want just don't bother glen with it. Please He's guy he's got away bigger things to do with its teach. You probably wouldn't know how to do it. anyways. Here's and bothered. Could Go Watch Bob Ross. When we come back, we're going to talk to Liz kkob and the emoji classrooms. GonNa come up again. So stay with us. Welcome back to the. PODCAST. Everyone Liz. Is a clinical associate professor of education technology. So University of Michigan, she teaches courses in education technology for the undergraduate elementary graduates, secondary and masters and certification programs. She's the author of a number of books on the use of technology in the classroom including learning I technology second in practice new strategies, research and tools for students success, and she joins us now welcome to on Education Liz. Thank you. I'm excited to be here. So, Liz I just kind of gave the Coles notes of your background but why don't you give us a bit of a longer story on who you are and what you do and You know what brought you to us today? Sure. Well, I'm definitely an educator I've been in education for over twenty years. Now, I started as a classroom teacher and honestly because I knew how to use powerpoint back in the nineties I was voted to. Address now. I was I was honestly promoted to. The technology coordinator because I could use powerpoint and that's kind of how it was back then and I started to learn on the job as I was teach I was teaching and I was technology coordinator because also how it was. And I learned a lot about the technical end of technology. But I really didn't know a lot about pedagogy and technology I was just guessing. I would go to conferences and see really cool shiny new things and bring it back to my school and I really thought that we should always be using the latest. Technology whatever is emerging, but I really didn't have any pedagogy with it and I thought that was the right thing for years and then I got to the university level. And started to realize that what I was doing with technology in the classroom encouraging all my teachers to do was actually what the opposite of good practices around student learning and it caused me to really take a pause and to research. Well, what does the research say about education technology and learning and best practice and what I started to realize was that a lot of that revolved around how students learn best and good pedagogy and things we new teachers and learned but often we kind of throughout the window because we sometimes let the technology guide us more than what we know is experts around how students learn best, for example, things like being social and learning that you can't just stick a child in front of an APP and think they're gonNA learn We have to let them reflect and talk about it So some of those basics and so I spent many years kind of researching how students learn. and Best Practices with education technology and I ended up developing a practitioner. A very simple practitioner framework called the Tripoli framework that I started to use with my pre service teachers that I was teaching at the University of Michigan, and kind of spiraled from there a little bit that inservice teachers got a hold of it and found it to be really useful to make sure that they weren't just using shiny new technology without purpose and That kind of led me to putting together some of these books today and I continued to work with hundreds of pre service and INSERVICE teachers every year on making sure that they are actually doing research based approaches and strategies when they're integrating technology. So. Liz It. It's interesting that you said as far as that powerpoint thing 'cause we know I mean those of us that were around that. We know how long ago. That actually was. When that was The the shiny new thing where it's like if you know how to do that, that's that's amazing. You know you could start doing that as far as your classes. But I don't even know if we've actually moved that far unfortunately as far as an education because I was out as I was writing this question up. I feel like educators as you wrote in and you were just saying feel the need to use hardware and software because it's shiny or because it's new or in the case of this spring and we talk about this law because it was free. Because someone was offering something to us felt like Oh, we have to go use that because. That's the thing to do and there are a lot of technology integration frameworks that our listeners may already be aware of. So things like Sammer or t pack. But can you tell us more about the triple E. Framework and how it may be different or similar to to those frameworks that were that we've at least? We've heard of. Whether or not applying any of those things. That's that's something else. Sure. So t path with definitely around long before my framework and I had used it. So t pack Is really looking more. It's more of a theoretical framework and lens for us to think about we need to have technology knowledge and pedagogical knowledge and content knowledge are working together and I thought it was a wonderful frame and I still do and I use it. But what I began to realize was with my teachers, they would say, yeah. But what does that look like in practice? Like what does that mean do I do that? That makes sense and I realize that they needed something that really brought it to practice. So my framework really took the P. and T. pack the pedagogy and really blew that and said, well, what kind of pedagogy would we need around and within technology in order for technology to work well, in our practice and of course, there's tons of. Research on good pedagogy with teaching and learning, and it was just a matter of bringing forth that. Good. With. Technology. So the Tripoli framework has nine questions and they're all kind of pedagogical based and they look at three areas with technology and learning one area is engagement. So how are students engaging in the learning goals and that's the emphasis is in the learning goal. So in the content, not just in the tool because there's a difference between engaging in a tool and engaging in the contents. And then we look at enhancements and we look at how are the suit? How are how is the technology enhancing the students learning experience? So adding support scaffold, adding value to what they may have done traditionally getting students to those higher level thinking skills how is the technology supporting that and then finally the last e that we look at is extension and we look at how is the technology extending the students learning to their everyday life and making their learning authentic and so those three e's really encompass good pedagogy with technology and there's three questions which I go through each one but there's three questions, each e that. The teachers can ask themselves around the lesson that they're designing to make sure that they're actually meeting those good pedagogical areas of of teaching and learning. So the difference between that model the Tripoli model and something like Sammer, which is also a practitioner framework. Or there's pick rat and a few others The difference really comes down to the focus starts with the learning goals and not the technology tool of choice. So the focus really is around, you know what is your? What is your outcome and your intended target, and I try not to convolute that with health fancy are you using the technology? So sometimes in Sammer people get caught up trying to get to that redefinition level that our level even though poon even though you know the creators. Of Samour with Oh it's not about getting to that level all the time a lot of time teachers look at it as though they have to get to definition. But sometimes, if you're doing something fancy like making and movie that may actually not be helping and supporting the students learning, they may end up focusing so much on making the movie and the bells and whistles of that that. Yes you've redefined the project you move from paper to a movie, but maybe you actually haven't Really enhanced or extended the learning. So, you know focus on making the movie that they forget what the movie's about share right we've all had that experience with students where they get. So they're loving it. They're having a great time. But when you say, can you tell me about those biomass those kind of go But I can tell you all about how to make fast and slow motion and sure those soft skills are nice. But you really WanNa make sure that they're working with the learning outcome that you have So there are times that make sense to make a movie, but there are also times where doing something at a lower level with technology actually is really beneficial to the learning So for example, going back to the powerpoint example, yes, we've all been seen power points where. You're getting lecture to and you're falling asleep and it's not really doing a whole lot. People are just reading text on slides but I've also seen teachers use powerpoint incredibly thoughtful ways I've seen teachers who have pictures on powerpoint that have incredibly rich discussions and go into detail about them and all they're using just a teacher centered you know visual, but it's very effective because of the pedagogy that the teachers using around the powerpoint. So it's not the powerpoint that's bad. It's the pedagogy that how the teacher is actually enacting it that can can cause the learning experience to not be so great. So I'd like to get away from this idea that you know. Certain tools are better. And really focused more on certain pedagogy around the tools are better choices to make. So I I try and in this model to not focus so much on the tool choice. Or how fancy you're using the tool, but rather the pedagogy using with the tool choice. Makes me think of like John John John. Spike. In Wisconsin who does branching narrative games in Google slides. I mean it's like I. If my head exploded when when he tells me that he's using Google slides to make game space learning narratives with branching narratives based on choice I mean in in slides, which you know is is amazing. Super Point. Follow up before Mike us the next question do you think Liz far in your experience over the number of years now you know from moving from as an educator to now being a professor, and then even in the writing of these books you've that you've written. Have Week grown. For his at as far as. You know the United States educational. So our North American. Educational System because so often. The questions that I'm answering at in my local district in the things that I'm seeing discussed as far as on edge twitter. Is Very tool centered, very tool oriented versus learning outcome oriented. You know it's it's this hyper focus on. On that shiny thing or what it does that's fantastic. Mike and I have brought. We you know we talk about on reality and virtual reality and all kinds of other things at tools you know even ranked tools and what our top thing whatever might be you know. Because those are think fun things to talk about and do. But if we really get down serious and with Mike and I have as far as on some of the topics were just like how does each of these things actually connect to the learning should be the questions that people are asking by people I mean our educators, administrators, and everybody in between. Do you think we've made some progress? You know? Because every time. I see Progress I. See like Oh goodness I. think that's a great question and it's a fair question. You know have we move the needle as far as trying to move away from always using the shiny tool? To going deeper, I, honestly think we have. Our we wear we should be no we. Still have a tool centric focus. If you even look at university in a teacher prep classes for new teachers, a lot of times they are pretty tool centric and tools are you to know how to use tools you need to know without there but. One of the things that have given me some hope is dat. I have been contacted more in the last I would say two years by. At school administrators, superintendents, principals who are coming to me and saying. We. Are Realizing that we purchased you know a one to purchase a one to one program and our teachers really don't have good pedagogy. They don't understand actually how to use these tools to engage students in learning they know how to use the tool, but they don't know how to engage students in learning and we're realizing missing a a framework and one of the things I always say to my own students is at the very least have a framework doesn't have to be my framework. I'm not offended it can be another research based framework but have something so that you know what good teaching and learning with technology should look like and it is giving me hope that so many administrators are starting to see this and we are seeing it a lot as schools are moving to one to one There's the excitement around one to one, and then like a couple of years in they start to go oh, we missed the pedagogy we miss the actual. How do we engage students and you know during the pandemic and in the spring you know as as you both mentioned. So many tech companies were saying here's free. We'll give you our tool for free just start using it and and and teachers were overwhelmed by that just being thrown all these free tools and one of the things that I just kept saying to the schools that I worked. With was us what you already have and already know because you have good pedagogy and even if the tools aren't great, even if they're not ideal the fact that you know the tool and the students know the tool means that you can throw in your good pedagogy around the tool and make it something better for them compared to try to learn something from scratch that may or may not fat. It's funny. Liz, it's twenty twenty. And we're still building capacity. You know I've been going to tech conferences for the better part of a over a decade almost, and we're. Talking. I'm not convinced. We've moved the needle hardly at all like you know if you WANNA hot take for me and I'm sure you don't. But that's what people listen to forget. Sometimes You know we're still like it's we're still building capacity were still getting administrators just to get