Search Results for “the hollywood medical reporter” – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 The Hollywood Medical Reporter – The Martial Arts Kid http://brainblogger.com/2015/09/21/the-hollywood-medical-reporter-the-martial-arts-kid/ http://brainblogger.com/2015/09/21/the-hollywood-medical-reporter-the-martial-arts-kid/#respond Mon, 21 Sep 2015 23:02:44 +0000 http://brainblogger.com/?p=20611 The Martial Arts Kid began as a Kickstarter campaign announced in 2014. After learning that two of the most iconic martial artists in the industry—11 time World Kickboxing Champion Don “The Dragon” Wilson and the “Queen of Marital Arts Films”, Cynthia Rothrock—would be teaming up, over 430 people pledged $173,486 to help bring this project to life.

Such action demonstrates to what extent this project was made by the people for the people. However, rather than spit out the expected, standard computer-generated action scenes, producers James Wilson and Cheryl Wheeler chose a different path, one with a sense of social consciousness. It’s an approach that makes The Martial Arts Kid an original film in its own right.

“We don’t tolerate bullies here.”

Cynthia Rothrock delivers this keynote line, which truly serves as the underlying message of this out-of-the-box, anti-bullying martial arts film.

Co-writer and director Michael Baumgarten’s film has powerful, albeit untraditional, scenes that reveal the film’s true purpose. After attending the sold-out premiere at the Burbank International Festival on September 12th The Martial Arts Kid is a clarion call to shine light on the epidemic of bullying.

Red Carpet Burbank Film Festival Premiere

This coming of age movie follows teenager Robbie Oakes (Jansen Panettiere). Abandoned by his father when he was born and having witnessed his mother die while trying to crossing the street, he lives with his grandmother in Cleveland, Ohio.

The film opens with Robbie in an intense chase-down with the police. As the cops handcuff him, Robbie pleads with his grandmother, promising her things will be different. However, this was the final straw. Robbie’s past has clearly helped brew a troubled young boy with deep-seated feelings of aggression that his grandmother can no longer control. As such, he is forced to move to Cocoa Beach, Florida, to live with his Aunt Cindy (Rothrock) and Uncle Glen (Wilson).

No sooner does he unpack his bags than he meets a cute girl, Rina (Kathryn Newton), and her a hot-tempered boyfriend, Bo Whitlaw (Matthew Ziff).

Matthew bullying face off 3 in film

Bo quickly makes it his mission to make Robbie’s life as brutal as possible: basic teasing, getting pushed into the girls’ bathroom, whispered promises of upcoming beatings while sitting behind Robbie in class, followed by the aforementioned beatings, and so on.

Bo behind Robbie in Class

Robbie learns that his uncle is a martial arts instructor and his aunt is one of his finest students and fellow instructors. At first, Uncle Glen won’t consider taking Robbie on as a student because at that point Robbie only demonstrates a selfish, lazy and uncontrolled anger. Glen explains that this is a dangerous trait in a martial artist trainee: revenge and anger are not what martial arts are about. However, after one too many run-ins with Bo, Robbie finally begins to demonstrate the caring and dedication his uncle needed to see. Uncle Glen explains to Robbie:

“Street fighters fight to force their will on others, but martial artists fight for only two reasons: to defend themselves or to defend others.”

Matthew Ziff, the runaway star of the film, who won Best Supporting Actor at this year’s Sunscreen Film Festival, summed up the point of martial arts as well as the film:

“It’s about respect and self-respect and not revenge.”

Matt Ziff Winning Best Supporting Actor at Screen

Ziff has trained in various forms of martial arts since he was 3 years old and believed strongly in the project, even before he was granted the part. In fact, despite his expansive athletic abilities and knowledge, Ziff understood that he had to assume a character, and that character looked nothing like he once did.

Matthew Ziff Before and After

Just like his physical transformation, Ziff takes on an entirely different persona, and truly becomes Bo Whitlaw. Sure, assuming a role and becoming a character is, by definition, the job of all actors. However, in today’s celebrity-obsessed culture, viewers often see the actor just as much, if not more than they see the character the actor is playing in a given movie.

“Bullying” is no new dynamic. For decades, bullying behavior has plagued American schools. Traditional methods of dealing with bullying at schools, including detention, suspension and at times expulsion, have proved fairly ineffective.

In a 2008 study, psychologists of varying specialties evaluated the Gentle Warrior Program, a traditional martial arts-based intervention to reduce aggression in children. This specific study consisted of 254 children in grades 3, 4 and 5 as part of a larger school violence intervention. Some groups attempted to get the guardians and adults in the school to be more aware of the bullying problem in the hopes they may become more active in tending to and even preventing such behavior.

This study examined the effectiveness of martial arts training as one method of intervention that is well suited for changing behaviors and actions of children and young adults. Martial arts is characterized by a substantial emphasis on the psychological and spiritual, and has a goal towards non-aggressive behavior.

The Gentle Warrior Program attempts to, at least contribute to a shift in the overall social climate that has led and is currently still producing these aggressors in schools. Attempting to affect the overall consciousness of America (and the world at large) has the amazing possibility of shifting children’s understanding of how to deal with their emotions and subsequent actions. It offers students instruction in peace-promoting philosophy (non-aggressive attitudes, respect for self and others), self-protective techniques and problem-solving skills related to common bully-victim-bystander scenarios.

The results of the 2008 study revealed that boys who participated in more Gentle Warrior sessions reported a lower frequency of aggression and greater frequency of helpful by standing (i.e. proving helpful towards victims of bullying) over time, compared to boys with less frequent participation.

It is not a far reach to claim that The Martial Arts Kid movie is attempting the same basic goal. Both the Gentle Warrior program and the film preach non-violence, respect and empathy in an effort to change society. In other words, they attempt to spread the real philosophy of martial arts. Don Wilson said:

“We are very reluctant to get into behavioral problems as a society. We don’t because we think “oh it’s someone else’s responsibility”. But I think its everybody’s responsibility. An epidemic that’s widespread as this, we should as a group, and as our movie speaks to it, and addresses it, so we can realize that the problem exists and then we can realize ways as a society to fix it.”

The film’s title may make you think that The Martial Arts Kid is a rip-off of the 1984 classic. That would be a mistake.

The Martial Arts Kid is filled with legends and newbies, but nearly all share a common trait: they are all actually trained martial artists. This was particularly palpable in the rising star that is Matthew Ziff. Having begun modeling and acting from the age of three while holding a second degree black belt in Taekwondo, using the word rookie to describe anything about Ziff simply feels wrong. Unfortunately, experience and talent not yet noticed counts for nothing in Hollywood. That said, it was inspirational watching this up-and-comer on screen, literally going punch for punch with world-renowned grand masters and successfully holding his own with great poise.

That adds to the authenticity of the action for sure, but, more to the heart of this film, it assures a sincerity of purpose. Matthew Ziff explains:

“We’re not trying to throw a crane kick, we’re trying to show how someone would actually defend themselves in a real situation… we’re not trying to glorify martial arts, we’re trying to show it for what it is showing them we don’t have to take being bullied.”

The authenticity shines through and the truth about this amazing weapon against bullying, and the social responsibility inherent within this film is what makes this film truly so unique.

One example of how this film has already exceeded its own goals is the following story Cynthia told me:

“I got a message from a boy, that he saw the trailer and he can’t wait to see the movie because he’s been bullied and it gave him hope. After, I immediately sent an email to the producer saying this is what we want.”

Traditionz Entertainment debuted the independent film The Martial Arts Kid in select theaters and times from September 18th in Los Angeles and New York. It is expected to gain a wider distribution by other top markets including Chicago, Texas, Florida and Washington, DC.

Refererence

Twemlow, S., Biggs, B., Nelson, T., Vernberg, E., Fonagy, P., & Twemlow, S. (2008). Effects of participation in a martial arts-based antibullying program in elementary schools Psychology in the Schools, 45 (10), 947-959 DOI: 10.1002/pits.20344

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The Hollywood Medical Reporter – The Mind Behind “Brain Games” http://brainblogger.com/2015/03/08/the-hollywood-medical-reporter-the-mind-behind-brain-games/ http://brainblogger.com/2015/03/08/the-hollywood-medical-reporter-the-mind-behind-brain-games/#respond Sun, 08 Mar 2015 11:00:55 +0000 http://brainblogger.com/?p=18909 This Emmy-nominated series tests the ultimate supercomputer – your brain. Back for its fifth season, Brain Games uses a host of interactive games, experiments and, yes, even magic tricks to expose and explain some of the most complex regions of the brain. We sat down with Executive Producer, Michael J. Kovnat, to discuss the truly mind-altering show.

