But a new study has shown that playing the computer game Tetris within hours of experiencing trauma can prevent those feelings from taking over your mind.
PTSD occurs when intrusive memories linked to fear from a traumatic event become consolidated in a person’s mind by them visualizing the event in a loop until it becomes locked in their brain.
Competing with the visualization, such as with a game like Tetris, can block that consolidation form happening.
“An intrusive memory is a visual memory of a traumatic event,” said Emily Holmes, Professor of Psychology at the Karolinska Institute in Sweden, whose team led the study. “Tetris also requires imagination and vision. Your brain can’t do two things at once, so this interrupts.”
Tetris is a simple, visual and addictive computer game in which the goal is to line up falling shapes to form rows that then disappear when aligned. As rows disappear, more shapes fall and the longer the game lasts, the higher the score.
The goal in Tetris is to line up falling shapes to form rows that disappear when aligned.
Holmes hopes that use of these simple and early strategies with patients could help prevent the onset of PTSD. The current standard treatment doesn’t begin until after people develop the condition.
Researchers tested the game on 71 patients in a UK emergency room who were seeking care after a motor accident. Half of them received standard care for their injuries, while the other half received a psychological intervention within six hours of their accident in which they were asked to recall their trauma, practice playing Tetris and then given the game to play on their own.
The patients were then monitored for one week, during which time they tracked how often they had memories, or flashbacks, relating to their accident. The people who has played Tetris reported 62% less memories on average over the week.
“After two days they had gone down to pretty much zero,” Holmes told CNN.
Researchers have long believed that intervening early — within hours or days of the event — could stop the fearful memories from developing in the brain. This is the first study using something as simple as a computer game.
Holmes has been researching the use of Tetris in this way for more than a decade in the lab and this proof-of-concept study is the first time she has experimented with patients.
The research remains in it’s early stages, she stresses. What we need to do is a larger study,” said Holmes who also hopes to monitor the effectiveness of her approach over a longer period of time, up to six months.
The need for more insight using a larger cohort of people was raised by consultant Mark Salter from the Royal College of Psychiatrists, as well as the need to test options other than Tetris. “The study is small … and not everyone plays Tetris or is computer literate,” he told CNN. He added that there is also the challenge of “getting someone to participate when they’ve just seen something terrifying.”
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But he was intrigued by the findings and the ability of this prevention measure to be given soon after someone experiences a trauma. “What’s exciting about this is that it happens quickly,” he said. “It allows an immediacy to the intervention.”
Salter said the approach needs to include other options that are more universally acceptable since “it’s not just Tetris that does this.”
Holmes said that anything visual and engaging could have a similar effect. But, he added, other engrossing activities using other parts of the brain, such as number or word activities, may not work, or make things worse.
UPMC informed the Allegheny County Health Department, Pennsylvania Department of Health, and U.S. Centers for Disease Control and Prevention that its independent testing led UPMC officials to believe the linens were the likely source of the outbreak, according to the emails.
The new emails reveal additional testing seeking to pinpoint the source of the outbreak.
An email sent May 5, 2016, by Jeff Miller, a field epidemiologist for the CDC, said that environmental samples were taken on February 21, 22 and April 21, 2016, at UPMC Presbyterian and Montefiore hospitals and Paris Co. laundry facilities. The testing was requested by UPMC and conducted by an independent contractor.
A whole genome sequencing report by an independent laboratory based on these specimens “[suggests] that fungi from Paris have been brought into the [Presbyterian University Hospital] laundry,” according to the report provided in the email.
“It is looking more likely than ever, that the linen vendor is the more likely potential source of mucor as you can see by the reports,” said an email sent by Allegheny County Health Department Chief Epidemiologist LuAnn Brink on June 21, 2016, in which she shared “notes from UPMC.” It is unknown who from UPMC sent Brink the notes. Mucor is a species of mucormycosis, which are fungal spores commonly found outdoors. However, they can cause a rare and sometimes fatal fungal infection in patients who are immunocompromised, according to the CDC.
A whole genome sequencing report compares environmental samples from which the DNA has been extracted and sequenced to show the fingerprint of the sample at a high resolution, according to Dr. Barun Mathema, an assistant professor of epidemiology at Columbia’s Mailman School of Public Health who CNN contacted independently on Monday.
“Nobody is a 100% sure, if you read carefully, there will always be a bit of a wiggle room caveat,” said Mathema, who was not involved in testing the samples from Pittsburgh. In general, it is rare that epidemiological testing comes to an absolutely conclusive result because of variables that come into play when epidemiologists attempt to replicate the exact environment in which the case occurred.
Additional testing
This isn’t the first report to link the mold outbreak to hospital linens. In a separate, UPMC-contracted internal report, testing conducted on February 1, 2016 by hospital environmental specialists Andrew Streifel and Michael Buck found a heavy buildup of lint and mold near the Paris Co. linen facility vent through which unfiltered air dried the linens.
When Streifel and Buck went to the hospitals and tested linen from Paris Co., a cart of wet sheets delivered to the Montefiore laundry storage area bore “heavy fungal growth of Mucor and rhizopus,” according to their report, which was not made public until early 2017.
“Our hospitals are safe, and our ongoing monitoring and testing show no evidence of a mold outbreak. We and the nation’s top health regulators have found no definitive or unifying cause of the previous infections, which are known to occur on occasion at most major medical centers,” UPMC spokeswoman Allison Hydzik said in a statement to CNN when asked to respond to the contents of these emails.
UPMC “will address specific allegations in court and not in the media,” Hydzik said.