it. And it's you know we're we're twenty one, twenty years into twenty first century skills. You know what? I'm saying and you know and and you brought up the pandemic and I wanted to ask you about that a little bit in the sense that you know we did go through this moment where teachers. Like I feel like we backslid you know in the sense that you know we just focused on what tools we had to us because that's you know it was like, what can I do for this? What can I do for this? What can I do for this tool? Can I use I knew tons of teachers that were just learning how to use an LMS. So it had nothing to do with learning how to use the LMS for teaching and learning. It had everything to do with just learning how to use the Damn LMS to post an assignment. and you know that seems like we actually took a couple steps back. You don't I don't know if a greedy but certainly, it seems like this was a trying time for the idea of building capacity and pedagogical frameworks for education This this put that kind of idea to the test I think, right Yeah. Absolutely. Mike you bring up such good points and I can't disagree that the pandemic pandemic. Silver linings in there but there's also some some frustrations because there was an emphasis on the tools and there was a quick notice of how many educators just didn't have the knowledge around using the tools. So trying to quickly get them up to speed and you know some you know fought against it for years they were like I'm face to face teacher. I don't do this right and all of a sudden they have to take this crash course. In there is still you know I think of the The bit Mogi classrooms really popular right now, everybody wants to have their. Classroom and it's cute and it's fun. But you know what? That's not what I want my teachers focusing on right now I want them focusing on pedagogy and not spending five hours making a cute bit. God. I'm so you fell on that way. Thank. God. Talk 'cause 'cause we just talked about this a long segment last week. So you know and I get how it's attractive. Right it's so cute and fine but you know what some of it actually goes against good learning practices right if you look at the bit Mogi classrooms there really overwhelming. Stimulating I think of my students on the autism spectrum I think of my adhd students that's going to be too much for them. So it again, they know that as teachers you know that your students with certain identified. Analyses don't need over-stimulation but why are you creating an over stimulating environment for those students because it looks cute and it's fun and everyone's talking about it so imc i. am seeing that during this time that there is attraction to the cute the fine the shiny but ultimately you know it does still come down to the good pedagogy with it and I have been trying to emphasize to schools that have come to me and said well. How do you use the Tripoli framework if you're teaching remotely and Kinda say the same way you use it when you're teaching face to face, you know you still are getting students to a learning outcome right near using technology tools to get there. So evaluate the tool choices you're making with the pedagogy around them and seeing if they're fitting and if it's working and I had to walk through a little bit with teachers and they went, Oh yeah, I do see that. but also to your point Mike I did a survey before the pandemic I was part of a national survey where we surveyed Novice teachers and administrators, kind of acting how well they prepared to teach with technology and one of the most interesting parts of the survey was there was this huge huge discrepancy between how confident administrators were to evaluate teachers using technology. They were like eighty percent confident that they could do this well, and the teachers were seventy percent confident that the administrators had no idea what they were doing. When it came to evaluating them using technology. So, yes, we see a lot of. Just kind of systematic breakdowns in the in school systems where a lot of administrators feel like they're more confident than they are with understanding you know looking in a classroom thinking that if they're all using chromebooks and they're making movies than it's good. Yes talking on on that same topic Liz. Is Far Systems and I had said this kind of off air that move in the there's a move in the United States and I already kind of see it shifting and it's been happening at least the last three to four years. But now in the last one to two years, really a big shift in I'm really happy about the shift happening but people I don't know if we. Can know how to make this the ship and it's it's in the case of of we had five or six years ago. The invention of a position called a technology integrationist and it was kinda coinciding and maybe it was even longer ago than that where a lot of districts going one to one and you needed someone to be able to basically teach how to use an lms how to turn on your your Matt Book and and you know used the hot keys and dude some different things and eventually that tech integrationist position I feel now six, seven, eight years down the road of a one to one program. Has outgrown that that purpose you know that thing you don't need to be doing those things at any longer. And maybe we shouldn't have been doing them in the first place in a lot of districts are transitioning to these two instructional coaches turning us into instructional coaches. I do you do see that as a movement number one in the number two? How do we make that transition? The understand because what has happened a lot of a lot of dishes are going? Yes. We're GONNA rename your position from Tech integrationist to instructional coach gets they don't offer the the training for us to become those people to become. Great at that because that's a completely different set of skills and knowledge and and I'm sure that that's exactly at a university level when you're teaching your courses that's the things that you're going over and talking about have to do with INSTRUC- great instructional practices related to both in person and virtual learning and blended, and whatever else might be. So I don't know if there's a question in there as I. Go Crazy. But do you see this shifting towards that and then what can we? Offer to our administrators for us that are kind of moving into those positions whereas. Would, what do we do as far as the training for us? Yeah I'm actually I. Am I see that shift quite a bad and not even just for kind of the old tat coach or instructional specialists but also for the librarian, the school librarian or media, all of us, they went from a librarian to the media specialists, and now they're expected to be kind of the instructional designer, the instructional coaches. In between, they were supposed to be kind of the tech. Support. You know again, most of those programs didn't train them to do that kind of work. But so they're expected to learn on the job and on the fly. And some do it better than others But yes, there's there's not a lot of actual sound training. There's no certificates or required certification to do that kind of work in most states, there's definitely not in the state of Michigan and so you can do that work with having very little knowledge about what you're doing, which means that you could end up being that you know instructional designer. That is tool centric and of having everyone do cahoots all day you that instructional designer that doesn't actually know the pedagogy that particular fields maybe you taught Yele and you're working with a math teacher and so it's putting you in positions where you're supposed to be an expert on something that maybe you don't really have expertise, you may have gotten that position because you use powerpoint did. Because you must. Be in your classroom and they think you're PECCI or you're the one who fixes, the printers, all the time for teachers and it's really unfortunate that we don't have a higher standard for that and I think the pandemics really brought out the kind of the the dearth or the holes that we have. In this field we're seeing one that we have a lot of digital divide homework. APP issues. That have always been there and people like us have always said things about it that this is a problem but all of a sudden now people are taking it seriously We've talked about how teachers really aren't well trained to work with technology in the field and don't have instructional designer framework and it was always dismissed, and now all of a sudden it's come to you know risen to the surface and. We're seeing teacher program saying Oh we need to add more credits in this, we need to really train teachers we need to do this work so I think that is maybe a silver lining of the pandemic is that we will see a change in how teachers are prepared and what schools are emphasizing for their teacher professional development, and we may even see some new certification programs coming out of this. So. There's in chapter five. Of Your New Book, You have twelve lessons from K. to twelve educators. And at the top of each lesson, you include the demographics of the class used in the case study. I had a very long talk with my wife about this today it was I find it fascinating. Context other contexts I'm Canadian and so in Canada, we do not have this like. Hard. DEMOGRAPHIC FOCUS in education like Americans do where like there are administrators that could tell you the percentage of African Americans. The percentage of Hispanics you know in their schools and no those numbers like off the top of their heads the free and reduced lunches. They know these percentages we don't. We don't have a really strong focus on that in Canada. So I always find it fascinating when when these like. Overt overt demographics are brought into the context. So can you make a connection for our audience as to why that matters in the context of your lesson plans? What makes it important for us to know the percentage of students on free or reduced lunch or ethnicity in the context of the lesson plans in your book? Mike, I'm so glad you asked this question nobody has ever asked me this question. Thank you for noticing that So I can see how some might find it strange to include that But in fields I have always encountered a lot of people educators will say, well, we can't do that in my school because we have too many children who are from low income. and. They won't be able to do that or they won't have access to that or we have you know too many children who speak a different language they're Hispanic or they speak Arabic and so you know they wouldn't be able to do that. You could only do that in an affluent school. And of course I understand where they're coming from. But I also wanted to push against those narratives. I wanted to show examples of teachers using technology in really deep ways and hitting all three of these ease and just kind of over the top who were doing it in all sorts of different environments and with. Different demographics of students So I wanted to be able to show you know schools that were a title one school, and they're doing these amazing projects that doesn't necessarily mean the again the is shiny and amazing is another that necessarily that they're using a bunch of robots and Spiro Balls all day to learn that. But to show that this teacher is using this really high level high expectations challenging project in a school system that maybe has been written off to do something like that So it was important for me to push against that narrative and to make sure. That we're seeing for example, one of the lessons is Sheila or. And she's a math teacher. From Lansing Michigan and she does social justice in her mouth. And her, and she's a white teacher in a you know she she's in a title one school, and so she really pushes how you can use math to do social justice work, which I think is awesome and I also think that that's something where it's important to to show that she's doing this work in a space where she's working with students were this is really GonNa, matter for them. And others can do the same thing, and here's one example. Here's her. You know links to where she's getting some of these ideas So I think it I. Think it's important to push against that narrative especially in Ed tech where the idea is if you're affluent than you can do these high level projects but if you're not then you can't fantastic. So, Liz if people want to connect with you online social media accounts or also to be able to go in and find your book working, they go to go to be able to do those things. Yeah absolutely. So my book is available on Amazon Learning. I technology second in practice it's also available through Esti C dot Org is the publisher. And for me, I work at a public university. So my email is publicly available. To anyone who would like it if you just type in lives called and the University of Michigan and you can grab my email I'm on twitter at L. K. O. L.. L. Cold You can follow me and tweet with me there too. I'm pretty active So yes, please feel free to connect I would love to called. Thanks so much for being on. Thank you Mike, Thank, you glen thanks for listening to on education. My name is Glenn Irvine. My Co host is Mike Washburn. On education is part of the on podcast media network. You can listen to this show and many others by great educators like Monica Burns Mike, mattera tissue, Richmond, and many more by visiting on PODCASTS MEDIA DOT COM. WanNa, get in touch with US check out our website on education PODCAST DOT com. You can tweet us at on Education Pod. Mike is at Mr, Washburn on twitter and I can be found on twitter at herbs Spanish. You could find on facebook by visiting FACEBOOK DOT com slash on education pod. We're also on instagram at on Education Pod. If, you're enjoying the show and think others were to we would be thrilled if you shared it with them, please leave us a rating or review in apple podcast or Google podcasts. When you leave a rating, it gives our rankings abuse. This helps others discover the show we want to thank our presenting sponsor participate for supporting. US, check out. PARTICIPATE DOT COM to learn more about them. Thanks as always for listening state awesome and see you soon.