BB: Can you share one thing you knew about the brain that made you want to work on this show, and one thing you’ve learned about the brain since you began work on it?

MK: I had heard that the brain is the most complex known structure in the universe – which had seemed hyperbolic. As I’ve dived into working on the show, I’ve come to appreciate what that means – and all the surprising ways our awareness arises from this three pound organ. As one example, our episode on color gets into how your subjective experience of red, green, etc. has to do with how your photoreceptors interact with other brain cells, and that system can be easily fooled and confused.

 BB: What can you tell us about the inception of Brain Games?

MK: The idea was to create a show that would invite the audience to play along with a series of perception experiments. Over time, that concept was refined by a number of very talented producers, writers, and executives.

BB: Can you share a bit about your background and how you eventually began working on this show?

MK: I’d been producing non-fiction television for about 20 years, and had developed a sub-specialty in science programming. When I was hired as a staff executive producer at Nat Geo Channel, Brain Games was already in its second season. It was the first project I lobbied to work on when I was hired.

BB: More than mindless entertainment, this show demands an interactive viewing experience. That being said, what is the ultimate goal you wish to achieve through people watching this show?

MK: We want to inspire viewers to get curious about how their brains work, and hopefully change their perceptions on everyday actions. We’re making the processes of the brain come to life through interactive experiments that will keep viewers guessing and wanting more.

BB: How do you go about choosing both the human subjects for the interactive experiments on the show, as well as the experts/guest(s)?

MK: The team reaches out to people in a variety of ways. Experts are usually sought out based on their published work in the subject area of an episode. Other participants are solicited online or approached on the street.

BB: Has the show changed and/or developed in any obvious or not-so-obvious ways over the seasons?

MK: The show has actually gone through many changes over the seasons. It premiered as unhosted, hour-long specials. Then it became half hours and Jason Silva was brought in as a host. The tone and style has shifted slightly season to season. And more changes are coming soon!

BB: Can you share any details with us about what viewers can expect to see in the rest of Season 5

MK: This summer, you’ll see new episodes covering topics such as scams, positive thinking, and the surprising differences and similarities between human and animal brains. We want to ask big questions, always seen through the lens of how the brain works.

BB: Is Brain Games meant for a particular audience or viewer, and has that changed at all over the seasons?

MK: The ideal viewer is really any curious person. We’ve found that people in just about every demographic have found something they love about Brain Games. Viewers play along and get interested in the “why” behind the “wow.”

The following questions refer to episodes featuring Magician, Eric LeClerc:

BB: How would  you compare the two worlds of science and magic?

MK: Magic, done honestly, can provide an excellent guide to gaps in human attention. These tricks show how easily the brain can be fooled. Many magicians, like scientists, are first-rate skeptics.

BB: What is your favorite magic-trick?

MK: Any trick where my mind appears to have been read. Gets me every time.

BB: How do you decide what insights about the brain as well as the corresponding magic-tricks and interactive brainteasers to feature on a given episode? Does one typically come before the other? How much collaboration is required and does that collaboration ever involve outside consultation?

MK: Typically, we start with a show topic or theme. Then we work with magicians to come up with related illusions.

BB: How do you find ways to distill all the complex scientific insights you discuss on the show into viewer-friendly material that is not simply related in understandable terms, but can resonate as well? How, if any, do the “magical” aspects employed play a role in this?

MK: Just as a good magician never reveals his or her tricks, I don’t want to give away all our secrets. But when we use illusions in the show, they function as a fun way to call attention to the gap between what you expect and what’s really happening. That can be an entertaining way into a complex scientific idea.

BB: In that same vein, how do you balance the incredibly complex element of science with the goal of entertainment? Does one ever get in the way of the other?

MK: This is really an entertainment-driven show. The science comes along for the ride, but if we can’t entertain, viewers won’t watch.

Image via Linda Bucklin / Shutterstock.

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Invisibilia – Interview with the Co-Hosts of NPR’s Latest Show http://brainblogger.com/2015/01/23/invisibilia-interview-with-the-co-hosts-of-nprs-latest-show/ http://brainblogger.com/2015/01/23/invisibilia-interview-with-the-co-hosts-of-nprs-latest-show/#respond Fri, 23 Jan 2015 12:00:31 +0000 http://brainblogger.com/?p=18305 “What were you just thinking?”

“Are your thoughts related to your inner desires?”

“Do they reveal who you REALLY are?”

Invisibilia_Alix_LuluThese are the questions Alix Spiegel and Lulu Miller explore in NPR’s new show, Invisibilia (Latin for “all the invisible things”).

With the first episode, The Secret History of Thoughts, we are introduced to a man referred to only as “S” gripped by violent thoughts of killing his wife, and another man trapped inside his body for 12 years; his thoughts being the only thing he could control.

Invisibilia proved to be a prime example of what The Hollywood Medical Reporter aims to examine and discuss. Granted film and television have taken much of the influence once held by radio, the later has not been extinguished by a long shot. Radio and podcasts remain quite popular. As such, so does their influence and power.

This show exemplifies the possibility of that power. Spiegel and Miller take a scientific topic – such as modern psychoanalysis – and shape their presentation with a personal human narrative. The listener gets pulled in – not wholly, but arguably in large part – by the human story of a man consumed with the thought of stabbing his wife, and along the ride learns of the various forms of psychoanalysis the man experienced.

The first episode alone offers such a vast array of topics to discuss that we will be breaking up this coverage into two parts. The first installment we will share our interview with co-hosts Alix Spiegel and Lulu Miller.

How do you pick your interview subjects?

AS & LM: This depends a lot on the subject of the story, but when our focus is someone with an unusual brain condition, we usually talk to a bunch of people with the condition (six to twelve, sometimes more sometimes less) by telephone. We interview them enough to get a decent sense of how they are experiencing the world and what they have to say – then we set up studio interviews with two or three of them. From there we will usually focus on one in particular to visit in person and build into the main subject of the story. That person is picked because there was something they said that seemed particularly interesting, or they are just open to talking about their experience. It’s not really a science, it’s more like a gut reaction to the interview. There are some stories where it’s not possible to talk to a bunch of different people. For example this season we did a story about someone whose brain makes her biologically incapable of fear. That is such a specific condition that it wasn’t possible to talk to a bunch of people about it.

How does this decision factor into the shaping of the tone and general content of the given episode?

AS: I think what’s important is that they seem representative of what it is that you are trying to explore and they seem trustworthy. It’s not possible to know before you sit down for the actual in-person interview what the shape of their story is going to take, what their real experience has been. You just have to talk and see where it goes.

What are your hopes for this program?

AS & LM: We hope it will be received kind of like The Interview was – we’re looking for a statement from President Obama and maybe a formal complaint against us at the UN by North Korea, but we’re kinda doubting that will happen.

Our more realistic hope is that these stories expand listeners’ own thoughts and understanding. We want to be thought-provoking! And we also hope that some people will find a kind of comfort or edification in the stories and that those people will tell their friends about it and then some of those friends will also find a comfort or edification in the stories. We’d be really happy with that.

Do you employ medical experts to assist and advise you on how to go about this project, particularly in regards to any potential caution that may or may not be needed in choosing your interviewees?

AS: I don’t think that we’ve talked to anyone on the show who has been dangerous in any way. Our first program involves someone who initially sounds like they could be dangerous, but the story is about how he is actually one of the most decent, non-violent people you will ever meet. We do talk to lots of scientific experts though – tons of them – and they always give us advice on what we are doing.

How did you come to choose this as NPR’s newest program? What went into this decision?

EN: At NPR, we like to maintain an innovative culture, so we are vetting new ideas all the time. Sometimes it is for a radio show, a special series, a podcast, a blog—lots of ideas percolate all the time. For new shows, like Invisibilia, we follow an iterative development process, which means we work on new ideas a little bit at a time so we can really understand the idea, the work involved, and its potential. So an innovative idea like Invisibilia isn’t unique at NPR; it’s just the only idea (of many) that made it this far in the process.

How do you balance being entertaining with being informative; not to mention being reliably accurate and consumer-friendly so as to produce good ratings?

AS: Well we try very hard to be both! Lulu came from Radiolab and Alix came from This American Life, and so we both were trained in how to tell stories that deliver a lot of information in a way that feels fun.