The Allegheny County Health Department provided CNN with the emails, which were incorrectly redacted to reveal more information than intended. The emails were provided in response to an open records request under the state’s Right to Know Law. The county records department withheld several other emails on the grounds of privacy for patients’ information.
“While we were made aware of all steps that UPMC was taking to identify potential sources, including looking at linens, there was no identification of the linens as the source of the outbreak. Similarly, as has already been stated by the department, ACHD was an observer in this process, not the regulatory agency looking into this,” Allegheny County Health Department spokeswoman Melissa Wade said in a statement to CNN when asked about the emails.
“Our products are safe. We have nothing to hide. We have followed and continue to follow protocols of the Healthcare Laundry Accreditation Council by providing hygienically clean linens to our customers,” Paris Co. CEO Dave Stern said in a statement to CNN when asked about the content of the emails.
CDC and state officials respond
In a phone interview this week, Sharon Watkins, director of the bureau of epidemiology for the Pennsylvania Department of Health said the mold investigation is continuing. At no time has the state or the CDC determined that linens were the most likely cause of the UPMC mold outbreak, she said.
“I don’t know why anyone would say that,” Watkins said, referring to the email that said “the linen vendor is the more likely potential source of mucor.”
UPMC is required to provide the Pennsylvania Department of Health with regular updates concerning the investigation, Pennsylvania Department of Health spokeswoman April Hutcheson said.
Since May 2016, the Pennsylvania health department has been “in constant consultation with the CDC on this issue, including epidemiological evaluation of new information, a site visit, and current review of system-wide UPMC data,” Hutcheson told CNN in a statement when asked about the emails.
“There is no evidence to indicate an ongoing outbreak at this time; however, the state health department is in the process of reviewing additional information as part of the ongoing investigation.”
The UPMC hospital system mold outbreak began in October 2014. By September 2015, four patients had died of fungal infections at UPMC Presbyterian and Montefiore hospitals. By that time, the transplant ICU at Presbyterian had temporarily closed.
In September 2015, while the Presbyterian transplant ICU was closed, the CDC investigated possible sources of the mold outbreak. The results of the investigation were published in the May 2016 Morbidity and Mortality Weekly Report. Investigators said that the fatal infections were not attributed to the mold-covered linens, but rather to ventilation that may have allowed dust and mold spores to enter the hospital rooms.
The CDC maintains that conclusion despite what the newly uncovered emails say, Skinner said. The CDC findings were not addressed in the recently released emails.
In May 2016, Pennsylvania Governor Tom Wolf again requested the CDC consult with the state health department and UPMC because a fifth fungal infection recipient had been identified in the Presbyterian ICU, CDC spokesperson Tom Skinner told CNN when asked about the content of the emails. Wolf’s press secretary, J.J. Abbott, confirmed the request in an email to CNN.
That additional patient was Daniel Krieg, a kidney transplant patient who died in July 2016. UPMC medical reports show Krieg had fungal pneumonia and that fungal-infected sections of his left lung were removed. A CDC representative returned to UPMC on June 22, 2016, with officials from the state and county departments of health to discuss the outbreak and Krieg’s case, Skinner told CNN on Monday.
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An agenda in the newly revealed emails said health officials were to discuss laundry processes at Presbyterian, Montefiore, and Shadyside hospitals at the June 22, 2016 CDC visit.
The day before that visit, an June 21, 2016, email sent by Brink also said that UPMC was working with the linen vendor to “improve their product.” The email also said the hospital system was “aggressively pursuing” an alternative linen solution for all transplant patients in the ICU at Presbyterian hospital.
UPMC said in a January 2016 statement that high-risk transplant patients would receive linens with a lower bacterial count going forward. Hospital linens are required to be “hygienically clean,” according to the Healthcare Laundry Accreditation Council. (PDF) That means linens are not sterile, but in a clean state, free of pathogens in sufficient numbers to minimize risk of infection, and the clean textiles are not inadvertently contaminated before use, according to the CDC.
“Despite the lack of a definitive source, UPMC still went above and beyond state and federal recommendations in order to implement changes to protect our patients. One of the many changes includes the provision of specially treated bioburden-reduced linens to our highest risk transplant patients,” UPMC spokeswoman Hydzik told CNN previously.
You may hear revelations from new books that purport to tell the “real story” about Jesus, opinions from friends who have discovered a “secret” on the Web about the son of God, and airtight arguments from co-workers who can prove he never existed.
Beware of most of these revelations; many are based on pure speculation and wishful thinking. Much of what we know about Jesus has been known for the last 2,000 years.
Still, even for devout Christian there are surprises to be found hidden within the Gospels, and thanks to advances in historical research and archaeological discoveries, more is known about his life and times.
With that in mind, here are five things you probably didn’t know about Jesus.
1.) Jesus came from a nowhere little town.
Nearly all modern-day archaeologists agree the town of Nazareth had only 200 to 400 people. Jesus’ hometown is mentioned nowhere in either the Old Testament or the Talmud, which notes dozens of other towns in the area.
In fact, in the New Testament it is literally a joke.
In the Gospel of John, when a man named Nathanael hears the messiah is “Jesus of Nazareth,” he asks, “Can anything good come from Nazareth?” He’s dissing Jesus’ crummy backwater town.
2.) Jesus probably didn’t know everything.
This is a thorny theological question. If Jesus is divine, wouldn’t he know all things? (Indeed, on several occasions Jesus predicts his death and resurrection.)