Mike Bob Ross Ross Mr Rogers twitter US Liz Liz It Liz cold Google University of Michigan president Lavar Burton Glenn Glenn Tripoli Canada Lin Manuel Miranda professor Glen Irvine
357: Thomas Hollmann, Customer Experience Education

Crack the Customer Code

29:12 min | 1 year ago

357: Thomas Hollmann, Customer Experience Education

"Get ready for crack the customer code your audio guidebook for creating incredible customer journeys. So Adam, I think you have a specific connection to our guest today. Is that accurate? Yes. And no, I don't know our guest personally, I've not met him. But I actually did the program at the university where he is a professor so happy certificate in customer experience. And I got many years ago from Arizona state university's center for services leadership. And it's a really interesting program for one thing it is one of the few, and I mean truly few programs in an academic environment about specifically customer experiences almost nothing else. Like it right now. I hope that's changing. I don't know if it is. I was going to say that's changing, and I stopped myself because based on our conversation, I'm not sure I can say that. But it is pretty interesting to think that there's this world that we haven't really explored from an academic perspective when it has so much to do with the success of business, and you look at kind of how those how academia and business intersect in so many different areas like the Harvard Business Review and all the studies that come out from all those different business programs, but customer experience is still kind of an island that hasn't been touched in that same way. So I think it's a really interesting discussion something we haven't really talked about a lot here. So I'm thrilled that Dr Holman was able to meet with us and share a little bit of insight not only about what's happening academia, but how that translates to the to the real world. Okay. I'm gonna get all sorts of hate mail over that. But the. You know, the business side of things and what that means for everybody. No, it's fine haters gonna hate genie. That's what they say. Bulk is valid point. It's a valid not with our guest professor home because he very much is from both worlds. Right. As a Mississippi, and you find that a lot more in the business world. Yeah. There's a lot less of the distinction or the gap. I'll say between sort of academic theory and real world reality in the business world is a lot more Ross over the academia, interacts better. I think in the business fear than it does maybe in the social sciences, and then some other fields. So I think you find lots of it. But there is always that concern. Right. And I think one of the things it's evidence of that is just the very thing. We're going to talk about in this episode. The fact that we've all talk. About customer experience for how long now and how much focus do we put on? We have an entire podcast your careers or dedicated to it. And academia is barely touched the stop, right. It's just very slow and catching up to where the actual market is. So I think you know, dot your home and brings up some great points really explored that force. And then talks a lot about, you know, some of the things he's learned in some the knowledge that they have there in that program. So I think we should get into it. Well, let me share a little bit about our guest. Dr Thomas Homan is a clinical associate professor of marketing and the executive director of the center for services leadership at Arizona State University. Thomas's work experience spans four countries and over ten years in fortune one hundred companies including black and decker Xerox and as an executive at Sun Life financial his research interests include services, science with a focus on BBC service analytics and release. Ship marketing with a particular interest in relationship outcomes. His research has appeared in the journal of the academy of marketing science the journal of business and industrial marketing and several leading marketing and services conferences, he has received research grants and awards and Thomas has consulted with a range of fortune five hundred firms and he received awards for his teaching at Arizona State University. And at NC state Thomas earn a PHD in marketing from Arizona State University. Dr Thomas home, and thank you so much for being with us today. I'm really excited about our conversation. Jews on what for inviting me on your show. I'm looking forward to optimization. Well, I am super excited. I was super cited when Alicia reached out to me because I am a graduate of the very program. Your report of the leader of the center for services leadership at Arizona State University. Actually did get the certificate customer experience from there. It was a fantastic experience. And I can't wait for. To give us some behind the scenes and talk a little bit about service and experience here. So the first question, I have is what do you think the role is of higher education in the world of customer experience today as I think it's a very important role in. It's it's a key role in that higher education can provide on the state companies and the employees at all levels with the knowledge and tools to really be good in excellent at customer service at any customer facing role and one of the opportunities for that is of course to take a program like the one Youth Day, can there's a multitude of avenues to pursue. And we can maybe talk about some of those. But I think that's a key role for us as academics as the education field to play is to help people gain the tools knowledge to be better at what you do in in the broader academic world. Do you think that customer experiences represented? Well, or that it I mean to Jeanine we've talked about this it feels like to us that academia's obviously, not where you're at. But overall academia's lagging behind the marketplace that everyone is focused on not everyone, but most people are focused on customer experience. Now, if nothing else at least to give it lip service and doesn't seem like academia's catching up, what's your view of the whole landscape? Why it's an interesting landscape, and it's something that isn't true only for the whole topic of customer experience. But there oughta speaking while I always compared to when I talk to industry and in the center, we do that a law when I talked to industry, I feel like the Marty MC fly in back to the future. Like, I step out in its nineteen eighty-five because industry is struggling with and looking at totally different topics than the ones that we do when we go economic conferences and totally different levels as well. So that's where we they kademi or sometimes falling short in helping industry employs, just everybody. That's that's also for any organization nonprofit or government to just see what is already existing than take it in apply that without doing a good job of that. We're we're in our center here. We're trying to do a better job at that. While that is certainly something that has needed. Well, and the funny part, I don't know if it's funny. Ha ha, but I guess ironic because that I know a lot of people who are in higher education who are struggling a little bit with attracting the right kind of student body they want because the realizing they need to up their own game in what we would call customer experience in student experience. Right like students have totally different expectations than they did ten years ago. They are looking for a really well rounded experience in higher Ed and a lot of the organizations in higher education that had something that worked for literally hundreds of years like it worked for a long time. Suddenly have to kind of wake up and realize that they are competing in this market just like everybody else. So are you seeing that as well as far as creating customer experience around higher educations? We have certainly here original stage universe. Versity, but also elsewhere in the country where talked to my colleagues we have seen that students or much more educated fun, pardon the pun but much more about engagement. They really looking for that draw experience. They wanna have things that they can apply, but they also want to understand they want to be challenged on beore truly a different generation than I would say certainly twenty years ago, but even just ten years ago. So this group is always say they have to settings zero and two hundred and wanna dial into that two hundred wanna figure out how to get how to get them excited engaged in. Now, that's something that I worked on my classes all the time. But it is really interesting challenge whereas ten fifteen years ago, you would have you know, the normal setting. So that usually sit under thirty to fifty in the get up to eighty or ninety these students now, it's it's really extreme. And they are just sitting there anything up in wonder what's going on in that head right now, they're super aged just just just really driving my own performance in the classroom into a different level of by just demanding and asking it's really it's really I was always at one hundred the night before the exam or the night before the paper was due. The pros. So here's a question talking about customer experience in academia. Your PHD is specifically in what I have a PHD in marketing with a focus on service. Science service is okay. So that's interesting. What what I've looked at. We actually tried to catalog is years ago sort of the experience programs out there, and there are so few and it's grown. It seems like a lot of the people teaching what few experience programs there are coming over from marketing at this point. Do you see a lot of sort of people that came out of customer experience? Roles in business coming into these positions either as adjuncts or or trying to be more traditional get masters in PHD's. What what are you seeing as the marketplace starts to the academic? Marketplace starts to embrace this idea of customer experience. It's a raid to time. I think to be thinking about it, certainly. Companies have started to understand at least many of them understanding quite a bit. Now that the customer experience is key in his really the center of what needs to be focused on the needs to understood and universities are little behind the her of there. But there's a lot of students in my classes and the master's level plazas that are actually at university since always kinda fun to talk them a little bit about how they are trying to take what they learn in Microsystem our forces here now they're trying to take that into their institutions and tried to really drive that understanding and knowledge about the customer and the customer experience into their institution. And there's tool said that the really powerful in that are really making a difference. I'll give you one which is the blueprinting which which is hard off. What you went through at him talk from blueprinting and the blueprinting tool is always in our executive education seminars. One of the highlights for people that they just jump on in fling on just run right back to the organization with and say, hey, this is a great tool. We wanna use it right now. And just that ability to just take some of that knowledge in some of the tools and immediately applied I think that's key. I I'm one of those people I love service blueprinting, I think it's awesome. So I totally get why why people gravitate to it because it works. And it's so like approachable, but one of the warning Thomas you have entered the hill. One of the things that I think you would agree based on all of the background that you have in both industry. And academia is that the idea of creating the right culture for service is super important. And so I'm wondering you probably have some opinions or observations right now about what do you think of good service culture is and what do the best organizations do to achieve their the old adage is that culture eats strategy for breakfast that that's very and I've seen that in my industry works as well. As the economy true of trillion Verdy repeatedly, the idea of culture is sort of in the academy and really weird one. When we talk about culture will be read articles about culture, it's all these on terms for us like artifacts. It's and thinks that nobody talks about in the normal language like what is an hour defending Zack. So when you add missions of culture in textbooks in is not clear to me if I didn't know what they're talking about. I would note afterwards. It's just really weird. The symbols all kinds of things they talk about that don't make sense on. So I go back to industry experience. They're on something that when I was working in new street on that I struggled with in that then fought a very simple idea or simple solution to and the way. I look at culture has that culture is simply the way we work that this all it is so Elvis spent if I'm on a whiteboard, I write down WWW, and it's