How much would you say good storytelling plays in the success of this and other radio/podcast programming (NPR and not)? In what way, if at all, does the role, technique and implementation of storytelling differ than in other media such as novel writing, screenwriting?

AG: Storytelling is not a technique for us. Because, if you think about it, we all are living our own stories. Life is a story. At home. At work. So, finding and telling stories seems to us like the most natural way to share information. Serving up information, facts by themselves, takes it out of context.

Sure, a lot of the time reporters don’t present the two together, because they need to be quick. Gathering information and getting it out to people fast is often the most important thing. But we are taking the time (and we hope our listeners will too) to keep story and information together.

As for radio versus other media, radio is the most intimate medium, a human voice connecting with your imagination. It’s probably the oldest too, isn’t it? Really fundamental to our human experience. So we think radio is the right medium for Invisibilia.

How common is “Harm OCD,” [the condition which caused “S” to be consumed with thoughts of killing his wife]? Does the intangible nature of its symptoms impact the ability to diagnosis it?

AS & LM: Turns out Obsessive Compulsive Disorder with harming obsessions, or Harm OCD, is a well-recognized condition that is regularly diagnosed. I (this is Alix) had never heard of it before I got an email from someone who had it, but once I started looking into it, I was surprised by how many people had it. To find out more about it you can look here.

Indeed, I have to say (now this is Lulu), once I starting talking to people about this piece we were working on — in which an otherwise normal man is plagued by violent thoughts everywhere he looks — the amount of people that privately confessed they had such thoughts really shocked me. I think maybe it is not as rare as you might think. I think there is huge stigma around it, and thus people are often left alone with these thoughts, worrying about them, which is exactly the perfect way to make them worse.

Also – and this is important – mental health professionals who work with people who have violent thoughts have various ways of diagnosing whether the thoughts are signs of OCD. It’s not as though everyone off the street who is complaining of murderous thoughts is told the thoughts should be ignored; it takes a therapist or psychiatrist time and investigation to get to that point.

And of course, as with any condition, medical or psychological, the diagnosis is always (at least in some very small sense) a bet. Which is sort of the point of the show. Frustrating as it may be, it’s very hard to get to an absolutely scientifically perfectly perfect absolutely certain answer to the question of “how are your thoughts related to your inner wishes?” But in the case of the mental health professionals we were talking to, some of them have been working on this condition for 20 years and never once been wrong on their “bet.”

When attempting to reach large audiences, how do you overcome the distance between the two types of knowledge involved: scientific knowledge and common knowledge?

AG: We let each one inform the other.

How would you define the genre of entertainment INVISIBILIA fits into? Is it a simplified scientific message or perhaps, does it belong to a different category? To that end, how does NPR effectively use mass media to popularize science and medical subjects?

AG: Invisibilia looks at things that have a profound and yet mostly unrecognized impact on us. Intangible things like thoughts, expectations, fears. And sometimes tangible things, like computers, that affect us in unseen ways. As scientific research reveals how these things shape our behavior and our lives, we will try to share what has been found. So Invisibilia is stories about what we don’t usually see about ourselves.

Regarding NPR and science and medical subjects, our feeling is that we don’t need to popularize them. We just need to make them accessible. We all want to know about ourselves and our world. Sharing this kind of information in stories can make it clear and meaningful.

Can you share a particular story and/or moment you heard or experienced during production that stuck with you on a deep level and why?

AS: There have been so many: for me (Alix) one of the most powerful was when we went to interview this woman who physically feels the things that the people around her physically feel. It made me think really differently about empathy. Lulu?

LM: Can I have two? I have two. 1) “BOTHER.” When I was interviewing a woman from India for a piece about an all-Indian retirement community in Florida, she mentioned that where she grew up (in a small Indian village), there was no word for “bother.” “Why would you say that word?” she asked me. Her point was that, when she came to the States, everybody was always afraid of ‘bothering’ each other, of showing up unannounced on a neighbor’s doorstep, or calling to talk on the phone. I completely knew what she meant. I spend a large portion of my life being TERRIFIED of ‘bothering’ people. I will look at a telephone and literally sweat… before dialing. And here she was pointing out – that where she came from ‘bothering’ wasn’t even a thing. It started to make me realize just how much my private interior life (like the pounding worry that can be produced by fear of bothering) is in fact created by exterior forces like culture and society. Alix has known this for a very long time, but I’ve been a little late to the party. 2) THERE IS A FOOLPROOF ANTIDOTE FOR FEAR. It is not a controlled substance. It requires no prescription. It is just a very simple equation that this man, Jason Comely, an IT guy in Canada, discovered and told us about. But I suppose I shouldn’t tell you what it is, because it’s kind of the treat we dangle at the end of the “FEARLESS” episode. So. You will just have to listen.

Can you share a bit on what we can expect for future episodes?

AS: We’ve done a whole show about fear (that’s the one with the person who is biologically incapable of fear) and another about expectations. In the future we want to do a whole show that looks at the concept of personality.

LM: Well, there is the show about fear we just mentioned (Jan 16). There is also a totally cool and spooky episode about entanglements, and all the ways we are connected to each other in ways that REALLLLLLLLY surprised me (and in ways that aren’t theoretical but quite earthly, and real, and being capitalized on by the US gov’t). That episode comes out Feb 6. There may or may not be a partly sung segment in our show about how computers are changing how we behave (Feb 13). And, if they let us keep making this stuff, we’ve talked about wanting to do the show on personality (how consistent it is over a lifetime, what forms it, does it come from the outside or in?), teen pregnancy, and a town in Belgium where being psychologically abnormal is the norm.

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The Epidemic Of Prescription Drug Abuse http://brainblogger.com/2015/01/21/the-epidemic-of-prescription-drug-abuse/ http://brainblogger.com/2015/01/21/the-epidemic-of-prescription-drug-abuse/#respond Wed, 21 Jan 2015 12:00:56 +0000 http://brainblogger.com/?p=18248 Drug overdose death rates have never been higher. In the United States alone, 100 people die from drug overdoses every day, most of them caused by prescription drugs. The Centers for Disease Control and Prevention (CDC) has officially declared prescription drug abuse in the US an epidemic.

Prescription drug abuse is defined as taking a medicine in any way that is different from what the doctor originally prescribed, such as taking drugs prescribed for someone else, taking a larger dose, taking it in a different way to that in which the drug is designed to be consumed (crushing tablets and then snorting or injecting them, for example), or using the medicine for another purpose, such as getting high. What makes these drugs appealing is the fact that they can have effects similar to illicit drugs when taken in higher quantities than prescribed, or in the absence of symptoms.

Opioids

Although many types of prescription drugs are abused, prescription opioids take the lead. Chronic pain is frequently treated with prescription opioids, the clinical use of which nearly doubled from 2000 to 2010. This increase was accompanied by a rise in opioid abuse; it’s estimated that over two million people in the US currently abuse prescription opioids. Nearly 75% of prescription drug overdoses are caused by prescription opioid painkillers; these drugs are involved in more deaths than cocaine and heroin combined. In 2010, pharmaceutical drug overdoses were established as one of the leading causes of death in the US; drug overdoses were more lethal than firearms or motor vehicle accidents.

Opioids can create a feeling of euphoria, cause physical dependence, and lead to addiction. But these drugs can have many other health effects. Opioids can cause drowsiness, constipation, and impaired breathing. The latter effect makes opioids particularly dangerous, especially when snorted, injected, or combined with other drugs or alcohol. Depressed respiration decreases brain oxygenation, a condition called hypoxia, which can have short- and long-term effects, including coma and permanent brain damage. Long-term abuse of opioids can also cause deterioration of the brain’s white matter, affecting behavior, decision-making, and responses to stress. The abuse of prescription painkillers leads to the need of larger doses to achieve an effect and reduce withdrawal symptoms, which in turn can cause breathing to slow down so much that it stops, resulting in a fatal overdose.

Opioids such as Oxycontin and Vicodin can have effects similar to heroin when taken in high doses or in ways other than prescribed. A progression from pain pills to heroin is quite common, since it provides the same euphoric high but is cheaper and easier to obtain than prescription opioids. In fact, heroin use rose by 75 percent between 2007 and 2011, according to the Substance Abuse and Mental Health Services Administration (SAMSHA).