On the other hand, if he had a human consciousness, he needed to be taught something before he could know it. The Gospel of Luke says that when Jesus was a young man he “progressed” in wisdom. That means he learned things. (Otherwise how would he “progress”?)
In the Gospel of Mark, Jesus initially refuses to heal the daughter of a non-Jewish woman, saying rather sharply, “It is not fair to take the children’s food and throw it to the dogs.”
But when she replies that even the dogs get the crumbs from the table, Jesus softens, and he heals her daughter. He seems to be learning that his ministry extends beyond the Jewish people.
3.) Jesus was tough.
From age 12 to 30, Jesus worked in Nazareth as a carpenter. “Is not this the carpenter?” say the astonished crowds when he begins to preach.
The word used for Jesus’ profession in the original Greek is tekton. The traditional translation is “carpenter.” But most contemporary scholars say it’s more likely a general craftsman; some even translate it as “day laborer.”
A tekton would have made doors, tables, lamp stands and plows. But he probably also built stone walls and helped with house construction.
It was tough work that meant lugging tools, wood and stones all over Galilee. Jesus doesn’t simply stride onto the world stage after having dreamily examined a piece of wood when the mood suited him. For 18 years, he worked—and worked hard.
4.) Jesus needed “me time.”
The Gospels frequently speak of Jesus’ need to “withdraw” from the crowds, and even his disciples.
Today by the Sea of Galilee, where Jesus carried out much of his ministry, you can see how close the towns were, and how natural it would have been for the enthusiastic crowds to “press” in on him, as the Gospels describe.
There’s even a cave on the shoreline, not far from Capernaum, his base of operations, where he may have prayed.
It’s called the “Eremos Cave,” from the word for “desolate” or “solitary,” from which we get the word “hermit.” Even though Jesus was the son of God, he needed time alone in prayer with the father.
5.) Jesus didn’t want to die.
As he approaches his death, and prays hard in the garden of Gethsemane, Jesus says, “Remove this cup.” It’s a blunt prayer addressed to the father, whom he affectionately calls Abba. He doesn’t want to die.
Unlike the way some Christians portray Jesus as courting death, and even desiring it, like any human being, the idea of death is terrifying. “My soul is sorrowful even unto death,” he says.
In other words, “I’m so sad that it feels like I’m going to die.” But once Jesus realizes that this is somehow the will of the father, he assents to death, even on a cross.
It’s natural to want to know as much as we can about Jesus; that’s one reason I wrote my new book. But beware of the more outlandish claims about the son of God (he fathered children, he was married to Mary Magdalene, he spent time in India and so on.)
Many of these claims tend to project our own desires on a man who will always remain somewhat elusive, hard to fully understand and impossible to pin down.
In the end, as theologians like to say, Jesus is not so much a problem to be solved as a mystery to be pondered.
I recognized the dress immediately. It had been his older sister’s — cast away, no doubt, in a donation bag that was never donated.
I didn’t race outside, tear the dress off and proffer admonishments. I watched, instead, as his makeshift wand of willow danced through the air — a little princess going from flower bed to flower bed casting enchantments over the marigolds.
I let our child continue playing undisturbed, but before I returned to my soup, I did what we all do when we see something adorable: I grabbed my phone and snapped a photo.
Later that night, my husband and I went to dinner with another couple we didn’t know well. As a fellow mom will do, the wife asked to see photos of our children, so I took out my phone and began swiping through recent family shots.
“Aren’t their children adorable?” she exclaimed, grabbing the phone out of my hands and showing photos to her husband.
Before I could get my phone back, they had discovered the photo from that afternoon.
I saw them exchange puzzled looks, then the wife said: “This is your son?”
‘Indulgence and permission are two different things’
Sensing their disapproval, I smiled and responded as calmly as I could, “Yes, he likes to play princess sometimes.”
“You really shouldn’t encourage that behavior,” the wife said with the grave compassion usually reserved for a potentially terminal illness. “When our son was little, he liked to play dress-up, too, but we didn’t indulge it. Not one bit. I even hired a male nanny! And now our son is completely normal! A strapping teenage boy — very popular with the girls — nothing odd about him at all!”
“You can’t indulge it,” the husband concurred. “That’s the key. It’s no different than enforcing bedtime. Children are very malleable. You can shape them, but not if you indulge their every whim.”
I politely thanked them for their (unsolicited) advice and my husband deftly changed the topic, but as I lay in bed later that night I couldn’t stop thinking about the the word “indulgent.”
My child at play.
Was it really indulgence to allow our child the freedom to express himself? It’s not as if he was shooting a BB gun at the neighbor’s pet cat, or throwing sand in another kid’s face.
Since that incident, I’ve had the word “indulgent” leveled at me many times by various detractors who disagree with the unconditional love and support my husband and I have offered our now-eight-year-old transgender daughter, as if that choice was the same as offering her an extra slice of chocolate cake even though we knew she already had seconds.
And here’s what I would say to those people: when it comes to parenting, indulgence and permission are two different things.
When we indulge a child, we let them get away with something — usually a behavior considered reprehensible by others. When we offer a child permission, we give them the reassurance that what they are doing is okay.
I like to think that the permission we gave Samuel to play as he saw fit in his early years paved the path for later emotional security.
On the eve of his sixth birthday, after a four-year battle with self-hatred and depression, he felt safe enough to transition from living as a boy to living as a girl. It was like witnessing a second birth.
And now we have a daughter who greets each day with excitement. Her name is Sadie, and she’s just as precious to us as her male counterpart was, only much, much happier.