it's not a euro L for online. But it's the way we work. What culture has about to what are we doing? And if a customer comes with this problem or with this question, or if we internally if we have a snowstorm what we do do we all just home and say, oh, well, you know, too bad customers or do we get out? Do we get? Out our on the wonderful little cups of coffee in hockey in something stay overnight and try to figure out how to make our customers. Hold again. With a whatever it is that they are struggling with because of power might be out or maybe they don't have access to their financials or whatever it is. So how do we react to situations circumstances? That's really what culture is all about. So how do we work with each other with customers, and that that's that's much simpler than the whole notion of symbols and artifacts. What can you do? Well, the important thing that I found it that works is is storytelling. Just tell the stories off the customer associate that went through the snow deliver a package or tell a story of the customer support group that stayed in the office for three days overnight because everybody was snowed in still wanna be reachable to customers. You know, those stories in telling them, that's really the. Most powerful way of getting a culture come alive and to communicate to anybody old or new organization. What does this? We're trying to do. I like that definition of the way we work and I'm glad that's that's what you were doing instead of writing WWW for worldwide web 'cause your students would make little. Well, you know, it's interesting. Let's talk a little bit about customer success. This is like a term and buzzword that don't even think existed ten years ago. Now, we talk about it a lot and particularly in service based industries sorts of software. Those industries and talk about the value of customer says what what's the idea of excess wise it valuable, and how can organizations use it as a framework. Yes, we have in our sent one of the things we do is. We have to make sense of what I'm saying next step back a couple of yards. Here talked about the Sandra. So we're bringing together condemning in industry practitioners. So we've got a fifty member firms that those companies organizations and over eighty faculty and one of the things that we're doing with in that network is we have something. Called community of practice. So in that community of practice re bring together, a subset of that group and talk about specific topics. We have one actually on customer success that we launched last year on based on the demand from our member saying, hey, they are all looking at this. What is this? Does this apply to my industry to my company in trying to understand what it means? And from there we've had a great event at one of our member firms here, and we have written white paper on that. So so that's me stepping back a few yards and coming back now to to look at customer success with you the different issues for us. Very simple customer success is when customers achieve their goals using our product or service, all it is and in that sense, how some success very old. So is the new topic? It's a new topic impart because I think the company's organizations are starting to really not just mentally. Also just emotionally understand how critical their customer success is to them. Being a successful firm. Now customers don't really want to buy anything. They buy things because they have something they want to accomplish. That's the jobs to be done perspective or the Gulf only because the have that goal. Do they actually come to us in bio things whether it's a Cup of coffee or it's a flight or it's Eucation they have adults that they want to accomplish. And without hours say, my classes, you know. It's really simple. If you have no pastor, you have no firm, you don't exist. So if you if you're looking at it from that perspective, then you will have no customer, if you don't help them meet their goals, whatever those are in so customer success should be at the centre off every business much. Just the software as a service weighed all as a term start. But really every business any business anywhere, any organization, nonprofits, whatever you are is all about the customer succeeding with what they want. It is that's the golden ticket that people still can't seem to get some. I can grant's in and they all look at me like dove. Well, I'm sorry. With all that you've seen because you've had both impressive corporate and roles in academia, I'm really interested in what you see for the future here because I think we've been I feel like customer experience in general is kind of reaching that point where people are like, yes, it's actually thing that we should care about after we've been talking about for twenty thirty years now, in some cases, and there are you know, dedicated resources there are titles at companies now that are all about the customer experience. So what do we need to tell people about leading in the future in order to really compete? What do leaders need to do differently in the future them what they're doing today? All the woman it listen to you. So start. Now, we're talking. Yeah. Without a customer. There is no firm in the pulpits are starting to really understand that how central the customers in central their for the customer experiences and how to then figure out how to improve that not understand. That is the challenge for them. And there are break tools, the blueprint blueprinting. We've talked about this one on. There's another tool that we use our activity -cation seminars. Paul the gap model GAAP, just you know, gap, from the gap the gap model, and that is another fantastic tools. Many more. We have we have dozens of tools we go through and that we have developed in the academy. Many of them haven't really filtered into business practice to the level that economics things they should buy. That's on the Demings. That's because we haven't done the a great job of translating those tool. So that's number one really to look at all these tools that have already been created and demand tools. Ask questions say here's something that. My business is struggling with. Let's partner on something. It could be as simple as a folk Paul too old professor and saying, hey, remember me from you know, twenty years ago when I was sitting there, and I get those emails and phone calls from my students. I have an open door policy with him. And you know, just talking about, hey, I'm struggling with XYZ is there's something that you can point to just looking for that knowledge base looking for those tools. So that certainly one thing, and then the other thing is I think from from asks from the academics, we have a job to do on number one, the translational the tools that already exist. But number two really the future off services or the future off word is a topic. That has also come up in the last year or two very strongly in people are always somewhat freaking out because they think the rotor robots take everything and gonna be reduced to sitting by a pool. Goals and drinking my ties it's gonna be so bad. But you know. The robot Butler. That's what I'm looking for Taylor, actually. Really really take off because like two or three years. Now, she was so hopeful that she will not need to learn how to drive because she thought the self driving cars have arrived by the time. She would need that. And it's not looking that's not gonna happen in time so fees unhappy, but you're at all. Let her let her know that every generation is disappointed by the promise of the Jetsons flying cars, right wet, whereas my point. Know whether the with role to play to help with that transition. So on a robots all of that is due come on come in very different way than the two extreme scenarios that always people talk about one is that everything will be just fine without us wondering and worrying about anything it'll just work out because it's always worked out while that's not how it works. The other side of it is the you you can watch going back to terminate. I guess all these wonderful movies. That were the roads are taking everything over is gonna be really a horrible situation for us. That's that. I don't think we'll come to pass while there's this middle ground this middle Brown where if we can find the right path with the tools knowledge phase kind of innovation. We need to move forward. In a way that we have another great transition. We had the transition from ninety five percent of people working in. In agriculture in the fields to you know, where we are. Now that transition so where those ninety two percent that are now not in the field anymore. Where are they now while they all have great opportunities jobs wonderful services that we've come up with? And I think we can do that again. And that's a role for the academy that me here at the center for services leadership a really driving right now is to figure out what that path forward. I think the beauty of what you just said is that I'm probably that. I meet the description of the person who's like, it's all going to work out. It's always worked out and Adam meets the description of Skynet is taking over. Just just assuming that machines will evolve differently than us and not come self aware. That's. So yes, so we will get there. I think there's a beautiful compromise somewhere. So I appreciate the way you put that. But this whole thing is so interesting. I'm sure you are seeing so many cool things throughout what you do. And who you teach and what you're sharing with different organizations. So this has been really really enlightening. So thank you so much for joining us today. And if people do want to know about the center, or you what's the best way for them to leak out and find you. These interval services leadership in Arizona State University. That's a lot of things to type in the easiest way is if you go to your engine and type in ASU as space C S L. So it was on university center Servizi ship AS UCS L. We will come up right up there. I on your search engine that will be easiest way to find us into pumped us here. Okay. That's perfect 'em. We will as always make sure that's in our show notes. So that's an easy way for everybody to find it as well. But this was really great. Thank you for all the work you doing and here's to the robots not taking over completely except I'm pretty excited about the robot Butler idea. So. Thank you having me on your show. Thanks so much. We'll exciting to think about what will be next in this arena his net atom with what will we be teaching in the future? How will we how will we combine this idea of what actually happens in business with customer experience, and how to really translate that back to academe and vice versa because based on all the research and the tools that they're developing. How can we use that better in our work as well? So I think this is like brave new world stuff even though it's been around for while. Well, it's not just that. I think it's also the ability of academia to prepare tomorrow's workforce. Right. I mean, that's how you how do you go into customer experience? If you're an we've talked about this. I think it's been a long time since we really covered the topic. I think that's if you're going into marketing, right? You go. You do your you get your marketing degree, and then you go to your couple years paean, Jay or whatever. Right and Brian than you. Yeah. Go to affirm go out on your own whatever it may be. There is a sort of obvious path customer. Experience doesn't have that path. And that may be good in some ways. But it's also I think challenging is a lot of learning curve in customer experience. So I think the more. This trickles down or trickles up. What to look at it? I think the better it will be. I totally agree. And I think that I I really appreciate it. What Thomas had to say about a lot of the ways that they are listening to students and their students are running back to their organizations and sharing the knowledge that they have to and that's that's what's going to work. That's how we're all going to win. So yeah, it was kind of fun. It was kind of fun to think about this in a different way. And to really crack the academic code if you will. Yeah. We really schooled everybody. Oh, there is. Jaydee ticks away. Well, thank you all for studying with us at crack the customer code. Crack because we're code is a proud member of cease we radio so be sure to check out all the great business content at C, suite radio dot com and C suite TV dot com. We so appreciate you being here with us. I'm Jeannie Walters, and you can learn more about me and our journey mapping programs CX, training and speaking at experience investigators dot com. About important, and you can learn more about the Mike. Keynote speeches are customer service in training, and our strategic advisory at customers that step dot com until next time to kill yourself and take care of your customers.