Other drugs

But opioids are not the only class of prescription drugs being abused. Stimulants for treating Attention Deficit Hyperactivity Disorder (ADHD), such as Adderall, Concerta, or Ritalin act on the same neurotransmitter systems as cocaine. Prescription central nervous system (CNS) depressants for relieving anxiety, such as Valium or Xanax produce sedating or calming effects in the same way as the club drugs GHB and rohypnol. Over-the-counter (OTC) drugs are also abused, mostly cough and cold remedies containing dextromethorphan, that, when taken in very high doses acts on the same receptors as PCP or ketamine, producing similar out-of-body experiences. When abused, these drugs cause an increase in dopamine in the brain that is perceived as pleasurable. Repeatedly seeking such pleasure can lead to addiction.

The health risks of these drugs are also abundant. Stimulants can have strong effects on the cardiovascular system, dangerously raise body temperature and cause irregular heartbeat or even heart failure or seizures. High dose or repeated use of some stimulants can lead to hostility or paranoia. CNS depressants decrease brain activity, causing sleepiness and loss of coordination, and continued use can lead to withdrawal symptoms associated with physical dependence.

ADHD drugs may boost alertness and are often abused by students aiming to improve their performance. However, there is little evidence they improve cognitive functioning in the absence of a medical condition. Dextromethorphan can cause impaired motor function, numbness, nausea or vomiting, and increased heart rate and blood pressure. In extreme cases, hypoxic brain damage can occur due to the combination of dextromethorphan with decongestants present in the medication. Also, as with other drugs, abuse of prescription and OTC drugs can alter a person’s judgment and decision making, leading to dangerous behaviors.

All of these drugs have the potential for addiction, and this risk is amplified when they are abused. Concerns over addiction and drug abuse are causing some primary care physicians to prescribe fewer opioids for chronic pain, according to a recent national survey on prescription drug abuse. But an increase in the awareness of the prescription drug abuse epidemic is still urgently needed so that adequate prevention measures are set in motion.

References

Centers for Disease Control and Prevention (CDC) (2013). Vital signs: overdoses of prescription opioid pain relievers and other drugs among women–United States, 1999-2010. MMWR. Morbidity and mortality weekly report, 62 (26), 537-42 PMID: 23820967

DrugFacts: Prescription and Over-the-Counter Medications, NIH National Institute on Drug Abuse. Accessed 19 January 2015.

Hwang CS, Turner LW, Kruszewski SP, Kolodny A, & Alexander GC (2014). Prescription Drug Abuse: A National Survey of Primary Care Physicians. JAMA internal medicine PMID: 25485657

Policy Impact: Prescription Painkiller Overdoses, Centers for Disease Control and Prevention. Accessed 19 January 2015.

Prescription Drug Abuse Statistics, Center for Lawful Access and Abuse Deterrence. Accessed 19 January 2015.

Prescription Drug Overdose in the United States: Fact Sheet, Centers for Disease Control and Prevention. Accessed 19 January 2015.

Warner M, Chen LH, & Makuc DM (2009). Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006. NCHS data brief (22), 1-8 PMID: 19796521

Image via Sean Locke Photography / Shutterstock.

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The Hollywood Medical Reporter – Alive Inside http://brainblogger.com/2015/01/05/the-hollywood-medical-reporter-alive-inside/ http://brainblogger.com/2015/01/05/the-hollywood-medical-reporter-alive-inside/#respond Mon, 05 Jan 2015 12:00:26 +0000 http://brainblogger.com/?p=18092 Social worker Dan Cohen is the founder of an organization called Music & Memory, which brings personal music players (typically iPods) to people with Alzheimer’s disease. Cohen asked filmmaker Michael Rossato-Bennett to follow him as he went to various nursing homes, trying to bring one-on-one “music therapy” to sufferers of dementia. Little did Bennett know that this side-project would soon turn into a documentary, Alive Inside, which would become the hit of Sundance and spark a viral craze of hope and compassion.

In recent years, Alzheimer’s disease and its victims have been depicted in many Hollywood films and television shows. However, these efforts have rarely provided real insight into the human story of the disease, much less any focus on hope for treating it.

For example, the 2011 film Friends with Benefits is a romantic-comedy whose premise carries just as much depth as its title suggests. Films of this well-worn genre frequently encounter a problem about halfway into the second act – they are just too darn funny. The solution? Throw in a parent, sibling, relative or friend (anyone, really, since it typically carries no real consequence to the overall story) and give them an unquestionably heart wrenching disease that will turn the upbeat tone into one of sympathetic poignancy and, hopefully, give the film some weight. And, by the way, if you don’t feel what you’re supposed to feel, well then, you’re just a heartless monster.

So, in Friends with Benefits, one of the main characters, Dylan, has a father with Alzheimer’s. Since this sub-plot of what is otherwise a romantic comedy doesn’t have a lot to do with the overall plot or the characters’ development, one might say that the portrayal of Dylan’s father’s condition (e.g., a scene in a restaurant where his father has forgotten he has been divorced for 10 years, and becomes wildly agitated when he’s reminded) is in the movie simply as a ploy for poignancy. As such, in a way, it trivializes the condition. (Am I being a heartless monster to suggest that?)

I suppose the other side of the spectrum would be films where the tragedy of the disease overwhelms the entire story.

Representing this disease with compassion, without being sappy, and accuracy, without being coldly clinical, is not an easy task.

As such, when I had the opportunity to speak with Rossato-Bennett I instantly expressed just how shocked and grateful I was to finally see, in Alive Inside, a film on Alzheimer’s and dementia that is both informative and uplifting. To this he responded:

“There’s a huge tradition, documentary tradition, of being a watchdog in a way. It’s showing the world problems that they don’t see. It’s igniting action through empathy. But the problem is right now in the world is that there are so many problems that people kind of shut down and they’re overwhelmed by the scope of the problems facing us. And actually our social structures have sort of shut down in a way… So it doesn’t seem to help to shock people into action. What really happens is people get shocked and depressed and then they kind of hover for a moment and then they turn on a movie or something.”

So how did Bennett’s film turn from the dark, tragedy filled we’ve seen before to the informative and uplifting documentary focusing on the human rather than the patient? And what caused this change?

“Honestly, I have Henry (an Alzheimer’s patient shown in the film) to thank for this. I was making a film with a model for a documentary film that I rode up in, but then the Henry clip went viral worldwide in an accidental way and it was never intended to be seen by anyone, just like I never thought this film would be seen by anyone. But the response to the Henry clip was so profound.”

Bennett was referring to someone who is perhaps the most popular subject of the documentary. Henry, 94 at the time, had spent the past decade of his life as a resident of the Cobble Hill nursing home, and was one of the five million people in America suffering from dementia. Henry usually spends his days in what could easily be confused as a catatonic state: unresponsive and entirely shut-off from the world. Then one day, Dan Cohen and Rossato-Bennett came to visit.

Dan puts a set of headphones on Henry so he can hear the 1940s and gospel music that he grew up with. What happens next is nothing short of miraculous. It would be hard to believe it if you did not see it with your own eyes. Instantly, Henry comes to life. He begins to tap his fingers and bob his head to the rhythm and even sings along to Cab Calloway’s I’ll be Home for Christmas. He then progresses to share detail after detail about his life.

Rossato-Bennett exposes us to dozens of other people like Henry, all having similar, yet all unique, reactions to their music. John, a quiet Army veteran begins dancing in his wheelchair as the sound of the Andrew Sisters fill his ears. Denise, a bipolar schizophrenic tosses her walking frame away and proceeds to dance as the sounds of Schubert flow from her headphones and through her mind and body.

Rossato-Bennett consults with several medical professionals and experts in the field of aging. Alzheimer’s first attacks the hippocampus, the area of the brain where the majority of memory is stored. However, music – called by many a “backdoor to the mind” – is not stored in the hippocampus alone. When music enters the brain it stimulates numerous different parts at once and at so many different levels. Because these other areas of the brain are largely the last to be affected by Alzheimer’s, music still holds the power to fire off these synapse fireworks of communications. Essentially, because our brain reacts to and stores music in such a unique way, it gives a brain crippled by dementia access to memories they would otherwise have no access to.

Unfortunately, many– if not most – of the facilities meant to care for people like Henry do not see value in investing time and money into musical therapy. Gerontologist and advocate for long-term care reform, Dr. Bill Thomas, MD, says:

“What we’re spending on drugs that mostly don’t work [for dementia] dwarfs what it would take to deliver personal music to every nursing home resident in America. I can sit down and write a prescription for a $1,000 a month antidepressant, no problem. Personal music doesn’t count as a medical intervention. The real business, trust me, is in the pill bottle.”