What if we had punished Samuel instead of embracing Sadie?
I sometimes ask myself what would have happened if we had taken our dinner companion’s advice. What if we had shamed our son, or punished him? What if we had refused to let him out of his room unless he agreed to behave like a traditional boy?
In those early years of our child’s life, when my husband and I searched the Internet for information about children who claim to be the opposite gender than their anatomy indicates, we found these two statistics: Forty percent of transgender people attempt suicide each year, whereas a child who is accepted by his or her family is eight times less likely to attempt suicide later in life.
Better to be labeled as over-indulgent parents for letting our son play princess, we told ourselves, than to have a dead child.
If you worry that you, or someone you know, is indulging a young child by allowing him or her to cross-dress or do otherwise non-stereotypical activities, think again. Child development experts claim that children understand their gender identity as young as age 2.
But most children lack the vocabulary to articulate how they feel when they are so young. Their only recourse at gaining understanding may be to don a tutu as a boy, or to wear a Superman costume as a girl.
If your young child or student is a boy who likes traditional girl things, or a girl who likes traditional boy things, it doesn’t mean that he or she is transgender. It might mean nothing at all, or it might indicate that the child is what experts call “gender fluid.” It could be a phase, or it could be something more permanent.
No matter the reason, a child’s gender exploration isn’t something to punish.
Of course the nonconforming child’s behavior may be something you fear, and possibly for good reasons. You might live in a community that lacks understanding and compassion. You might be part of a religious group that doesn’t accept transgender identity as a possibility.
It doesn’t matter. Support that child anyway.
‘We’re living our lives, just like you’
Some may decry this decision, as if you are aiding and abetting a criminal. Nothing could be further from the truth. You are aiding and abetting the crucial work we all do in trying to figuring out who we are and why we’re here.
Like me, like my husband, like hundreds of other parents who have faced their young children’s gender dysphoria, you must push past fear and replace it with curiosity. And then you need to start learning, and connecting with other families who are going through similar experiences.
And if you don’t know any gender nonconforming children, or if you think the parents who support nonconforming children are mentally ill, child-abusing monsters — all things we have been called — I would wager a bet that if you came over to visit some afternoon, you might be surprised at how similar we are to you.
You might notice my teenage daughter’s school books and SAT prep manual scattered around. You might hear the sound of my younger daughter’s squeals as our dogs chase her around the house. You might notice we have the same favorite show playing on our TV, and if you look closely enough, you might see the imprint in the sofa where my husband naps as he pretends to watch.
What you wouldn’t notice is that one of my two daughters is transgender. You wouldn’t notice because there is nothing to notice.
We’re living our lives, just like you: struggling to keep things balanced, trying to look on the bright side, trying to get enough sleep, to drink enough water, to remember to brush our hair before we leave the house, to floss before bed, to say please and thank you, to apologize when wrong.
Those of us who are raising transgender children know it is time for us to be brave; to step forward; to introduce ourselves to you and welcome you into our lives; to prove that we haven’t indulged our children but merely chosen to love them.
He called on the American Urban Radio Networks correspondent first, and the two exchanged forced pleasantries. Moving on, folks, was the clear message. Nothing to see here. We are professionals and combat happens.
But, lost amid that Tuesday exchange was the actual substance of Ryan’s question. It was an important one, which goes to the heart of where President Donald Trump finds himself — the Gallup daily tracking poll has Trump at 35%, a new low.
Pressing her way through interruptions, Ryan suggested that the Russia investigations and the wiretapping claims, contributed to a storm cloud around Trump that could hamper his administration.
Spicer’s response was among his most combative, full of push-back. He referenced Russian salad dressing, and offered the SNL-ready line, “please stop shaking your head.” Spicer was evasive, short-tempered and dismissive. His answer only underscored Ryan’s assessment of this administration’s image problem.
In politics, image is everything. And probably even more so for this President, who is clearly enamored of the performative part of the presidency, if not the policy demands.
Beyond the stagecraft — the meetings and photo-ops in the Oval office, the signing ceremonies for executive orders and the announcements about commissions — Trump’s image will ultimately rest on results, competence and how Americans feel about him.
So far, by those metrics, Trump is struggling. Polls show voters increasingly doubting his honesty, leadership skills and whether he cares about average Americans. A rebranding, or in Ryan’s words, a revamp, is in order.
Saying that it would “start a new era of production and job creation,” Trump signed a sweeping executive order Tuesday scrapping much of Barack Obama’s climate legacy.
Some analysts have expressed concern this could enable Beijing — the world’s leading emitter of greenhouse gases — to water down its own commitments, but others say it is more likely China will step into a leading role in the vacuum left by Washington.
“China now finds itself in the unenviable position of being world leader on climate change, thanks to Trump’s willfully blind irresponsibility,” Mark Lynas, a fellow at the Alliance for Science at Cornell University, wrote for CNN Opinion.
Speaking Wednesday, Chinese Ministry of Foreign Affairs spokesman Lu Kang said the country will “continue to work with relevant parties for enhanced dialog and cooperation, hand-in-hand to manage climate change, to promote efforts to put the global economy on a green and low carbon path, in order to pass on a better future to the generations to come.”
New order
While Trump’s actions may force Beijing into a leadership role, it will not be one for which it is unprepared.
“There has been an embracing of environmental issues generally in China over the last few years,” said Matthew Evans, dean of science at the University of Hong Kong (HKU).
“China is increasingly taking its position on the world stage (as) an economic superpower in its own right.”