Arizona state university Thomas professor Adam Harvard Business Review executive Mississippi Dr Holman Ross Gulf journal of the academy of mark Dr Thomas Alicia Dr Thomas Homan Jeanine Marty MC Paul Xerox Versity
The Brain Game of Reopening

Here's Something Good

08:13 min | 3 months ago

The Brain Game of Reopening

"We are so grateful to our launch partners founding partner PNG and Bank of America together. We're bringing you something good every day and it wouldn't be possible without their support. Welcome to this episode of here's something good, a production of the Seneca Women Podcast, work and iheartradio. Each day we aspire to bring you the good news. The silver lining the glass half full because there is good happening in the world everywhere every day. We just need to look for in share it. Here's something good for today. So here. We are three months after the start of covid and the US reopening in ways large and small, but for some people instead of bringing joy, the new reality means more uncertainty and unease, because for much of the US life. Today is a set of either or's. We can go to the park, but we might worry about whether others at the park will be wearing masks we can eat at. At a restaurant if we sit outside, but we don't know our fellow diners will be keeping the proper distance when everything was locked down, we knew what to think and do now. We don't know whether we should be cautious or carefree. How do we play the brain game reopening? We talked to psychiatrist. Dr Gail felt who had some great ways to think about life in this new sort of normal. So. Let's consider why this time is so challenging. In some states, Corona virus cases are dropping to new lows, which is great news. While in other states were hitting record highs, all fifty states have reopened in some manner, but the restrictions vary greatly. You can go to the theater or a gym or a bar in Arizona or Florida, but not in Colorado or California and while Oregon was pretty much open early June the governor. Put a pause on that when Cova cases soared this month to add to the question about what we can do their. Their concerns about our fellow citizens, a study in April showed that only fifty five percent of Americans said they would wear a mask in public with all this uncertainty. It's no wonder that eighty percent of Americans are waiting for some additional reassurance before they resume normal activities according to a recent McKinsey study fortunately. Dr Gail Saltz has some advice on how to navigate these times. Dr Salt is a clinical associate professor of psychiatry at the new. York Presbyterian Hospital, a bestselling author and host of the IHEART podcast personality. Let's hear what she had to say. In the majority of the country think there are real and genuine concerns about risk exposure, depending on how closer to people whether they're wearing nap or not. The how your area is handling reopening and the numbers that exists there and. Because there's real risk. And by the way there's also risks involved in not reopening, and so that's conflict for everybody, great risk of Covid and tracking it versus the risk of being out of work or having businesses close these are risks on either side, and that puts people into conflict. Try to look in your local area as to what is actually happening and you stayed. Make your informed decision and then try to look inside your mind. And some people making risks is very comfortable for them, and they need and take more risks than they should be because they're essentially risk-takers birther. If you know yourself and he knows that actually you tend to be warrant anxious person. I'm seeing more of that. People have high anxiety can to solve their anxiety for themselves by avoidance and the more that you avoid. The more you will avoid because it makes you feel read. You are mentally know something about how you think. Whether you can be on risk-taking anxious side of things. And you also want to be able to follow them what you decide and not you have to be swayed. By what other people want you to do for example, one person who's navy frank, saying little restaurant with us. And, maybe you're saying you know I've looked. I don't cultivable for these various reasons. Maybe you just are looking around saying I. Don't think we're going on here. SMART I'm not comfortable with it. You have to be able to talk to people that are in your life. We have very different approaches. Maybe essentially peer pressuring you and saying you know I really value our friendship. Will I really value our relationship and I? WanNa keep it up in these ways, but right now I really feel uncomfortable and I hope it can respect that for me and hopefully, if you're very open about communities that ring you avoid. You know we'll call it. Obviously the world is not as it was, and you were person who was pretty copy in the world as it was, and you feel that the things that you had to do to accommodate taken away a lot in court and things for many people right here, cavers financial who be and who they rent with their, there are real office for people, and there is a certain amount of accepting that being said there are definitely things at once you for oneself partake, and you know moment to moment fine joys in life, and you know one way to do that is the practice of gratitude. is about every eight meeting naming three things in your day for which your rate all and really have appreciated your daycare smallers, neither one of the copy this morning it could be as I had a really meaningful conversation with my mom though. You know really really thinking about during the day things which you appreciate your brake before which is very easy to overlook in the difficult circumstances we're in now. And that may offer the subject warrant here that you and appreciate you enjoy. It's always reassuring to talk to Dr Salts and it's good to know that it's our personal comfort that counts not what others might say so if you don't feel ready to get into the full swing of activities by all means don't. So here's something good for today. We should recognize this time of gradual. Reopening creates unease, and that's totally normal. If taking extra precautions increases our comfort level, we should do that, but remember there are plenty of activities particularly outdoors. That are both enjoyable and safe, and to keep in a positive frame of mind. It's always good to practice gratitude for the small moments in life that can mean appreciating a great cup of coffee, or even a meaningful conversation, and for some fascinating listening be sure to check out. Dr Salts podcast personality on iheartradio. Thank you for listening and please share today. Something good with others in your life. This is Kim as early co author fast forward and Co founder of Seneca women to learn more about Seneca. Women go to Seneca. Women Dot, com, or download the Seneca women APP free in the APP store. Here's something. Good is a production of a Seneca woman, podcast, network and iheartradio. Have a great day. For more podcasts from iheartradio, check out the iheartradio APP, apple podcasts, or wherever you listen to your favorite shows in the past few months, the notion of home is no longer just the place drop into at the end of the day, especially when our homes have become our workplace, school and full service restaurant well. Here's something good. For Today we spoke to Borgen sheer scientific communications manager at PNG about how cleaning can foster a sense of calm and control. You can start with an easier way to clean thanks to Dawn power-wash display, so you can spend less time scrubbing and soaking dishes, and you can get back to the things you love. Bizet DON DISH DOT COM.

Seneca Women Podcast US Seneca Dr Gail Saltz Dr Gail Dr Salts Seneca founding partner Dr Salt IHEART Dr Salts PNG apple Cova York Presbyterian Hospital Dot Bizet Borgen Arizona
Can New Zealand Contain New Coronavirus Outbreak?

TIME's Top Stories

09:46 min | Last month

Can New Zealand Contain New Coronavirus Outbreak?

"After one, hundred, two days cove Free New Zealand's resurgence highlights the difficulties of returning to normal life by Melissa Godin. For the past three months New Zealanders have enjoyed a cova free country with citizens hugging one another children returning to classrooms and sports fans filling stadiums but this changed on Tuesday when a family of four from Auckland the country's biggest city tested positive for the virus breaking a one hundred, two days streak without any new covid nineteen cases as a Friday twenty nine people had tested positive for the virus, all of whom remained linked to the original four. Cases although the government says, the latest outbreak appears to currently be limited to one cluster. It's taking tough actions to prohibit any further spread. The small outbreak has sent a third of the population back into lockdown and the rest of the country into restrictions. Auckland has been placed under level three lockdown with residents asked to stay home unless they have to go into work buy groceries or exercise. We can see the seriousness of the situation we're in just into. The country's prime minister said at a press conference it's being dealt with an urgent, but calm and methodical way New Zealand has been lauded internationally for it's handling of the covid nineteen pandemic with some suggesting are dern is the most effective leader on the planet intense contact tracing isolation and testing made New Zealand. One of the first covid free countries in the world on June eighth, all social distancing measures were lifted after a fifty one day lockdown allowing citizens to return to normal life strict border controls remained in. Place however prohibiting entry to non new. Zealanders, and requiring all returning citizens quarantine for fourteen days. But the latest outbreak in New Zealand country held up as an example by the world. Health Organization shows that even a covid free nation that is implementing the toughest border control measures. Corona virus remains a threat. Once again, we are reminded of how tricky this virus is and how easily it can spread ardor and said in a televised media conference on Thursday going hard, and early is still the best course of. Action. New Zealand is an alone in confronting new covid nineteen waves after initial success in curbing the spread of the virus. The at Phnom went nine days without any new cases only to see a surge of new infections in July centered on the port city of Danang. Australia where officials had talked of eliminating the corona virus there as well recorded its deadliest day of the pandemic on August tenth due to a major outbreak centered on Melbourne much of the city and surrounding state of Victoria was forced into a second lockdown to curtail the spread. How did the virus resurface in New Zealand on Tuesday four people from the same family tested positive for the virus becoming the first cases since the country declared itself Covid free on June eighth none of the patients worked at the country's borders or had traveled overseas raising questions about how they became infected in the first place as of Friday the cluster of cases had grown to twenty nine but remained connected to the original cases in Auckland thirty. Eight people are in government quarantine over two hundred people who may have been exposed to the. Patients have since been tested the majority of whom are from the same to workplaces as the infected individuals. One unproven theory is that the virus arrived in new? Zealand. By way of cargo as one of the original infected individuals worked at Amirah cold, a cold storage facility with imported food everyone at the company has been tested with seven workers testing positive for the virus surfaces at the company's facilities have also been tested amid evidence that the virus thrives in cold storage facilities. The company has mandated that all employees and their families self isolate. Additional testing is also being done at Rotorua a town one, hundred, forty, two miles southeast of Auckland where the four family members visited prior to testing positive with the virus. Although new, Zealand has seen success in curbing the spread of the virus experts. Say It's unsurprising the countries experiencing a new surge even with quite stringent precautions. I don't think we can be too surprised to see clusters arising said garage. Davis a clinical associate professor in microbiology at Swansea University. As symptomatic or near a symptomatic infection and transmission makes this infection very difficult to track and can circulate below the radar before being picked up especially in clusters of younger people. Although all cases have been linked back to one cluster. It's too early to know whether the virus is circulating more widely the original patient started showing symptoms on July thirty first making it possible that the virus has been spreading undetected in New Zealand for several weeks as we all learned from our first experience with covid nineteen. Once you identify a cluster, it grows before it slows are durin. said at a media briefing. In Wellington on Thursday, we should expect that to be the case here. New. Restrictions has the government imposed on Wednesday. The government implemented a three day lockdown in Auckland requiring residents of the city to stay home except for work necessary shopping and exercise all schools, childcare facilities and non essential businesses have been closed although restrictions are less strict across the rest of the country. People are required to socially distance by maintaining two meters apart and wearing masks. The government has released five million masks from the national stockpile and is circulating them too vulnerable people who may be unable to afford one. All retirement homes have also been shut down and gatherings have been limited to under one hundred people unlike with the previous lockdown all patients who test positive for Cova nineteen we'll. Be Required to stay in government managed quarantine. The government is also rolling out a covid nineteen tracer APP to allow individuals to create digital records of where they've been that will help with contact tracing in the event of an outbreak. All businesses and services are required to display a qr code at the entry of their sites so that people using the APP can check themselves in to that establishment. On Tuesday night alone one hundred, thousand people downloaded. The APP the ability to contact race is one of the key tools we have to find new cases and get them in isolation to avoid future lockdowns are dern said using the APP is a big investment in keeping our businesses and economy open. Since lockdown measures were announced on Wednesday. The country has seen a mixed response with many abiding by the new rules and some fighting against them in the Northland City of Wonga Ray. A small group of sixty people protested against the new lockdown measures on Thursday. The protesters argued that the government's latest restrictions violated their rights on Friday are dern announced twelve day extension of the Auckland lockdown. They have achieved such a good of control and so few cases that quite drastic short-term local measures are justified in order to preserve relative normality in the medium to longer-term said Davies. How did do Zealand contain the virus the first time? When covid nineteen was beginning to spread to other countries at the beginning of this year New Zealand took decisive action to protect itself from the virus on February Third New Zealand, which didn't yet have any reports cases of covid nineteen banned entry to any foreigner coming from or via China where the outbreak began shortly after covid nineteen, which declared a pandemic in March officials imposed a mandatory. Lockdown, for all those entering the country, one of the strictest lockdown measure in the world during that period within weeks, the government closed the border entirely to all non citizens and residents at the same time. The government implemented a countrywide lockdown that restricted movement and limited social interaction to within a household. The government also carried out over ten thousand tests a day and implemented extensive contact tracing. Although, the island country is isolated and has a low population density making containment efforts easier experts say it's the government's decisive action that helped curb the spread of the virus. New Zealand had the advantage of being an island, but also established a hard lockdown and strict border controls early on which were critical said Davies. Part of what also appears to have made New Zealand strategy. So successful is the willingness of citizens to abide by lockdown rules. Overwhelmingly, New Zealanders, support the government's approach to the pandemic with one poll finding that eighty seven percent of citizens backed the government's lockdown measures and only eight percent opposed are dern has repeatedly thank the New Zealand public referring to the country as a team of five million.