Without question, iPods are not the cure-all vaccine for dementia. Nor is there a clear and easy solution to bringing musical therapy to more of the five million affected by this disease. Nevertheless, this film shows us that this approach can help, frequently wonderfully and miraculously.

As a film, Alive Inside is, perhaps, not perfect. For example, there are many different people in the film who basically make the same point about the possibilities of music therapy, and that can be a little repetitive. That’s an extremely minor point, though. The film focuses on Dan Cohen’s effort to bring this therapy to patients in nursing homes across the country. In doing so, filmmaker Rossato-Bennett provides information about the nursing home system, the obstacles Cohen faces, and how he is gradually overcoming those obstacles.

But the core of this film’s emotional impact is with the patients. Their reactions to – and improvements with – this therapy is an absolutely thrilling and uplifting thing to see.

Image via Tushnov Alexey / Shutterstock.

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The Hollywood Medical Reporter – Big Eyes and Delusional Disorder http://brainblogger.com/2014/12/03/big-eyes-review/ http://brainblogger.com/2014/12/03/big-eyes-review/#respond Wed, 03 Dec 2014 12:00:15 +0000 http://brainblogger.com/?p=17732 Simultaneously grotesque yet tender material is director Tim Burton’s specialty. Burton was therefore the perfect choice for a film about Margaret Keane’s art, which was mostly recognizable by children with strange – but sweet – over-sized eyes. Big Eyes is easily among my personal favorite Tim Burton films.

Left to Right: Tim Burton, Christoph Waltz and Amy Adams

Left to Right: Tim Burton, Christoph Waltz and Amy Adams

I recently had the pleasure of attending the Film Independent at LACMA screening series for the world premiere of Big Eyes, which will open Christmas Day. Burton and stars Amy Adams and Christoph Waltz, after watching it for the first time themselves, participated in a panel discussion moderated by Film Independent curator, Elvis Mitchell.

Big Eyes tells the story of Margaret and Walter Keane in the 1950s and 1960s. The Keanes’ marriage ends after years of Walter defrauding the world, and perhaps even himself, into thinking that his wife’s paintings of wide-eyed children were his own creation.

The film begins with Margaret (Amy Adams) packing her things and driving off with her daughter (Delaney Raye), just having left husband number one. She moves to San Francisco, where she soon meets Walter Keane (Christoph Waltz) at an outdoor art fair where they both have set up shop.

You can instantly see why Burton was the right director for this story. The over-sized, pastel teal car, driving along a bright and symmetrical suburban street of 1950s San Francisco is iconic of his work. A voice-over narration, used throughout the film, adds to the storybook feel.

However, this storybook suburbia is real. While the aesthetics of the time and place fit right in with Burton’s taste, the larger than life character of Walter Keane truly seems to have lived for the sole purpose of providing Tim Burton with an ideal subject for a film.

The moment Margaret and the audience meet Walter we both fall in love. Who wouldn’t? He is the definition of charming and charismatic, with a mouth so smooth and fast it deserves its own Olympic category. At first, the worst we may think is that he is a delightfully manipulative scoundrel. However, we soon understand that Walter’s ability to manipulate the truth is out of control, and a symptom of deeper issues. In 1986, 20 years after Margaret leaves Walter, she decides to sue him for slander to finally set the record straight on who the true artist of the family is. During the case, a court psychologist diagnoses Walter as having delusional disorder.

Delusional disorder, according to the DSM-IV, is characterized by the presence of either bizarre or non-bizarre delusions (or a fixed, false belief that is resistant to any reason or opposition with genuine fact), which perseveres for at least one month. The inclusion of bizarre delusions was a fairly recent addition, updated in the latest edition of the DSM 5.

A bizarre delusion is one that is clearly implausible and not understandably derived from ordinary life experiences. For example, if a person claimed that someone took out his or her organs and replaced them with someone else’s organs without leaving any scars or physical evidence of any kind, this belief would be deemed “bizarre.”

Non-bizarre delusions typically are about something occurring in a person’s life that is not out of the realm of possibility. Some examples include when a person believes: their significant other is cheating on them; a close friend is about to die; a friend is really a secret government agent; and so on. All of these examples are situations that technically could be true, or at least could be labeled as a possibility, but when checked by a third-party, proves not to be.

People like Walter Keane, who had delusional disorder, by and large do not show a noticeable impairment in their daily life. Their outward behaviors cannot generally be labeled as objectively out-of-the-ordinary or show clear signs of alarm.

Much of diagnosing delusional disorder can be categorized as being one of exclusion: the delusion in question cannot be better diagnosed as schizophrenia, a mood disorder or any other clear and strong potential diagnostic alternative.

Even without knowing the specifics, the average viewers could easily walk away from the film having made the diagnosis about Walter Keane for themselves. Even more convincing than his threats to “whack” his wife if she speaks the truth, are the wide smiles and fantastical justifications Waltz makes while calmly explaining his way out of whatever hole he happens to have been caught in. For example, years into their marriage (and lie) Margaret is taken aback by a surprising stepdaughter Walter never bothered to tell her about. While it is obvious to you, me and of course Margaret, Walter, through a clenched but convincing smile tells Margaret that he was sure he told her, and that it must just be a simple misunderstanding, not worthy of another thought. This character clearly does not deal with reality well.

The film is a far cry from perfect, or even greatness. No one could delude themselves into thinking Big Eyes is a masterpiece worthy of Keane’s own ego. There are many narrative threads it left unresolved, such as the surprise daughter. It seems as if Burton may have been a bit overwhelmed by the details of this story, unable to resist including each one, since they were all so awesomely perfect for the screen. Unlike some other films by the director (such as Alice in Wonderland, where the convoluted exploitation of the narrative may have been caused by overreaching), in Big Eyes, the filmmaker curbs his enthusiasm: he is firmly in control of his subject.

Nevertheless, the Burton touch is very much alive and all the more effective for its restraint. It maintains the fairytale feel while at the same time being both real and realistic.

The depiction of Walter Keane’s delusional disorder is 100% realistic. While the film never actually uses the phrase, “delusional disorder” it knows it could not deny this fact about the character. But more importantly, it wouldn’t want to. This character’s condition defines what happens in the film.

For example, the court sequence draws the viewer in with the fantastically absurd actions of Walter. While serving as his own lawyer, he questions himself, literally scurrying back and forth from the witness stand to behind the examiner’s table. After the judge orders both Margaret and Walter to paint in order to prove who is telling the truth, Walter still does not, and perhaps cannot, admit the truth. Rather, he clutches his arm in pain and claims to be suffering from an injury that renders him incapable of painting. Such actions, while not obviously irrational, are far more deluded than your average lie.

In the end, Big Eyes depicts the disorder accurately and exploits it with integrity. Without the disorder, there would be no conflict. Some films sacrifice accuracy (of such disorders) for the sake of heightening the drama. That is not the case here: the disorder underlies the conflict of the film without sacrificing authenticity.

Image via Ramon Espelt Photography / Shutterstock.

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The Hollywood Medical Reporter – “Sleepless in America” http://brainblogger.com/2014/11/30/the-hollywood-medical-reporter-sleepless-in-america/ http://brainblogger.com/2014/11/30/the-hollywood-medical-reporter-sleepless-in-america/#respond Sun, 30 Nov 2014 16:24:46 +0000 http://brainblogger.com/?p=17779 The National Geographic Channel examines the science of sleep in the upcoming television event, Sleepless In America, premiering tonight at 8 PM EST/PST. Brain Blogger editor Dr. Shaheen Lakhan and I were invited for a sneak peak.

Sleep is the third pillar of good health, along with diet and exercise. This highly anticipated film exposes the hidden epidemic of sleep deprivation. It turns out that losing sleep deprives us of a whole lot more than we might think.

John HoffmanWith this production, award-winning producer Hoffman continues his legacy of sharing groundbreaking content that reflects a refreshing ability to present ethically accurate entertainment.

He’s known for spearheading unprecedented collaborations with The Public Good Projects and America’s foremost scientific authority, the National Institutes of Health (NIH). Here, he begins an effort with these authorities to draw the nation’s attention to the science of sleep.

In addition to placing demonstrable importance on facts, Hoffman does not ignore the other responsibilities and necessities in producing an effective and ethical entertainment: he never forgets that he must create content that is not simply accurate, but also engaging and entertaining.

When we hear the word “documentary,” we inevitably conjure up some notion of capturing reality in a way that’s factual and accurate. However, the film technique known as “Cinema Verite” (direct cinema) – having first gained popularity in early 1960’s France – is fundamentally characterized as filming people and things in uncontrolled, unrehearsed and non-manipulated situations. This is all done in an effort to capture as much of the “essence of reality” as possible.