Speaking in New York last week, China’s ambassador to the UN Liu Jeyi said “whatever the vicissitudes of the international situation… China remains steadfast in its ambition to reinforce actions in responding to climate change.”
Liu said China is committed to “reducing carbon intensity by 40-45% in 2020 compared with 2005 and reaching the peak of carbon emissions by 2030 or even earlier.”
Carbon intensity levels are measured by a country’s emissions relative to economic output. According to the US Environmental Protection Bureau, China and the US were the biggest emitters of carbon dioxide in 2011, the most recent year for which statistics are available.
“(China and the US) are moving in opposite directions on this issue,” said Alex Lo, an expert on climate politics at the University of Hong Kong.
“The Chinese government has made a lot of commitment officially … those policies and initiatives are not going to stop.”
It was a dramatic statement of intent by the world’s largest carbon polluters, and a major win for the Obama administration in bringing China on board as an equal partner in the fight against climate change.
Following the election of Donald Trump however, Beijing looks to be standing alone.
Solutions
China is already a world leader is renewable energy.
The country’s National Energy Administration said in January that China will spend more than $360 billion through 2020 on renewable technologies such as solar and wind.
China invested more than $88 billion in clean energy in 2016, according to Bloomberg New Energy Finance, down from an all time high of almost $120 billion in 2015, but still significantly more than the $58.8 billion invested by the US last year.
Lo also predicted that China will take major action to introduce an emissions trading scheme this year, a means of controlling pollution via economic incentives.
“China might be able to take leadership in terms of motivating other partners, particularly those countries in the Asia Pacific region to follow suit,” he said.
China will not stand alone in terms of tackling climate change. The EU is another major player, albeit one hampered by political divisions over issues such as Brexit and the refugee crisis.
US states such as California are also taking action, with Governor Jerry Brown vowing to forge ahead on climate policies regardless of Washington.
“If China and the EU choose to act together then I think between them they can manage a lot of this,” said HKU’s Evans.
“But if the US tears up as many of their climate policies as it’s suggesting they’re going to, that will be a loss.”
“The atmosphere is a global good. You can’t constrain greenhouse gases released in the US to stay in the US, we’re all going to suffer from them,” he added.
Another major risk posed by the Trump administration’s action, according to Evans, is that it may encourage countries to move forward on their own on matters such as geoengineering.
Efforts to hack the planet in order to slow or reverse climate change have been put forward, but critics warn they could have unforeseen runaway effects that leave the world in a worse position than before.
“At the moment there’s a moratorium on any country doing that unilaterally,” Evans said.
But for nations most at risk from climate change, “you have to wonder how much of their country they’re willing to see go underwater before they take action unilaterally to modify the climate.”
“Is that not treason, when you work against your own government?” Huckabee said.
“I don’t understand why there isn’t a great outrage over the leaking of information out of the highest levels of US intelligence,” he said.
“I don’t understand why there isn’t a great outrage over the leaking of information out of the highest levels of US intelligence,” Huckabee, whose daughter is an aide to President Donald Trump, told radio host Laura Ingraham.
Huckabee continued, “This is of grave concern, because if people who are supposed to be guarding our secrets are letting them go — Laura, I hate to use this word, but I don’t know what else to use — is that not treason? Is that not treason, when you work against your own government?”
The former governor also criticized Republican Sen. Lindsey Graham for comparing House Intelligence Committee Chairman Devin Nunes to Inspector Clouseau from the Pink Panther.
“I’m very disappointed in Lindsey,” Huckabee said. “I sometimes wonder what uniform he puts on each morning when goes out to the field to play, and I’m not just talking about the partisan uniform.”
“But I think to bring that kind of criticism and to call the chairman of the House Intel Committee — who is a person of integrity — to call him Inspector Clouseau, to use those kind of terms basically to diminish him, it’s very unfortunate, it’s demeaning, and frankly it just makes no sense,” Huckabee added. “He ought to be calling Devin Nunes and saying, ‘Congressman what do you have? Tell me what you know that you can tell me about, because we need to find out if there’s something going on here that is nefarious.'”
President Donald Trump made the announcement at a meeting at the White House Wednesday, with Christie sitting by his side. Trump introduced him as a “very effective guy” and said the governor will work with representatives in state and local government, as well as law enforcement, medical professionals, and victims to figure out the best ways to deal with this epidemic.
Since 1999, the number of overdose deaths involving opioids quadrupled. From 2000 to 2015, more than 500,000 people died from drug overdoses, and opioids account for the majority of those deaths. It’s estimated 91 Americans die every day from this addiction, according to the Centers for Disease Control and Prevention, and for every death, more than 30 others are admitted to the emergency room.
The Trump administration has said opioid addiction and treatment are priorities. On the campaign trail, Donald Trump spoke about expanding incentives for states to use drug courts and mandate treatment. He also vowed to expand access to treatment slots.
The proposed Trump budget(PDF) released this month highlighted a $500 million increase from above 2016 levels to expand opioid misuse prevention efforts and to increase drug treatment. It is unclear if that increase would be from additional funds, or if it would be from money made available through the 21st Century Cures Act, which President Barack Obama signed in December. That legislation provides $1 billion for drug treatment for fiscal years 2017 and 2018.
Christie has spoken at length about his efforts to end the opioid epidemic. His state has had its share of problems. There has been a significant 16.4% increase in drug overdose deaths in New Jersey from 2014 to 2015, according to the CDC. There were 1,600 lives lost in 2015 alone, which is four times the number of homicides in the state and three times the number of fatalities in accidents that year.