New Zealand government Auckland New Zealand dern Zealand New Zealand Cova Auckland Davies Melissa Godin Danang Amirah cold Australia Melbourne Health Organization prime minister Swansea University Wellington
Irish Designers Take Architecture's Top Prize; Hemingway In Quarantine

Here & Now

43:08 min | 4 months ago

Irish Designers Take Architecture's Top Prize; Hemingway In Quarantine

"From NPR and WBZ. I'm Jeremy Hobson. I'm Robin Young. It's here and now. And today's the day in Florida. Many businesses reopening although and retail stores will only be allowed to have twenty-five percent capacity and the reopening does not apply to Florida's most populous counties. Miami Dade Broward and Palm Beach meanwhile the. Us Senate is back in session today even as Washington DC remains under stay at home orders and the House of Representatives remains shuttered. The Supreme Court has started back up to and for the first time ever. It is hearing oral arguments over the phone we're joined now by NPR national political correspondent. Mara Liasson Marlet. Start with the Senate Majority Leader Mitch. Mcconnell called the Senate back into session Democrats are not happy about it but with the house still out. What is the Senate plan to do? The Senate is going to do the things that can do by itself like judicial. Nominations are executive branch. Nominations those are things that Mitch. Mcconnell has made his number one priority. And that's going to continue. They don't need the house for that. And what about the House has speaker Pelosi given any indication of when they might return? Well that's really interesting. She has said they might return next week. She says that she's GonNa follow the recommendations of the capital attending physician. Brian Monaghan Who has said? Interestingly enough that he doesn't have enough Kovin tests for even one hundred senators. The White House offered Congress some tests after he issued that statement and in a rare show of unity. Nancy Pelosi and how the majority leader in the Senate Mitch. Mcconnell wrote a joint statement saying no thank you. We would rather save the tests for people who are really need them. The president didn't like that he tweeted. Maybe you need to do doctor over there. But the different Approach to opening between the House and the Senate really mirrors the red blue. Divide that we're seeing all over the country about how fast and how safely The states can open up and the Republicans in the house have been pushing to open. They've issued some recommendations they think could make it safe more plexiglass barriers larger hearing rooms. Some lawmakers could participate in hearings from home so the house is still a work in progress but it sounds like they'll open maybe next week well one of the things that people are going to be looking for from Congress potentially is more economic relief. Maybe another package but president trump now says he would only sign another bill if it includes a payroll tax cut. How does that demand go over with lawmakers well not all Republicans are on board with that and not all democrats are? It's interesting the president has said. Nothing's going to move forward without a payroll tax cut. Mitch McConnell said. Nothing's going to move forward unless corporations are protected from lawsuits around the pandemic for instance meatpacking workers who say they've been forced to work in unsafe conditions without protective equipment and McConnell has also said he doesn't want to provide aid to the states states should consider declaring bankruptcy. If it comes to that so there are a lot of red lines that are being laid down by Republicans. Democrats want aid to the states. The one area where you could potentially see some compromises on infrastructure. The president's says he wants a big infrastructure investment. Democrats have always wanted that But the bottom line is we're a very long way away from the next package. Tim Economic Aid. President trump also responded to news that he received two intelligence briefings on the corona virus. In January he downplayed their significance on twitter yesterday saying they only spoke of the virus. He's talking about his advisors in a very non threatening matter of fact manner. How does this play into the president's defense of his early pandemic response? The president is determined to convince voters that he acted swiftly despite a lot of evidence that he didn't and he said yesterday in this Fox virtual town hall that the intelligence community is going to be coming out with a statement today saying that they didn't warn him a now that he's put his own people in charge of the intelligence community. Maybe that will happen. But what the president is determined to do is to not be seen as being responsible for a slow and halting response to the virus. He said famously. It's not his responsibility and his political advisors know that his reelection at least right now depends on how voters judge his leadership in that crisis so he has been running ads. He says at every opportunity that he acted swiftly and decisively. He focuses a lot on cutting off travel from China At least for non US citizens which he did back in the winter to say that was a sweet early response But this is very important you know. He's going to be judged by how he dealt with this crisis so it's important that he not be seen as being warned and ignoring those warnings when he's going to apparently start traveling again next week. Let's listen here to vice president. Mike Pence at the Fox News. Townhall yesterday apologizing for not wearing a mask at the Mayo Clinic last week. I I didn't think it was necessary but I should've worn a mask at the Mayo Clinic and I wore it when I visited the ventilator plan in Indiana so that brings me to this question. More of the president's GonNa Travel in the Vice President. Says he should've worn the mask. Is the president just briefly going to wear a mask travels first of all? I don't know second of all. It's hard to imagine the president wearing a mask. It's just that if he did that would be an extraordinary moment. But I also have to say Mike Pence having a very human response to that question saying I should've worn a mask was also an amazing moment in that town is he really did set himself apart from the president. Npr national political correspondent. Mara Liasson. Thank you thank you. Let's go to Europe now where several countries are easing lockdown restrictions. Today Italy the verse country in the world to implement a nationwide lockdown is relaxing some of its restrictions for the first time in more than two months an issue probably know Italy has been one of the hardest hit countries in this coronavirus pandemic. The death toll is nearly twenty nine thousand country of course much smaller than the US NPR. Sylvia Poggioli has been that lockdown. She joins us from Rome. Sylvia's just outlined for us. What will people be doing now? That some of these restrictions are lifted. Well one thing is what they can do what they are. Today was the first day in my sense is that people are really taking it. Very slowly very cautiously. I did not see many many people out on the street more than before there was some traffic but by pre pandemic Roman standards. It felt like a quiet August when everybody goes away on vacation. There were some joggers. More people on the streets. Everyone is wearing face masks. But you know a few things can open. It's only manufacturing construction sites. retail shops except for bookstores and grocery stores are not yet allowed to open they. That's to avoid crowding. And for instance today I saw my bike shop is open. But it's only for repairs not for sales well and you mentioned what sounds like this fear and we heard about this in China as well. People emotionally maybe psychologically affected by what they went through. Not leaping out into the streets enjoy it. It's interesting here. In the United States. We have a lot of headlines. Now about how masks and social distancing have become kind of political statement people who don't like to be told by the government what to do rejecting them. How is that playing out there in Italy where I've seen this? Corona virus pandemic has had an amazing affecting reversing national stereotypes. Italians are the first to admit that they are the lease law-abiding people on the face of the earth and nobody has been more observant. I think of the rules. This has been a very very tough lockdown one of the most restrictive certainly in Europe and Italians have been extraordinarily obedient And as I said everybody I saw side was wearing a face mask It's required inside indoor public places but it has not necessarily been required as you walk down the street but they were all wearing them and the there's a lot of anxiety about going out one person talked to said you know I The lockdown was an imposition. Then it became a kind of coon very protective and made and now. We're all little bit afraid to venture out into the the world this new world that nobody really knows what the new rules are going to be like will but this lifting of restrictions. It was supposed to come here in the states with a declining infection rate. That's not happening in many places here in the state the openings happening anyway but what's going on there in. Italy has the curve in flat and remind us. Oh yes definitely. There's been a decline and and it's a very slow decline. But in the last few weeks it's been declining. And that's why we have the reopening. The government though has made it very clear that if the infections rise again lockdowns will resume if not nationwide at least in the areas where they are the infections. There's been a lot of pressure on the government from business associations to open up everything faster to to try to offset the economic impact of the pandemic. Which is you know going to be probably very devastating but generally public opinion as I said has been on side of the government. Well I was going to say. We mentioned the government How the government being seen by the people? Well it's doing very well and especially Prime Minister Giuseppe Conti who frankly was more or less a nobody until before the pandemic started. He had no political experience when he was tapped. Sort of compromise candidate to lead the coalition government but he. He's been a little bit awkward at times but he has grown tremendously in stature. Now he's obviously attacked by the right wing populist opposition for his cautious approach but his popularity it dropped a little bit over the last month but he still has a sixty four percent popularity rating. You know the biggest test is going to be ahead dealing with the economic crisis already. The lockdown has inflated the ranks of the poor There's been a huge increase in people seeking charity. You know it's going to be tougher ahead than even been up to now but interesting Italian. Not Blaming the government for that lockdown. Npr's Sylvia Pohjola in Italy lifting some lockdown restrictions. Today for the first time in more than two months Sylvia. What's the first thing you want to do? Well I really really want to go to the beach even though it's a little early but that's GonNa be a while because we still have a restrictions on travel outside of your region and where I WANNA go is in. Tuscany and I think it's going to be probably another month or so before I can. Do that. Joined the rest of streaming Sylvia. Thank you thank you One of the many things. You may have missed lately. Amid all the Corona Virus News the Twenty Twenty Pritzker Architecture Prize was awarded to the CO founders of the Irish design firm Grafton architects that would be Yvonne Farrell and Shelley McNamara. I spoke with them in March shortly after they won the prize which is sometimes referred to as the Nobel for architecture and I asked them how being based in Ireland informs they're designing. It's a wonderful thing to come from this country. Both shelley and I are products of the Irish education system. And we've had wonderful opportunities here to be architects and we were building here for many years before we won an international competition for Makoni. University initially is probably not terribly well known but the culture of architecture that has grown in our land over the last ten years. Let's say fifteen years has been gradually getting stronger and in many ways the the fact that we were invited to cure as the Venice Biennale A in two thousand eighteen was a recognition of the people are starting to realize that perhaps something interesting is happening in our land and Jeremy to add to that. It's also that when you live on an island. What is fantastic is that you both have indigenous Influences but also you're ready to receive indigenous from other places so you also have a perspective. That's both very anchored in place but also very open to the influences at global level. A lot of your work features a big open spaces either internal or external like multi-storey. Atri OUR OPEN. Staircases often illuminated with lots of natural light. How much do you think about how people are going to use those spaces as you're designing them well? Architecture is a framework within which people live out their lives. Our role is to make this framework and to give people a sense of dignity and a sense of worth in a sense of elation. I think what was interesting for us in the Venice. Biennale manifesto was was really teasing out. These first principles of architecture. What our material is we wanted to focus on space because we believe that are above all we are space makers were not just object makers and the basis of civic society is really making places and spaces where people can feel comfortable together. That's one of the key roles of architecture is is how to make that one on. Yvonne calls the Unexpressed wishes of strangers that that we're dealing with with particular users but we're also dealing with the stranger who passes by or who wanders into a building thus the joy of city it's joy of architecture is the joy of collective spaces. You learn by accident by Serendipity All of those things come into our thinking when we're we're making space speaking of gathering together and people getting together. How is it to work together as architects to do these projects with both of you involved? I think it's enriched by having more torches shining light on a particular issue. I think what's wonderful for both shelley and myself is also the team of people that we have around us that we really try to have a collective view that we we often discuss architects as as translators that we translate the needs of people into space. Do you know whatever they might be auditory or classrooms or in house depending what it is so we get this kind of collage of if we were making handmade bedspread all little pieces all these handkerchieves of needs we try and understand them for what they need to be themselves. And then we try to find a story that weaves this new scenario. We believe every project is like an invention that that every new project has kind of a an element of fiction in it. That you you. We've a story around which the new lives of all the people sometimes projects. Have you know three? And a half thousand people are going to live in these complexes that we might build the kind of overlap. That's the thing that I suppose. That fascinates Chilean. I is as architecture. Holes you totally. It holds you in the morning. As you wake up. It holds you as you go to. School holds you in cities or in the countryside so we really feel passionate about our profession. I think the fault of our profession is as we many times talk to ourselves and not enough to degenerate public and the general public are the very people who are affected by all the architectural decisions that are made. You know it's interesting. We spoke on this program Earlier with Balakrishnan dossier who also won the Pritzker prize is an Indian architect and Studied with Corbu and I asked him what They talked about what he learned from him. And he said you know we only. We never really talked about architecture. We only talked about life and and philosophy. Yeah well that's it's one of the wonderful things about being an architect. Who is that? You're not working alone in fact you it's it's very difficult to work alone so those conversations that one has enrich our lives and it's something that. I'm sorry thankful for every day that I can come into a space here in Dublin and have the best conversations of my life with my colleagues what we love. Really Jeremy is when architecture is not the object of delight necessarily but that people feel the warmth of a brick surface against their back or that I really beautifully positioned bench holes. You when you're tired or that architecture is at the service of humanity and we often speak about the fact that since two thousand and eight more than half the world live in cities so therefore what is built becomes what we call the new geography so that what we are building is really the if you like the holder the tender arms that whole future generations so that that architecture is not only about the beauty of a particular thing but in how each particular things put together and thought about infrastructurally. That's that's the thing that that that we're really passionate about that. Architects should become much more involved in the infrastructure of of cities. How water is dealt with. How as sewage is dealt with all those things could have a cultural component and our certainty when vast amount of money are spent on huge human needs what we would argue for. Is that a component of this is also talked about as a cultural level. So what do you think about what's being built right now? Because you know for the last many years a lot of the world has been in a building boom and what you see going up in many places certainly in the United States are big glass towers and kind of boring condo buildings all over the place. Well I think good architects need to be given a chance to make the the best quality billings that they are capable of making and very often. The best architects are sidelined and are not in the forefront for a variety of reasons. But just it's interesting when you talk about glass buildings what we found extraordinary when we went to Lima where we WANNA competition. We made a building in Lima. Where it's released like a viaduct or an aqueduct or something. It's it's not like A building at all in a way you could say. And that's because we thought about the climate and that you could move externally because you it's a moderate city and it's It enjoys the breeze from the Pacific and so the only spaces we made were internal where the actual teaching spaces in this new University of Engineering and Lima and so many of the buildings around us were buildings. You could find in in Sydney or New York or Los Angeles or whatever old last buildings and we just found that so strange one really has to take the culture and climate of a place and make things which are particular tours which all of the engine architects would have done if you look at historic architecture. Recently I went to see the film Apollo Eleven. There were scientists who were able to design a craft that could go from Earth to moon and come back to the atmosphere so my point really is that we can make a craft collectively that can go from our atmosphere to a to the lunar atmosphere that we can make at buildings of the future that survives like we often refer to a wonderful building in Milan. Call US Battalion Majori which comes from the fourteen hundreds and it stealing use it still a university. It was a hospital and it has a series of these gorgeous or January courtyards and it still a machine. It still works. It's still very beautiful. That architecture is very interesting is both the future and the past and the present so what we would like to discuss. I suppose and make your audience aware or discuss with you. That can we not stink about buildings in the future that a very little maintenance at running costs and that we think about ordinary things that are very beautiful. The height of floor to ceiling lovely window that opens out. And you could hear a blackbird saying that that the pleasure of looking at a tree that architecture can be setting up very very simple relationships. It doesn't necessarily mean huge expenditure. It actually takes a certain way of thinking. Well I could listen to you both all day long but unfortunately the biggest room if you will that we have in. Our House of this program is eleven minutes long. And we've gone through it all but Yvonne Farrell and Shelley McNamara Co Founders of the Irish design firm Grafton architects and winners of this year's Pritzker architecture prize. Thank you so much for joining us. Thank you thank you bye bye bye. And we've got photos of some of their work at here. Now Dot Org by the way if that interview sounded like a blast from the past with all the talk of convenience spaces and getting together. That's because it was. It was recorded in March. The two architects were in the same room probably wouldn't happen today. There was an audio engineer recording. Their end of the conversation definitely wouldn't happen today and I was working from the studio rather than from those were the days and you may have recently tried to buy flour or sugar only to be greeted by empty shells. Darn everyone else got their first more. People are doing pandemic baking Colorado public radio. Stena SIEG has our story around the same time governors started ordering people to shelter in place. The videos began popping up on Youtube. Today we're creating the simplest quarantine birthday cake. Pandemic themed baking like that video from channel called quality POPs or countless others tapping into the same need misty from the pandemic Kito Comfort Food Channel. Puts it this way? It's okay to have a treat now and then when you are filling all the emotions she then demonstrates how to make a giant Kito Cookie Julie Baker in Grand Junction Colorado appreciates these kinds of baking. How to's because as a mom to four young children. She hasn't really had time to bake in years but now she's got a bunch of restless kids stuck inside and on the day that we talked. She also had a jug of old old milk in just the recipe for it man. Well that's our milk is like about to explode in my fridge. So I'm GonNa do that today. 