Of course, capturing total objectivity on screen is impossible. Even if such a thing was possible, such a film or TV program would have no obvious entertainment qualities. And as such, no one would watch it, rendering the exercise pointless.

In Sleepless In America, Hoffman shows a deep understanding of the multidimensional nature of documentary film. To rely on facts is absolutely a necessity, but it is not the whole package. This is something I believe so many films – documentaries and fiction films alike – fail to achieve or neglect to even strive for.

This can be seen first and foremost with the NIH’s involvement. Hoffman explained to me just how significant this collaboration is. For one thing, it demonstrates how the National Geographic Channel (NGC) appreciates the multidimensional aspects of the global health problem of sleeplessness. As such, they deemed it their responsibility to employ America’s foremost scientific authority – the NIH. Their goal was to draw attention to the fact that our lack of sleep is the most striking omission in today’s health conversation; the inclusion of the NIH in Sleepless In America adds scientific authority to the start of that conversation.

This NGC-NIH collaboration produced a meeting of the minds and abilities. As Mr. Hoffman told me:

“The NIH understands the importance of storytelling. They come to understand and learn and trust that we have a commitment and a need to use storytelling as a need to connect to any viewer, to hold their attention, and to make them feel that they can relate to the content.”

This documentary includes leading experts in the field who demonstrate, though scientific studies, that lack of sleep can have a direct correlation with many severe conditions. We see that it is correlated with an increase in the growth of cancer. We also see that 70% of high school students are sleep deprived, increasing their risk of suicide, mood problems and delinquency.

Hoffman knows that his show must present these scientific stats in a digestible form for the average viewer. And perhaps even more so, he knows it must be presented in a manner that viewers can relate to and feel the urgency of the subject.

This understanding is most clear in the basic structure of the documentary. The story is framed around a tragic car accident suffered by the Howard family. A drowsy driver crashed into and killed Mr. Howard’s wife and two of his children, and chronically injured the two survivors. This human story pulls in the viewer emotionally, beyond the statistics, graphs and studies, to show the real human face of the issue. It is dramatic and it is effective.

The documentary closes with Mr. Howard saying:

“As we start to learn about what happened with the accident, and that it was likely drowsy driving, I started thinking about the accountability. We make our own choices. If you’re drunk and you get into a car you made that choice. If you’re too tired and you get into a car, you made that choice. But if it is a medical facility or a trucking company or an industry that demands of their personnel to go beyond the limits of the human body in performance of their jobs, what is the accountability there? If our tragedy can create awareness, and if we can save one life, then I can’t say it would be worth it, but I can say that they wouldn’t have died in vain.”

I agree that nothing can ever bring real justice to such a senseless tragedy. But endeavors such as Sleepless In America, help spread awareness by posing tough questions, and presenting the facts. Like so many effective – and scientifically ethical – documentaries, Sleepless In America appropriately assigns the responsibility of action to the viewer.

Image via Brian A. Jackson / Shutterstock.

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The Hollywood Medical Reporter – Hollywood and Heroin http://brainblogger.com/2014/11/01/hollywood-medical-reporter-heroin/ http://brainblogger.com/2014/11/01/hollywood-medical-reporter-heroin/#comments Sat, 01 Nov 2014 11:00:35 +0000 http://brainblogger.com/?p=17469 The media’s interest in addiction is not new. As far back as the silent era, Human Wreckage (1923) portrayed the dangers of drug addiction. Later, we had the “Don’t Let This Happen To Your Child” cautionary tales, such as Marijuana: Assassin of Youth (1935) and the better-known camp classic, Reefer Madness (1938). A decade later, The Lost Weekend (1945) won Best Actor, Best Screenplay and Best Picture for its groundbreaking story of a struggling writer battling alcoholism.

Ten years later, The Man with the Golden Arm (1955) became the first major Hollywood movie to deal with drug use and addiction in stark and realistic terms. All these films, though, are a far cry from the gritty, oftentimes gruesome, high definition sweat withdrawals today’s audiences have grown used to.

The way film and television have portrayed drug use has undergone a distinct shift over the years. Unfortunately, the change has not always been towards accuracy. While the stigma surrounding addiction has decreased exponentially from the Reefer Madness days, and the media now freely exploits these conditions in dramatic – and sometimes melodramatic – ways, what audiences see nowadays rarely enlightens them.

The emphasis is on the gritty and the real. No, make that the “real looking.” There is much more care put into aesthetics than into the accuracy of the story.

As a result, it was both sobering and encouraging when I first learned of Roxi Blews. Wolf Brothers Entertainment’s latest film tells the story of a young woman who, after witnessing the tragic murder of her brother, succumbs to the dark world of heroin abuse.

I was first introduced to Screenwriter and Executive Producer T.E Kendall back in 2011. Still on the East Coast at the time, I was working for Michael Lynne and Bob Shaye’s development company, Unique Features. While sifting through the finals of the Motion Picture Nichol Fellowship, I encountered a script entitled Georgia Skies. The screenplay, written by T.E Kendall, tells the story of an interracial couple during the 19th century, who risk death to pursue their forbidden love in the Deep South. Years later, Kendall continues to take on some of the most riveting and relevant subject matters of our time with rare depth and deftness.

The first and perhaps most significant thing Kendall said about Roxi Blews is that it is greater than the sum of its parts. While it is fiction, it has an unbreakable tie to countless true events, real people, and life in general.

Too often, films simply exploit the aesthetics of the situation in an attempt to heighten the viewer’s sense of reality. As a result, reality is heightened beyond the true reality of the story.

Thrillers such as Limitless (2011), while not typically thought of as films about addiction, are based entirely on drug use. In Limitless, Bradley Cooper’s character is introduced to a miracle drug that, in the vein of 2014’s Lucy, helps unlock all his cognitive potential, allowing him to write a novel in a day, outwit the cleverest and most dangerous of villains, and, of course, get the girl.

Limitless before and after
While the film is filled with exciting chase scenes and high-stakes action, I would doubt most audiences were left contemplating the effects performance enhancing drug use has on society. This is not to say every film needs to provide such insight. Limitless accomplished exactly what it set out to do – entertain. If it had digressed into a bleeding-heart, after-school special warning kids not to sell Adderall to each other, I probably wouldn’t have been able to stomach it.

That said, I do wonder why a film that depicts drug use in such a casual (albeit justified) way is rated PG-13 while a film such as Requiem for a Dream (2000), which shows the whole truth and nothing but the truth, is rated R. This is not to say I believe that the latter film should be seen by underage children. However, it does feel a bit peculiar that, as long as there aren’t a certain number of curse words and/or mature aesthetic images, 13 year olds are waved into theaters disregarding any unconscious take-away from watching a film about a cool guy who takes a pill and becomes even cooler.

The cast and crew of Roxi Blews have no intention of ignoring their connection and subsequent responsibility to real life. Furthermore, every single person involved is so because of a deep-seeded desire to create a project fueled by passion and with the power to spread awareness…and impact lives.

It is because of this passion that the Hollywood Medical Reporter and everyone else at Brain Blogger took notice. In fact, Brain Blogger Founder, Dr. Shaheen Lakhan has officially become the film’s medical consultant. He joins the incredible crew, along with director Keith Holland, producer Christopher Wolf, co-producer Deidra Wayans and screenwriter T.E. Kendall. The stellar list of talent continues with the cast of Gregg Wayans, Kim Estes, Drew Wade Taylor, Rafael Zubizarreta and Shey Lyn Zanotti.

This wonderful group of passionate artists welcomed me into a one of a kind behind-the-scenes experience where I had the privilege of speaking one-on-one with the entire cast and crew and sitting in on their first official table reading. In a series of upcoming articles, the Hollywood Medical Reporter will share this experience of exclusive interviews, on-set developments and behind-the-scenes news for Roxi Blews.

Learn more at Roxi Blew’s Webite.

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How Temperature Affects People With Multiple Sclerosis http://brainblogger.com/2014/09/13/how-temperature-affects-people-with-multiple-sclerosis/ http://brainblogger.com/2014/09/13/how-temperature-affects-people-with-multiple-sclerosis/#respond Sat, 13 Sep 2014 11:00:30 +0000 http://brainblogger.com/?p=17106 Multiple Sclerosis (MS) is a neurological disorder that presents with myriad of symptoms. The disease causes physical as well as emotional changes in the patients. One peculiar symptom seen in people with MS is their sensitivity to heat. While heat sensitivity is a symptom of many other conditions as well, the exacerbation of the other symptoms, when the core body temperature rises, is a disturbing and unfortunate feature that affects people with MS.