In response, Christie has signed Senate Bill 3, a bipartisan initiative that requires health insurance to cover treatment and substance abuse without delay. “Now, with this legislation, people seeking treatment cannot be denied access in their time of need,” Christie said when signing the bill last month.
The law also creates what Christie called some of the country’s strongest maximum limits on initial opioid prescriptions. That means doctors can only give their patients a five-day prescription for opioid pain pills. Other states, including New York, Massachusetts and Maine, have enacted laws that limit prescriptions, but those limits are typically seven days.
These pain pills can become a gateway to addiction and to heroin use, studies show. New Jersey already had a law that requires doctors to consult with a prescription monitoring database before they prescribe opioid painkillers. It’s one of 29 states to make that requirement.
“As I’ve said before addiction is not a moral failing, it is a disease and the more that we talk about it as a disease, treat it as a disease, regulate it as a disease, the more people will finally get the idea that asking for help is not a sign of weakness, but it is in fact a sign of strength,” Christie said at a press conference last month.
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At a CNN town hall meeting with Health and Human Services Secretary Tom Price this month, addiction recovery specialist and former addict John Brogan credited Christie in part with saving lives in the state. “If it were not for Gov. Christie, there would be 100 more people on top of the 1,600 that we lost last year for this epidemic,” Brogan said.
Christie met with Trump in February at a White House lunch in which the governor said they spent a “good amount of time” talking about the problem and other ways they could fight the epidemic on a “much broader level.“
At Wednesday’s White House meeting, Christie said he is honored to take on this task.
“Every life is an individual life from God and no one life is irredeemable, and people make mistakes we all have, and when people make mistakes of drug use, and it is a mistake, we can’t throw their life away,” Christie said.
During a check-up, on his 43rd birthday, his doctor named summertime flu the most likely culprit.
Then the same thing happened again, and it settled into a disturbing pattern: midweek chills and an escalating fever that would break on Sunday. By Monday, Chris would feel fine, only to have the sequence repeat itself.
He joked about it with colleagues at T-Mobile, where he works in software development, “Well, I hope it’s not cancer!”
On alternating weekends from May to October, Chris would volunteer as a back country ranger for the US Forest Service — a physically demanding role that involves patrolling Washington’s Cascade Mountain forests and hiking along high-altitude trails with a backpack that can weigh up to 32 kilograms.
But now, even at sea level, he was getting winded just walking his two dogs around the block. What was going on?
A medical appointment revealed a heart murmur and suspicions of endocarditis, an infection of the heart’s inner lining. The scare triggered another series of tests that led Chris and his husband, Bill Sechter, to Emergency Room 4 at the University of Washington Medical Center.
A whiteboard checklist documented his Saturday morning: insertion of a large-bore IV as a potential conduit for antibiotics, a round of blood draws, and discussions with the ER doctor.
Then the phone rang and the nurse answered, listened and responded to multiple questions in quick succession: “Yes. Yes. Oh, OK. OK. Yeah.” He excused himself from the room and soon returned in a “full hazmat suit”, as Chris describes it. Yellow.
“And that’s when we were like, ‘Oh s***, it’s on. Something is seriously bad.'”
Chris learned that his level of infection-fighting neutrophil cells, normally churned out by the bone marrow, had fallen so low that his defenses were in tatters. He was also severely anemic, with roughly half the normal amount of red blood cells in his blood.
It wasn’t endocarditis. And when one of his doctors performed a blood smear, she saw something on the microscope slide that shouldn’t be there: blasts.
These leukemic cells, stuck in adolescence, were the harbingers of the coming horde that had so astonished 19th-century surgeons.
The doctor apologetically broke the news and Chris and his sister dissolved into tears. In an emotional Facebook post later that day, he attached a picture of himself in a hospital gown and pink face mask and wrote: “this avowed agnostic could actually go for your good juju / positive thoughts or even your (gasp) prayers.”
More tests, including a bone marrow biopsy of his pelvic bone, painted an increasingly disturbing picture. He had acute myeloid leukaemia, a fast-progressing cancer.
The biopsy suggested that an astonishing 80 per cent of his bone marrow cells were cancerous. Strike one.
Chris Lihosit was diagnosed with acute myeloid leukaemia, a fast-progressing cancer, in 2015.
Other results suggested that chemotherapy wouldn’t be as effective on his form of leukemia. Strike two.
And genetic tests put him in the unfavorable risk category by revealing that his cancer cells carried only one copy of chromosome 21, a rare anomaly associated with “dismal” outcomes, according to recent studies. Strike three.
Chris needed to start chemotherapy immediately.
But first, he had his sperm banked. Then, with family and a close friend at his side, he celebrated his impending treatment with prime rib and cheap champagne smuggled into his hospital room.
Over three days, he received multiple doses of the anticancer drugs cladribine, cytarabine and mitoxantrone, the last a dark blue concoction often dubbed “Blue Thunder.” The drug turned his urine a shade he describes as “Seahawks green” in honor of Seattle’s football team. Other patients have had the whites of their eyes temporarily turn blue.
On the third night of his drug infusion, a sudden back pain grew into an intense pressure in his chest that felt like he was being stabbed. A heart attack? An emergency CAT scan instead revealed two newly formed blood clots: one in his right leg and another in his right lung — not uncommon consequences of chemotherapy.
Over the next six months, Chris would need transfusions of blood-clotting platelets whenever his level of them dipped too low, and daily injections of a blood-thinning drug whenever it rose too high.