'cause I keep saying I'm GonNa Join US tomorrow. It has to happen. It's happening today. We were making US goods. She hopes that when your children look back on this weird time. They don't remember being afraid. She wants them to remember being together and learning how measuring cups work love and happiness and Diana Ross. Yellow who lives in nearby? Fruita says that when Colorado's Governor Jared Polis encouraged people to reach out to others during the pandemic. She knew what to do. Teach folks how to make a Navajo staples over facebook live. I'll show you the fried bread. That's Ripe Red Golden and glistening. It's like a newborn baby and it's so beautiful. She immediately got thousands of views and lots of comments. Yellow has public health degree and is a bit chagrined. That fry. Bread has seven hundred calories per serving. But since we're in a pandemic it's all K- 'cause we'll have to survive on what we've got you know making and eating too much or just some of the hazards of pandemic baking in normal times. Katie Langford would bring her treats into the office at the Boulder Daily camera and they would quickly disappear but now she and her roommate are still eating their way through a pie. She made with pounds of strawberries and Rhubarb Pie. They won't keep Langford from the oven. However baking is a comfort a link to a time before Corona Virus. Now like in the past she can mix flour and water and yeast and bread like install combine butter and sugar and flour chocolate chips. And it's not become cookies so I think there's just a certain kind of stability not knowing that even though everything feels kinda crazy uncertain right now those things are saying and they still tastes delicious and since many baked goods freeze as well too she can save them in maybe even share them with her co workers someday for here now and demissie. So you've been spending time at home. Pandemic baking let us know. Send us some of your pictures and I'm talking to you the listeners. But also I'm looking at you. Karen MILLEN MEDICINE AND EMIKO. Toga our in house bakers and you can tag on twitter at here now Dr Richard Serra is an infectious disease. Doctor who says treating Corona virus can be like treating patients before antibiotics existed because there's not yet a Sure-fire Treatment Dr Sarah Works at the. Va Boston healthcare system. And he's a clinical associate professor of medicine at Boston University School of Medicine. He joins US now. Dr Sarah you've been working in the cove awards. What's it been like? The number one impression is a level of uncertainty that I haven't quite experienced in my medical career. It takes me back to when I was first a medical student and resident where you're learning everything in new and I have to say from a novel infection. We're learning so many new things so what I'm present to currently is a somewhat uneasy experience with patients of mine. In whom normal air would walk in feel quite confident but I could treat such and such and this scenario. I'm not entirely certain. So I've had some patients who I literally went off service and I said I think you have made it out of the woods and I said that at day fifteen of their particular illness and I mentioned eighth fifteen because the second week is usually the week in which patients go from asymmetric to having symptoms the most concerning is pneumonia and respiratory compensation. But I've had some folks who look like they're out of the woods only to discover that a week later they're back in the hospital de compensating and on a ventilator and some have died after you told them in person that you thought that they were on the right track absolutely. And that's what makes this the roadmap in my opinion a little bit difficult to offer reassurance. Not only to the patient but but to ourselves and so there's a there's a paradoxical presentation and I think what I'm alluding to in a lot of your listeners. May Be aware is the intense cytokine storm. It's intense inflammation that's occurring. Not Entirely Clear. Who will manifest that but again those with high inflammatory markers? Many of my patients in their seventies and eighties are presenting with that. Some have high inflammatory markers they peak in the amount of oxygen. They require recuperate. Others are doing fine on room air or two leaders only to discover that in twelve twenty four hours they're now on a ventilator and so sometimes it correlates and sometimes it doesn't well. I'm glad you brought up ventilators because there's been a lot of focus on ventilators on how many ventilators that hospitals needed around the country. We know that ventilators can save. Patient's lives but a recent study in the Journal of the American Medical Association raised questions about their effectiveness. They found a high death rate for patients who were put on ventilators at twelve hospitals in New York City and Long Island. What do we know at this point about ventilators and whether they do reduce the death rates from covert nineteen so the best way to frame this answer as ventilators are the last stop on the train so to speak and I work on the general medical wards not not the issue the intensive care units and my goal is to prevent as much as I? Can these patients finding themselves on ventilators long story short? What we aim to do is to avoid that scenario as much as possible and you may have heard some stories of reporting literature that other mechanisms high flow nasal cancer treatment pruning of the patient position in the body face down to optimize blood supply to more. Favorable portions of the lung may offset the need for requiring ventilation. There's been so much focus on the respiratory effects of this disease. You've pointed out as you've looked at all the things that are required to care for people with Kovic nineteen. It affects everything it seems. Like from your head to your toes vetoes. We're now hearing about. Have you ever seen a disease like this? That has had so many different effects. And also do you think there's been too much focus on the respiratory effects may be at the expense of trying to treat other areas that could be just as harmful or deadly. Well I think you brought up a good point and keep in mind that the initial presentation of this infection the most prominent clinical presentation. That is obviously life-threatening. Is KOBE PNEUMONIA? So it's a viral pneumonia but it's also augmented by the immune response making an individual experience problems breathing as if they're drowning because of that combination. So what we are seeing is more and more case reports of individuals that have recuperated or our ASE symptomatic presenting with a smattering of unusual symptoms. Such as a nausea. Which is the loss of sense of smell or excuse you which is the loss or change in the sense of taste plus these other conditions. You may your Cova does what we do understand about those presentations. Thankfully the vast majority of those patients did not progress to Kovin pneumonia whereas individuals who are presenting with fevers and muscle aches and a cough. Who Don't a loss of sense of smell have a higher probability of progressing towards pneumonia or hospitalization. At least I just WanNa pivot now and ask you a couple of questions that we're all thinking about at the moment as you watch states open up at different speeds right now. What do you think about that? Is it okay for some states to say the worst is over? It's time to get people back to work. Well a couple of lessons that we're learning from. This is the response to a pandemic and the focus on the public health infection and death rates verses the economy to me that balance is extremely challenging and it makes me nervous but I need to sort of qualified that we do understand that certain communities. There may be much more a symptomatic transmission or carriage of this virus than originally anticipated. So it really comes down to the prevalence of the disease burden at a particular point in time in populations to establish. Is that a safe thing to do. So I believe when Dr Chee and the CDC are mentioning this House to be done very very evidence base with an understanding of what type of communities have what level of prior infection. When Dr out she talked about the antiviral drug rendez severe which has had some early stage success in tests. He said that it wasn't a knockout that we have figured out a way to stop the virus. That's what he said but it wasn't a knockout. Are you optimistic? There will be a knockout treatment or even a vaccine by the fall. Yeah it's very very good question. I think rim disappear could very well be the front runner and Dr Phil. She says now we have a competitor arm meaning we now have a drug that is demonstrated some improvement and now we can continue to study at a different doses different time intervals higher doses for longer for shorter so time will tell and on another note one of the observations. I had is that this became an exercise in restraint for me as a provider on the journal medicine. Ward's I have a patient who I do not want to die and so it's very difficult to say no to something like hydroxy chloroquine based on very preliminary data that it could be useful but now we discover that for example that drug isn't as useful and maybe more harmful than we know and so every week that goes by. We say every week that goes by. We understand this a little bit more. We have more clarity. We have more signal to noise clarity in this in this pandemic this time period is one in which I feel like I can offer the least amount. Once the drugs have demonstrated more efficacy than will know that. Hey we can finally treat this decrease the downstream damage that occurs from this and in combination with other therapeutics. Like these interleukin six inhibitors. You may be hearing a lot about totalism and Sarala map. These drugs are what we're using now in combination but with further studies to come out in the near future. How're you doing personally? Well it reminds me of my first decade being a health care provider in which I relied quite heavily on the science and the clinical and the evidence. This time around this uncertainty is personally unnerving because I cannot quite yet rely on the clinical. I think in three six months from now this may end up being a happier scenario even though and may return in the fall with a fervor we may have more things to treat this with and as a result of that. I think feeling a little less unable to do things that will melt away and I think as a physician I will be able to offer much more than I have. Now that is Dr Richard Surrou- who is a clinical associate professor of medicine at Boston University School of Medicine and also an infectious disease specialist at the Va. Dr Sarah Thank you so much for joining us. Mo- Perjury Jeremy. Thank you and we should mention. Dr. Sarah has advised our workplace. Wb You are about public health during the pandemic so has been cooped up with your loved ones been difficult. Well at least you're not ernest. Hemingway or we should say his wife Hadley in the summer of Nineteen Twenty Six. She found herself in quarantine with her son. Bombie who had hooping cough bombies nanny? Her husband bombies. Father Ernest Hemingway's mistress. Pauline pfeiffer soon joined by the man himself all of them together in a small cottage bombie would eventually recover from his illness. Having way marriage did not author Leslie. Bloom tells this story in town and Country Magazine. Leslie welcome thank you so happy to be here and we'll sort of thank you because apparently you're you're huddled in your closet twenty. Get quite pleased to talk to us. Highly professional glamorous environment you broadcast is now so town and country of You. You Start Your article by trying to correct the record on a story that went viral. That wasn't true. It alleged that F. Scott Fitzgerald wrote a letter when he was in quarantine in nineteen twenty for the then a nine hundred eighteen flu and this letter claim that hemingway was a flu. Who WOULDN'T WASH HIS HANDS? You want to point out. That letter wasn't true. No well first of all it was written in. Nineteen twenty. Supposedly Fitzgerald did not meet Hemingway Until Nineteen Twenty Five. And yes so so. That was rather significant clue that something was peculiar said letter it turns out that the letter wasn't real and it was a parody that was written for mix. Sweeney's but this story you're about to help us tell is and talk about people behaving badly. It begins Paris. Hemingway his wife Hadley. Who's kind of a plane as you? Say CHURCH MOUSE POOR woman. Their son Jack or Bombay's they called him. They had moved there so that hemingway could be a famous writer as part of that. Of course he has to have an affair he does with the vogue editor. Pauline pfeiffer Hadley just really didn't quite know how to deal with it I should she laugh it off and hope that it blew over or should she probably start to come to terms with the fact that Hemingway was going to choose pauline over her and I think that your she was just getting used to the fact that pauline was real threat to the marriage when this strange interlude happened well. The strange interlude is that hemingway goes off to watch a bullfight. Hadley takes their son to visit friends but the sun is diagnosed with whooping cough. So they have to leave the fitzgerald. Who by now are their friends? Have a cottage. They can use as this quarantine shelter. Halley moves in with the little boy and the nanny but then soon along comes pauline pfeiffer. You're just what everybody wants right to in quarantine with your husband's mistress. I mean I don't know about you. I don't think I could take out right now comes to. How did they do this well? It's look historical records. Little unclear about how pauline materialized down in the Rivera. Some say look you know. She went down to help Hadley. She had whooping cough. As a child she was immune and we all know you know how precious immunity is now ready from our own experiences. You know other historical sources. Say That Hemingway asked her to go down To help relieve highly highly was going bananas So she comes down and then Hemingway comes. Also and Hemingway the mistress. The nanny. The sick little boy and Hadley are all in a two bedroom. Cottage quarantined for weeks. Hemingway thought this was just grand like a great place to right. Do we know what it did to Hadley Hadley was really at the end of her tether and you know she would take isolated walks into town once in a while she would get a shot of Whiskey someplace to steal herself to go back now. It's worth noting that you know when the Fitzgerald's and there are other friends from the Riviera come to visit them there. The pioneer social distance or. They're standing behind a fence on the driveway or on the front road. While the Hemingway Malaysia Trois is on the front porch. And you know on one hand the Fitzgerald. Who are who are full of mischief always. They're there to keep the hemingway's than Pauline Company. But they're also there to see what's going on. I mean it's quite an unorthodox arrangement. It's an odd story. You know it reads kind of with a fantastic devil may care kind of attitude. It's real human beings. I mean what a terrible corentin story. It's terrible Corentin story but with strange fashionable Mrs to it also and the thing that makes it especially strangers that the people in the story are not behaving how most of us would behave. I think that's what makes it. So fascinating and strange. In so hemingway possibly sending his mistress and then going himself and enjoying the setup or finding a you know a nice spot for rating pauline actually making herself available to go down and help you know. Hemingway's wife with the baby and then had lease own acceptance of the arrangement or trying to put a good face on it also seems unfathomable but maybe the most relatable reaction of the three somebody who's just trying to grapple with the situation and feel her way to the right path through it and by the way did pfeiffer get her man ultimately be she would say throughout. I'm going to get everything did she. Yeah well I mean she got him temporarily issue is wife number two and then he jilted her for Martha Gaelle Horn and then Martha got rid of him and then he went onto another journalist. His final wife. Mary became very hemingway. Leslie Bloom wrote about having quarantine for town and country. She adapted the piece from her book. Everybody behaves badly the two story behind him always masterpieces sun also rises Leslie. Thanks so much my pleasure. Thank you for having me your released in the closet and the doors flung open. Be Safe and thank you very much for having me on unless these new book fallout out in August in Germany. This week. We're going to have failed marriage. Counselor ASTAIRE PARRAL. A husband and one of her. Podcasts wants this problem cannot imagine. I'm Robin Young. I'm Jeremy this is here now ooh.