What causes the symptoms in MS?

Multiple Sclerosis is an autoimmune disorder. This auto-immunity, the tendency of the body’s immune system to offend its own tissues or organs, results in nerve damage in MS patients. The nerve fibers of the central nervous system have a protective coating called the myelin sheath. The sheath also covers many nerves of the peripheral nervous system. Immune reactions are initiated against the main component, myelin, of this protective sheath which eventually leads to nerve damage.

Most of the symptoms seen in multiple sclerosis patients are due to the damage caused to the specific nerves. The symptoms and signs depend on the part of the nervous system affected and the extent of damage caused to the nerves.

Heat sensitivity in people with MS

Studies report that about 60 to 80% of people diagnosed with MS show excessive sensitivity to heat. People with this neurological disorder experience a temporary exacerbation of their existing symptoms and also new disturbing symptoms when they are exposed to elevated temperatures. They are sensitive to even a slight increase in their core body temperature (0.25°C to 0.5°C) that may be due to physical exercise or a warmer environment.

In many people with MS, the disease presents with intermittent periods of relapses and remissions. But the heat sensitivity causing exacerbation of symptoms is different from relapses. The problem is actually a ‘pseudo-exacerbation’ of the symptoms. Increase in temperature as such does not cause any nerve damage. Most people with MS can actually figure out their intolerance to heat and they are aware of the fact that their symptoms get worse with increasing temperature.

But what causes this heat sensitivity? Scientists, who initially attributed vascular and hormonal causes, currently propose that the reason is a disturbance or block in the normal physiological nerve conduction mechanisms.

Recent research data suggest that demyelination not only causes slowing of nerve impulse conduction along the affected nerve fibers but also linked to a phenomenon called Frequency Dependent Conduction Block. Demyelinated nerves can conduct only single frequency or low frequency impulses. They are not capable of effectively conducting the high frequency nerve impulses. This being the case, it is also found that a slight increase in temperature can slow down or completely block the action potentials in the demyelinated nerve fibers.

Increase in temperature worsens the symptoms of MS

Most of the symptoms of MS are due to the impaired nerve impulse conduction and with an increase in temperature the symptoms worsen in the affected people. Among the various symptoms of MS, fatigue, limb weakness, visual problems, pain and numbness and cognitive dysfunctions are commonly worsened when the core body temperature increases.

  • Wilhelm Uhthoff in 1890 described the peculiar phenomenon of ‘temporary worsening of symptoms with exercise’ in optic neuritis patients. Optic neuritis is a condition affecting the eyes. It is a common problem in many people with MS. Uhthoff noticed that visual symptoms were aggravated when people with MS performed exercise. While he attributed exercise to be the etiology of this problem, it was later realized that any action or condition that increases the core body temperature can worsen the symptoms in MS patients. This is called the Uhthoff’s phenomenon or Uhthoff’s sign.
  • Fatigue is a common symptom and it is seen in nearly 70% of people with MS. Premature fatigue occurs in people with MS when they are exposed to even a slight increase in temperature. Weakness, especially affecting the limbs is also a symptom that is perceived during or aggravated by a temperature rise.
  • Central pain is another common symptom that worsens with an increase in temperature. Studies propose that the reason behind this may be the damage caused to the thalamus and the spinothalamic-cortical pathways leading to thermo-regulatory dysfunction. Numbness is another symptom that worsens with rising core body temperature.
  • Cognitive functions in MS patients are also sensitive to heat. Memory problems, judgment difficulties, concentration difficulties and problems with other cognitive skills like language comprehension are more pronounced with the increase in body temperature. A recent study pointed out that people with MS demonstrated worsening of cognitive functions in warmer days.

The influence of temperature on MS patients was established as early as the late 19th century. Heat sensitivity has been realized as an important reason for the disabling symptoms of the disease. Though the pseudo-exacerbation of the symptoms is a temporary phenomenon, they are quite disturbing and severe enough to restrict the activities of MS patients, especially during warmer seasons.

References

Davis SL, Wilson TE, White AT, Frohman EM. Thermoregulation in multiple sclerosis. J Applied Physiology. 2010 Nov; 109(5): 1531-1537. doi: 10.1152/japplphysiol.00460.2010

Flensner G, Ek AC, Söderhamn O, & Landtblom AM (2011). Sensitivity to heat in MS patients: a factor strongly influencing symptomology–an explorative survey. BMC neurology, 11 PMID: 21352533

Giuliodori MJ, & DiCarlo SE (2004). Myelinated vs. unmyelinated nerve conduction: a novel way of understanding the mechanisms. Advances in physiology education, 28 (1-4), 80-1 PMID: 15149966

Leavitt VM, Wylie G, Chiaravalloti N, DeLuca J, & Sumowski JF (2014). Warmer outdoor temperature is associated with task-related increased BOLD activation in patients with multiple sclerosis. Brain imaging and behavior, 8 (1), 128-32 PMID: 24146082

Marino FE (2009). Heat reactions in multiple sclerosis: an overlooked paradigm in the study of comparative fatigue. International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group, 25 (1), 34-40 PMID: 19219698

Rasminsky M, & Sears TA (1972). Internodal conduction in undissected demyelinated nerve fibres. The Journal of physiology, 227 (2), 323-50 PMID: 4647244

Rasminsky M (1973). The effects of temperature on conduction in demyelinated single nerve fibers. Archives of neurology, 28 (5), 287-92 PMID: 4696011

Image via Sergey Nivens / Shutterstock.

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The Hollywood Medical Reporter – The Land of Oz http://brainblogger.com/2014/09/07/the-hollywood-medical-reporter-the-land-of-oz/ http://brainblogger.com/2014/09/07/the-hollywood-medical-reporter-the-land-of-oz/#respond Sun, 07 Sep 2014 11:00:42 +0000 http://brainblogger.com/?p=16865 Ethics are murky when it comes to the depiction of medical science on television shows and films. Despite a growing consensus that many of these shows dangerously misinform the public, there is no clear consensus for a solution. The primary reason for this situation: these forms of media are designed as entertainment, not education. As a result, their artistic license – freedom of expression – frees them from much regulation.

However, this argument reflects dated preconceptions about the media, and television specifically. Broadcast television of today has nothing more than a tangential relationship with television of the past. Nothing is time-dependent anymore. You can watch whatever you want wherever you want, on a TV on a PC, on a phone, whatever. Television shows are therefore ubiquitous in society. More importantly, television has become acutely aware of it own power, not only to influence but to make audiences believe in a program’s “reality”.

This situation has given birth to (among other things) what many have deemed “The Dr. Oz Effect.”

Dr. Mehet Oz, once just a recurring guest on The Oprah Winfrey Show, today is the star of his own Emmy Award-winning Dr. Oz Show. Among the top-rated daily television programs in the US, the show is only one piece of the medical-media franchise he has now become.

Oz’s success and influence should not come as any surprise. When presented with a handsome doctor who, we are told, serves as the vice-chairman of the department of surgery at Columbia University College of Physicians and Surgeons in New York, in addition to having the coveted Oprah stamp of approval, why would you think to question his medical advice?

If his intent is not to influence medical understanding and subsequent action, then why not call it The Oz Show? It’s “Dr Oz,” thank you, a title that confirms credibility and trust. He’s got a joint MD and MBA from the University of Pennsylvania School of Medicine and Wharton Business School, after receiving his undergraduate degree from Harvard University. He directs the Cardiovascular Institute and Complementary Medicine Program at New York Presbyterian Hospital. Such a resume commands authority. This ain’t no fictitious doctor on a medical drama – he’s the real thing.

Dr. Oz welds the power of a primetime infomercial, a medical news report and a televangelist all in one. This immeasurable influence is evidenced by the countless times a product featured on his show experiences a radical, overnight boost in sales. Such strong and consistent correlations negate any argument that television personalities like Dr. Oz are not consciously contributing to the proliferation of medical scams that endorse false and/or misleading information in the guise as helpful medical facts.

For example, in November 2013, Cleopatra Mcdouglad of Los Angeles signed up for a free trial offer for a product advertised on Facebook claiming to be endorsed by the renowned Dr. Oz. Because, like millions of others, she hold Dr. Oz’s words in great regard, she ordered the “miracle” supplements of garcinia cambogia and green coffee extract, after being told the only charge was going to be $7 for shipping. In the end, though, Mcdouglad learned she had been scammed into a membership with recurring shipments at nearly $100 per bottle; she was charged $600 from August through October.