Thirteen days after being admitted into the hospital, he posted a more hopeful Facebook entry: “And I’m finally going home! Now the real adventure begins.”
New hope
Based on his leukemia classification, Chris was braced for multiple rounds of chemotherapy. He and his husband were overjoyed when a second bone marrow biopsy suggested that the leukemia had become undetectable after only a single round.
Because of his high-risk classification, however, Chris’s doctors said that the cancer was likely to return without a bone marrow transplant.
But Chris discovered that he had inherited an extremely rare set of cell-identifying protein tags. Only one bone marrow donor on the worldwide registry matched his genetic tags, and that person was unable to donate.
An umbilical cord blood transplant, Chris and his doctors agreed, was his best hope.
Like bone marrow, cord blood is unusually rich in hematopoietic stem cells — which can give rise to every type of blood cell — and their more developed descendants, progenitor cells, which are more limited in what they can become. But, unlike bone marrow, cord blood can be collected in advance and stored for decades in liquid nitrogen.
First, Chris would need to spend another five days in the hospital for a standard follow-up round of chemotherapy to pick off any hidden cancer cells. Chris marked the occasion with a Facebook post of himself in a grey felt Viking helmet and attached braids. “Round 2… And FIGHT!” This time, the chemo went off without a hitch.
He was a familiar face at the medical center, though, with three additional hospitalizations: twice for bacteremia, a bacterial blood infection marked by high fevers, and once so doctors could tame an allergic reaction to a transfusion of platelets, which always reminded Chris of chicken broth.
He had to steel himself again on Christmas Eve for the arrival of the “big guns”: two days of conditioning chemotherapy, headlined by a derivative of mustard gas. Its name is cyclophosphamide, and it works by sabotaging the machinery that copies DNA in rapidly dividing cells. As it does this, it breaks down to form toxic chemicals, including a pungent one called acrolein, which can destroy the lining of the bladder.
To neutralize its effects, patients must take another drug, called mesna, and drink plenty of water.
After a day of rest, Chris began a radiation therapy regimen so intense that it would have killed him if delivered in a single dose. Instead, his radiologists used a particle accelerator to fire X-rays at him in multiple bursts during morning and evening sessions over four days.
“You basically get into a tanning booth made out of clear Plexiglas,” he said.
Wearing nothing but a paper gown, Chris had to stay completely still behind two metal shielding blocks, each the size of a brick, positioned to protect his lungs from irreversible radiation-induced scarring. He did get a mild tan, he says, along with damaged skin that still resembles crepe paper.
Another absurdity still makes him laugh: while he requested punk rock for one of the sessions, he was instead blasted with the tune of Prince’s ‘Erotic City’.
When he finished the final round of total body irradiation on 30 December, the radiology team gathered for a final tribute and let Chris hit a small ceremonial gong.
Help from newborns
The morning of New Year’s Eve, Chris wrote on Facebook, “I’m as nervous as an expectant father!” An hour and a half later, he marked the delivery of his “zero birthday” with a small chocolate cake and a decorative “0” candle: the day when his own bone marrow cells, erased by radiation and chemotherapy, were replaced by roughly four tablespoons of a life-granting elixir from the cord blood of two baby girls.
Even with some of the best help that medicine can offer, transplant recipients face a daunting few weeks without functional bone marrow when nearly anything can kill them.
Chris and Bill have nicknamed the donors Amelia and Olivia based on their blood types, A-negative and O-positive. In a later post, Chris marveled at the new arrivals reseeding his bone marrow: “I use more vanilla flavoring creamer in my coffee than the volume of cells that are rebuilding my entire blood and immune system.”
Four hours after the initial infusions, he received his protective bridge of blood-forming stem cells, collected and expanded from the cord blood of a third baby, a boy he and Bill have nicknamed Eddie.
Less than three weeks after the transplant, Chris’s neutrophils had fully engrafted and genetic tests suggested that Amelia had decisively won the fight to form his new blood and bone marrow. He progressed so rapidly, in fact, that he had to stay in the hospital for two days after he was fit to leave, so that Bill could finish preparing the apartment.
28 January: discharge day. As his family packed up his hospital room, Chris was taking a shower when a wall of exhaustion hit him. He could no longer stand or even dry himself off and sat dripping on the shower bench until Bill heard his calls for help.
He had survived, but life had fundamentally changed.
At home, every surface had to be disinfected daily with a bleach solution. At first, Chris couldn’t walk 100 feet down the apartment hallway without leaning on his brother. Until he hit the 100-day milestone after his transplant, the end of the most vulnerable period for recipients, he returned to the Seattle Cancer Care Alliance every other day for blood tests and checkups.
On the 97th day, Chris and his family celebrated a hard-fought victory when he was officially declared cancer-free: a leukemia survivor.
Cord blood today
Despite dozens of studies documenting its curative powers, cord blood is saved after only 5 per cent of all US births. The rest is simply thrown away.
Michael Boo, chief strategy officer for the National Marrow Donor Program, estimates that only one in ten of those retained units passes the required screening tests and has enough volume to merit long-term storage.
Cord blood is also notoriously expensive, ranging from $22,000 to $45,000 per unit. Due to the relatively low demand from doctors, Boo says, public banks — at least in the US — are collecting as much as they can afford to keep. Beyond persuading new parents to donate, then, lowering the cost of cord blood transplants may depend upon persuading more doctors to use the cells and more insurers to cover them.
One potential use has attracted the avid interest of the Biomedical Advanced Research and Development Authority, part of the US Department of Health and Human Services. As part of Project BioShield, the federal agency has been on the lookout for medical interventions that could treat acute radiation syndrome after a dirty bomb or nuclear disaster.