Us Ernest Hemingway president Jeremy Hobson Sylvia Mitch McConnell Senate Pauline pfeiffer Hadley NPR Italy Pauline pfeiffer Europe Robin Young pneumonia Npr Leslie Bloom F. Scott Fitzgerald national political corresponde
How Can Sri Lanka Recover?

Knowledge@Wharton

24:13 min | 1 year ago

How Can Sri Lanka Recover?

"Podcast is brought to you by knowledge award. We are learning. More about the Easter Sunday and left hundreds others injured. Authorities say nine suicide bombers from a little known group the national to- heath Jamaa of targeted three churches and three hotels. They say the men and one woman who did this were from educated middle class backgrounds in grew up in different parts of the country. The Islamic state has claimed responsibility for the attacks. But it's unknown. How much they were involved with the group at least sixty people have been arrested so far in the government is apologizing for not responding to intelligence on this group sooner suicide attacks are not new to Sri Lanka during its twenty six years, civil war. Tim L tiger militants helped develop the suicide bomb vest and use it hundreds of times that war by the way, ended in two thousand nine in the country has been peaceful in the decade sense to take a look at how this terror attack has impacted the country and what the. Rippling effects might be we're joined on the phone by Dr Henrik size who is a research. Professor at the Peace Research Institute Oslo, he's also a professor of peace and conflict studies at Bjork nece University College and a member of the Norwegian Nobel committee and also joining us right now Andrew Perumal whose an associate professor of economics at the university of Massachusetts Boston. And we'll be joined shortly by Marian. Mo Henry who is a clinical associate professor of English at the university of Illinois, Chicago, Henrik Andrew gravy with us today. Thank you both for starting off the show with us. Thank you. Thank you. Thank you. Thank you Henrik. I think many people are wondering right now about the reports of this being retaliation for the New Zealand mosque attacks X, can you take his through how that perception might be a play here. Well, I think it's not chal to sink that way. When you have something as dramatic as what happened in. The church, and then you have this attack which seems to come out of nowhere. It's very hard to explain it clearly based on local Sri Lankan conditions, and therefore as we are searching for explainations to what this could be one of the things that has come up is exactly this. This is part of something that's not really Sri Lankan, its international and one of the ways in which some of these bombers have been motivated to do it is part of such a revenge now it's early days yet. So it's locked, but we don't really know. But it's true that that's one of those stories out there. Andrew I mentioned a little bit of the history around Sri Lanka and some of the violence that has been there in the past. Can you give your perspective about how that part of Sri Lanka history played out and this last decade, which is we mentioned has been relatively violence-free definitely especially given. How? Little communal violence. We have seen over the last decade there were two important flare against Muslims one in two thousand fourteen and another just a year ago last much, I think that the country has been going through the process of trying to figure out how to move forward and in many ways, the recovery from the water and the ten years ago has been slow. The rehabilitation process has been reconvened on many levels. Even if we look back at how the rehabilitation camps persisted for much longer than they should have. I mean, the country has been trying to deal with this. But then once again VC how much political instability the country has been experiencing just over the last six months, I think that in many ways it is easy to deal with it. The current president was elected into pine two thousand and fifteen with the. Idea of bringing a new era of addressing issues regarding corruption and abuse of power highest levels, and even in terms of trying to deal with some of the constitutional crises that coming up to the end of the previous presidency. But what we've seen over the last two years is that a lot of those have stalled there was lots of momentum early on as soon as he came into power. But that has been very little movement in the last couple of years. We're also now I'm sorry. Go ahead Android are. Oh, no. So my only point is that the issue then changes to if they're not going to address this systemically. Does this become the new concern for Sri Lanka? We are. Now. Joined also by Marianne, Mojo Marianne great to have you with his thank you. And if you can't give us your insight is similar to what Andrew just said about the history of Sherlock with violence, and where that country is right now. And also if you can discuss. As well. The the statements by the Sri Lankan government that this was there was information out there that was basically missed by the government and not acted upon. Thank you for having me. Glad to be here. Enter I think did a great job of covering the recent history. And where we are at the moment Oko back for a little bit. I don't know how much context your listeners have thrilling unusual. I think in that it was a multiethnic society for very long time for thousands of years, then you can still see that even in the architecture. You see, but it's temples that coexist with Hindu temples as you're traveling around. So you know, after canary tensions were exacerbated that erupted into riots at various points, and then the black July in eighty three eighty three which was when I had already migrated, but many of my own family who are Lincoln tunnels fled as refugees to Canada. And so on so we then had many years of conflict and civil war, and when peace descended the government at the time, I had a fairly heavy hand in their approach and kept a strong militarize presence in the conflict areas in the north, and these are primarily all. Well. And I think that concern now is we've had ten years of peace. We've had a president who was elected under says to try and heal some of these ones four and help the country move forward. But. Sorry, prime minister and the and the and going, but but there has been challenges to that. There have been an ongoing, you know, attacks against minority communities such as Muslims, and I think real questions about how committed the government is to to a path of peace, and peaceful coexistence. It's you know, I ran for office to your local office, and it's very easy to sell the voters on certain types of narratives, we're going to be tough on crime. We're going to be tough on the terrorists. We will lower your taxes there. There are things that people wanna hear. And it's I think the the real worry right now for me is how the government is going to react to this incident like do away. One is one. Of course, whether there will be any more along these lines, but but it's a real concern that the government where will react by putting in a host of supposedly anti-terror mechanisms that end up curtailing freedoms and slowing down this unification conversation that's been happening as every day single is some of you know, but as it is Muslims Christian try to live together in peace. And harmony, you know, the my parents would talk about how when three Lincoln New York came around. You would everyone would make their own special foods, but then would go to the neighbors and share it. And that is neither quintessentially what it was to be three Lankan. And that's what I think people there are hoping to get back to. Take us in with your insight about what we could be potential cking at four Sri Lanka and their reaction. And obviously one of the things that that they did in the wake of this was to shut down social media platforms because of a concern of of disinformation being put out there. We don't know the long term effects of that yet. We don't know how long that will last this shutdown. We don't know what sort of Texas will have people who find other ways of communicating through different social media platforms. But it's an interesting thing. Because one of the things we really see now in a number of countries is how these social media are contributing to to polarization when it comes to the longer term horizon for the wonderful country of Lanka now, I really eight for for the country. I feel so with everyone who's Sri Lankan is whether we can find a way to build on all the positive things that have happened over the last ten years. I was there just a few weeks ago. And you see the sort of optimism not leasing lot of businesses also visited to colleges you see a lot of the tourism going up. You see this pride in a nation that takes on a number of political and environmental challenges. Many things are, you know, going through on direction to you have political polarization, but still you have this sense that things are going in the right direction. And then you have this huge setback and the dangerous at such a setback works as a kind of black hole draws all of the attention to it which is not true because there is grief. There is fear. There is a need to make sure this doesn't happen. Again. There is a need to investigate. Why this wasn't stopped? If it was possible to stop it. But the danger is that then we take our eyes off all those things that that can be done all of the positive things when you look at for instance, relationship between Muslims and Christians intra Lanka. It's mo- split being positive. It's mostly being communal and friendly. And the question is how you find back to that in a situation like this. I think experience tells us about this. That is really hard. Fortunately answer that. Yeah. Go ahead. If I could just jump in to echo, everything Henrik said, but just to that early point about social media. I was I was there in December and met with various writer friends of mine who are very tech savvy. And there are people who are using the PIN virtual networks to get around social media and who are communicating with the outside world, they are tremendously frustrated about the the social media ban. Even though they understand the initial reasoning for it and the the spread of misinformation can be harmful rumors or flowing at the same time. Shutting communication is always wearing an especially this kind of open ended who knows when we'll be allowed to talk to each other. Again, is is the real matter of concern. And so if people are interested in looking into this more, I'd point you to you'd in Java Directa who is they're answering Lanka is something of an expert in. This area and is accessible, but with some of the things you mentioned before about this particular government, and it almost makes me feel like as as they are trying to lead Sri Lanka right now that they are still trying to to find their way as well. And obviously people make mistakes. Unfortunately, in this case, if these mistakes were made it obviously is cost a lot of people their lives. But there is a learning process as you said before it's one thing to say, I want a b and c it's another thing to actually get into office. And actually do that as well. Yeah. And you know, I think the some of the rumors seen flying about things like well, there must have been an international contingent behind this bumming, maybe maybe not there's there's no real evidence one where 'nother you see international groups claiming responsibility days after the fact with again, though evidence to support it. There's you know. A memo that comes in that targets, you know, that names one specific local group, but is not independently corroborated. I have to think that intelligence services are constantly getting warnings constantly getting things sent into them. And I do think it must be a process of burning which is a credible threat. Which ones do we need to respond to quickly do not want to dismiss the concern that, you know, which I'm hearing from, you know, Christian friends of mine. My while I'm not religious myself. My family them calculate and the have many friends and relatives who are out those churches that perhaps the government was paying less attention to that that was against Catholics rather than the majority groupings. So there I'm not saying we should not criticize and we should not inquire. But I think we should be very careful to. Cannot jump on things that sound credible without evidence injury. What are the longer term impacts of having this type of devastating event occur in Sri Lanka as you mentioned with having a decade's worth of peace at this point. What does this mean for the country moving forward, especially some of the economic opponents, which which is your background? Yeah. So I think that especially given how the country has weathered some of the big people's, but also even these relatively small ups a few years ago. I think that the economy's fairly comfortable shrugging a lot of it. All fortunately, because even if we just look at tourism growth over the last decade, it rebounded very quickly immediately after the war ended in may of two thousand and nine and then right now, we've actually had something like a four fold increase since that period. So even looking at for example to a lot of relatives back in Sri Lanka. There's a lot of anecdotal stories about how tourism seems to be down after the communal violence last month or even the political instability at the end of the year. But it actually turns out that there definitely may have been shifting of. The types of tourists. We have come into the country, but over all month over month, we've been having substantial growth of right now it's sitting at around two point three million having come in last year. And we also have been able to see that the overall receipts from tourism have grown traumatically. So. As long as this does not become more frequent. I would think that especially given the timing of this so man, June typically compared to the other months, you're relatively low months for tourism. So if it doesn't persist beyond this and the country also things about how to deal with these things systemically, maybe they will not be any long-term impact. One thing. I would sorry just like about so one complication, of course, is the comfort with maintaining the use of the prevention of terrorism activity Lanka now, while the war was going on minority groups were aggravated using that act and a lot of the hope from the minority groups myself included had been that the reason governments would do away with it, especially given the at least six seven years of. That we had had and that hasn't gone away. And now we see it so comfortably used to round up terrorists without any additional corroboration of the evidence. So I think has lots of big issues that could actually really drag down the economy in the long run. But I think this one event is not going to be the issue. I agree. And you know, we've seen this interstates right with the the Patriot Act after nine eleven these that there tends to be a a law and order correction after this kind of event that then often is very strong. Very powerful shuts down freedom shuts down communication, and it's been really hard to walk that back because people people are frightened and as long as they're frightened is hard to reach out your hand and say, no, I want to trust my neighbor. This is someone I've known this is someone who, you know, our kids go to school together. And that's that's I think when I talked to every day three Lincoln's now, this is what I'm hearing the last few days is people are hoping to move forward to go back to the peaceful multi-ethnic society, very community minded, and I worry that the governor. Will react to the loudest voices and feel that they need to strong arm. The populace right doesn't that also Henrik that that really then brings forth the need to have a joint move forward between the community and the government. So that everybody is thinking on the same page so that you can have the best outcome from a horrific event. There is a lot of will to do that in the Sri Lankan population. So this is huge challenge for the politicians and religious leaders of tra- Lanka to manage to find voice for this sort of togetherness. I remember Norway when we had a horrific terror attack. You're in twenty eleven one of the things that went right was exactly this sense that the politicians had a basic message of unity basic message of finding back to what unites us now, admittedly that was. A an easier situation because the culprit was apprehended quickly. He acted alone. Didn't have this sense of constant state of emergency. We didn't have a concentrate on urgency. But still think there is something to learn from that. But adding to that we must remember that while this is Sri Lankan tragedy. And I as I said, I really feel for and we for this fantastic country. It is also part of an international dialogue and international crisis. How religion is used to vindicate violence. How different groups are pitted against each other. And in some ways, you know, this happened. I it new-zealand with terrible Christ's church murders and now ensure long with this has relatively little to do with new-zealand entry Lanka per se, but are expressions of sort of dialogue that some extremists are trying to push. They want to create havoc. And we see that not just among extremists receipt. Among some even even some seemingly mainstream politicians who push dialogue of fear and division. And I think that's what we really need to respond to whether we are believers are not whatever countries, we are from we have to find ways of having a sort of peaceful, togetherness that can tackle these sorts of things not least to to withstand this sort of polarization. We will see now quite a lot of anti Muslim sentiment, which is directed against people who have never done. This would never done this. We will see a lot of essentially of religion Mosul. That's what for instance, Islam is really like or Christianity is really like instead of seeing the reality in the world and the human beings behind the faiths, and and faces. So I think that's not just relaunched talents right now. But it's a global challenge. In which we all play apart Memarian. How does that play out specifically injury Lanka? How did those elements? Come together. Do you think? Well, you know, what I'm seeing on the message boards right now is I'm seeing Muslim friends frightened who are pleading for peace pleading for people to understand that they are not part of some shadowy conspiracy that this is not what their religion chance for what what did you find heartening is at least on some of the message boards. When one of those sort of voices speaks out saying all MS limbs are like this. They're all inherently violent. I I'm seeing a lot of three Lincoln voices coming back and saying don't be ridiculous. Right. This is, you know, think of your neighbors think of your friends clearly the actions of extremists of any religion of any of any grouping religious or Matt grouping or or otherwise can't be held to be Representative of what the majority of people think. And I think if people will keep putting that forward if they will, you know, the statement is seen coming out from various screw. Oops, saying that the important thing now is to continue to work on unity and not let ourselves be divided. This this divide and conquer was a practice of Lhasa various effective practice of the colonizers. Right. They would pick different groups against each other. And it made it much easier to stay in power. And that continues to be the case around the world. And that's what we have to be aware of and what we all have to resist. Andrew your thoughts. Yeah. I think that I have personally been happy to see that. There hasn't been instances of immediate retaliation against Muslims in the country, which I think would have been much easier to envision maybe even a year ago. So there has been I think some learning taking place over the last few years, and I think as the country hopefully continues to move forward and politicians do not try to utilize these. Instances to shore up their own pieces. I think them them might be in a positive out of this that maybe there's positive change. Thank you all for giving us your insight today, greatly appreciated Henrik Andrew Maryanne. Thank you again. Thank you. Thank you. Thank you, all Dr Hedrick size from the Peace Research Institute. Oslo also Bjork nece University College Andrew Paramore who is with the university of Massachusetts, Boston and Marianne mo- hunter is of the university of Illinois at Chicago. For more insight from knowledge at Warton, please. Visit knowledge dot Lordon dot U, Penn dot EDU.

Sri Lanka Lanka Dr Henrik communal violence university of Massachusetts Bo university of Illinois Andrew Chicago president Bjork nece University College Marianne mo- hunter Peace Research Institute Oslo Lincoln Mo Henry Henrik Andrew gravy Professor