Keeping people alive
Cord blood transplants in adults, still an option of last resort in the early 2000s, nearly slammed to a halt over the quandary of how to keep patients alive until their new bone marrow cells could kick in.
Some researchers reasoned that they could boost the transplant volume by giving adults two cord blood units instead of one. John Wagner and colleagues at the University of Minnesota performed the first double transplant in 2000, using cells from two infant donors.
The tactic dramatically reduced the rate of graft failure, in which the recipient’s body rejects the new cells. But it barely changed the time needed to regenerate the bone marrow, and some critics have questioned whether a double cord blood transplant offers any significant benefits.
Wagner says his research suggested that transplanting enough blood-forming cells was necessary − but likely not sufficient − for better results. Improved patient survival, in fact, seemed to depend more upon a revised roster of drugs given pre-transplant.
Blood is extracted from an Umbilical cord at UCLH in London.
To their surprise, researchers also discovered that the donors in a double cord blood transplant seem to battle for dominance, a curious “graft-versus-graft” phenomenon that almost always results in the victor dominating the recipient’s new bone marrow and blood cells.
Filippo Milano, associate director of the Cord Blood Program at the Fred Hutchinson Cancer Research Center in Seattle, compares it to a pivotal scene in the 1986 movie Highlander, when the antagonist exclaims, “There can be only one!”
On a sunny morning nearly a year after Chris’s transplant, he and I meet the Italian-born doctor in his lab so he can greet one of his star patients and explain the science behind the therapy that saved Chris’s life. Milano is passionate about coaching soccer and cooking. On the side, he jokes, he conducts research on cord blood transplants.
Upon his arrival to “The Hutch” in 2009, Milano teamed up with Colleen Delaney, founder and director of the Cord Blood Program, to test and refine a treatment strategy that may yet prove a better option than a bone marrow transplant for people with leukemia who are at high risk of relapsing.
Based on collaborations and discussions with other experts in the field, Delaney pioneered a method to minimize the risk of infection and bleeding after a cord blood transplant by reducing the time needed for the new blood cells to kick in. The strategy relies on what she and Milano call an “expanded” blood unit.
Starting with an extra batch of cord blood, they separate out the minuscule fraction of blood-forming stem cells and their early descendants and expand that population in the lab.
The hundreds of millions — even billions — of resulting stem and progenitor cells can jump start the generation of protective blood cells in the recipient. When infused along with a more traditional transplant, they can act like a temporary bridge until the replacement bone marrow takes over. “The net gain was that you didn’t have those very prolonged periods of recovery,” Wagner said.
Blood extracted from an umbilical cord and placenta by a member of the Cord Bank Team at NHS Blood and Transplant.
One crucial component, Delaney discovered, is a protein called Notch ligand.
When added to the blood-forming stem cells, Notch ligand lets them divide quickly in the lab but temporarily pauses their development by preventing them from maturing into the normal range of cell types. Critically, they never give rise to T or B immune cells, which would seek out and destroy any perceived threats lacking the proper “self” ID tags.
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Putting a donor’s T cells into an unmatched recipient, Delaney says, would trigger fatal graft-versus-host disease. “That’s the key: we get rid of all those bad parts of the immune system that need to be matched or they can kill you.”
The “bridge of recovery” lasts only so long before the full contingents of other donor cells begin attacking and dismantling it. But, with no cells checking IDs initially, the early flood of blood-forming stem cells need not be matched to the recipient at all, meaning that the “expanded” cord blood unit could be created well ahead of time and used whenever needed as a universal donor.
Other researchers are working on strategies toward the same end, and Mary Laughlin describes the overall progress as “very exciting”.
Delaney’s work, she says, “is very important, saving lives and improving the tolerability of these transplants and the success of these transplants”.
This is an edited extract from an article first published by Wellcome on Mosaic. It is republished here under a Creative Commons license.
Jessica Chastain said she’s careful to chose projects that feature strong women
“The Zookeeper’s Wife” debuts in theaters March 31
“I think every woman is a strong woman. I think that in the past, we’ve connected strength, leadership, ambition, power, as masculine traits,” Chastain told CNN in an interview for her upcoming film “The Zookeeper’s Wife.” “We’ve connected compassion and emotion and kindness and softness as feminine traits. The great thing about today is the boundaries are being blurred.”
Chastain said she embraced the mix of gentility and power in her role as Antonina Żabińska in the film, based on the true story of a husband and wife who helped people escape the Holocaust in Warsaw, Poland during World War II.
“It was a great responsibility to play this character. I definitely felt the weight of history. I felt the weight of the family,” Chastain said. “There are incredible examples of women in history who have created paths that we walk on today. Antonina is an example.”
Chastain credits the women in her family for her success.
“I look up to my grandmother and my mother. My mother raised us, she was a single mom, and it was really difficult,” she said. “I’ve seen my grandmother and my mom sacrifice so much for their children. I am where I am today because of the sacrifices they made.”
“They didn’t have the opportunities to go to college and to create these careers,” she continued. “I think because of that, I’m very protective of single mothers out in the world and what they do for their children. I think we should support them as much as we can.”
Chastain hopes that audiences will feel uplifted by “The Zookeeper’s Wife,” despite the horrific time period in which it’s set.
“This is a film that also focuses on the light,” Chastain said. “Yes, there is a dark side of humanity. But, also, there is beauty, love … and those who really stick their neck out to exhibit love and to show compassion.”