Currently, the Food and Drug Administration (FDA) has no legal power to regulate weight loss supplements. As such, companies can make claims, lacking any semblance of scientific backing (or rational and ethical thought). Because no approval is required, the FDA can only investigate products after reports of harm have already transpired. Such a system is only reactive, not preventative.

There have been increasing efforts aimed at keeping regulations up with the times. For example, Title 16 of the Electronic Code of Federal Regulations (e-CFR), Chapter I of the Federal Trade Commission (FTC), Subchapter B of “Guides and Trade Practice Rules, Part 255: this addresses the “Guides Concerning Use Of Endorsements And Testimonials In Advertising.” Despite the regulation’s efforts, it makes a distinct point not to purport any absolute and clear rules for evaluating or even defining endorsements and testimonials. In May, they sued the sellers of Green Coffee Beans for “deceiving consumers through fake news sites and invented health claims.”

Many of these advertisers used video of Dr. Oz promoting the miraculous benefits of Pure Green Coffee. Dr. Oz did this in full awareness of the feeble scientific evidence supporting green coffee bean extract as an effective weight loss supplement.

On June 15th, 2014, Dr. Oz faced a Congressional hearing, with specific investigation into his promotion of weight loss products on his show. Sen. Claire McCaskill, chairwoman of the Senate’s Consumer Protection panel, said, “I’ve got no problem with celebrity endorsement of any product but I do have a problem when a science-based doctor says something is a miracle when there’s no science to back it up.”

Here are a few quotes made by Dr. Oz in past episodes of his show:

“You may think magic is make-believe, but this little bean has scientists saying they’ve found the magic weight loss cure for every body type: It’s green coffee extract.”

“I’ve got the number-one miracle in a bottle to burn your fat: It’s raspberry ketone.”

“Garcinia cambogia: It may be the simple solution you’ve been looking for to bust your body fat for good.”

Sen. McCaskill noted how, “the scientific community is almost monolithic against you [Oz] in terms of the efficacy of those three products [the three aforementioned quotes] that you called miracles.”

While I share the Senator’s outrage, I believe she would agree that we know the answer. While Dr. Oz told the committee that he avoids endorsing specific brands outright, his website lists six “trusted partners”: Aquaphor, Eucerin, Meramucil, Omron, Schiff and Walgreens.

When actor Chris Robinson endorsed Vicks’ new cough syrup in a 1984 advertisement, he said, “I’m not a doctor, but I play one on TV.” Oz gets to say, “I AM a doctor and I play one on TV.”

The Dr. Oz Show, and others like it, demonstrates a media culture that is actually taking steps backward in ethical responsibility. Now personalities like Dr. Oz are saying, “I’m actually a medical doctor, and let me show you this magical new product that happens to be for sale.”

Dr. Oz, admits to using “flowery language,” on his show. Furthermore, he expressed regret that his “passionate” language, “ended up not being helpful but incendiary and it provided fodder for unscrupulous advertisers. Yet, in the same breath, Dr. Oz claims he is the victim of scam ads using his name, and giving viewers/consumers the false impression that he supports the given products’ sales.

This defense eludes me.

This is a bona fide medical professional that elects hyperbole over scientific fact. Such behavior is not merely reprehensible but reflects the antithesis of a true health professional.

Dr. Oz cannot hide behind good intentions, victimization, and certainly not ignorance. The fact is this man can provide good, ethical advice. But, he chooses to trumpet pseudoscience to a trusting audience who he knows cannot separate the fiction surrounding his facts.

Image via Filipe Frazao / Shutterstock.

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The Hollywood Medical Reporter – Review of “Lucy” http://brainblogger.com/2014/08/31/the-hollywood-medical-reporter-review-of-lucy/ http://brainblogger.com/2014/08/31/the-hollywood-medical-reporter-review-of-lucy/#respond Sun, 31 Aug 2014 21:10:39 +0000 http://brainblogger.com/?p=17156 It’s been a long time since I’ve seen such a hard swing with such a loud miss. Lucy truly deserves an A for effort; and in the world of this film, effort probably does start with the letter A. After all, in the world of this movie, 1 plus 1 does not equal 2, life did not begin 3.5 billion years ago (only 1 billion), and dolphins use twice as much of their brains as humans. Oh, and cerebral metastasis (otherwise known as cancer) gets you high and gives you superpowers.

Now, despite what you may think, I highly recommend this film. For any of you who have not seen it, I promise, you are missing out on a once in a lifetime opportunity. It is a brilliant, postmodernist masterpiece that subverts any presumed universalities, through an incongruous combination of speculation, suppositions and searing bullshit.

Luc Benson’s Lucy (starring Scarlet Johansson in the title role) follows an American student in Taiwan. She quickly gets kidnapped by Korean gangsters who place an experimental, synthetic hormone inside her stomach, with the intent of making her a “drug mule.” The drug, called CPH4, winds up leaking into her bloodstream, allowing her to access 100% of her brain.

I went into this film expecting to experience a basic summer blockbuster fantasy film. Such films are not intended to provide an accurate science lesson. It would be silly to condemn Superman for not being realistic. Such films are supposed to live in a reality of their own creation and rules.

Lucy on the other hand, argues that Superman – or, rather, Super Lucy – does, or at least can, exist. Really. It makes a demonstrable effort to convince its audience that it is based on fact. Not inspired by or stemming from fact and not just within the rules of the film’s reality. This narrative decision paints Lucy not as a unique chosen hero endowed with fantastical abilities, but, rather, as a representation of the fully evolved human. We, the audience, are the un-evolved apes, meant to gaze in awe at what we actually are capable of. Lucy implies that real science would lead us to believe that its super-human lead character is absolutely possible. This irresponsible (not to mention ridiculous) approach, not only allows, but encourages viewers to believe that what they are watching is fact.

Fantasy/superhero/sci-fi movies are often set in our reality, to make the story appear more grounded. This is largely done only to contrast and heighten the awesome yet unreal elements of the fiction. Clark Kent is introduced as having been raised in Kansas, but once we transition to Superman, the story is set in the fictional American city of Metrolopis. Moreover, the character is clearly defined as an alien from the fictional planet Krypton. Unlike Lucy, Superman is not a representation of humanity’s untapped potential and true abilities. As such, it does not attempt to deceive the audience into really believing that what they see on the screen is scientifically accurate.

Sure, you can speculate freely in a sci-fi film. However, that speculation must at least have a basis in rationality. Take Star Wars, for example. Their reality has “midichlorians”, which are intelligent microscopic life forms that live symbiotically within cells. The more cells a person has that contain midicholorians, the more ability they have to sense the ubiquitous energy field known as “The Force”. Obviously, midichlorians do not actually exist. But that does not matter: they serve the purpose of helping to define and justify the fantasy world that makes up the film.

Lucy, however, uses real data from the real world to support fallacies. The manner in which it depicts futuristic speculations is not only inaccurate, but defies rationality.

Let me be clear, I do not mean Lucy is irrational. Rationality can typically be relative. Rational is when someone gives something meaning. Without personal understanding, someone can label a behavior meaningless and therefore irrational, while another person does see meaning, thus sees it as rational.

A psychological experiment known as the “ultimatum game” demonstrates the difference well. One person, labeled the Proposer, is given an amount of money – let’s say $10 – which he or she offers some portion of it to the other participant labeled the Responder. The Responder has two options: either accept the offer, allowing the Proposer to keep the rest of the total amount, or reject the offer and neither person gets anything. Experiments reveal that low offers (less than 20% of the total monetary sum) are regularly rejected.

Rationally speaking, the person should always take the offer. Regardless of how small the offer may be, it will always be more than the alternative of getting nothing. And yet, people commonly choose to take an indignant stance. Their actions are made out of spite towards the Proposer offering them less than what they want. Even though the Responder gets no money they take satisfaction in that the Proposer at least didn’t get more than they would have. This behavior is irrational, but does not defy rationality as it still has meaning. The meaning just happens to be fueled by emotion as opposed to logic.

Getting back to the point, Lucy defies even rational irrationality. It knowingly makes statements that are false, with no emotional or meaningful justification supporting that decision.

In point of fact, it is not the countless scientific inaccuracies that ruin the film. Fantasies of any kind can, and typically do, have a concept inconsistent with science. In order to successfully allow viewers to suspend their disbelief and relate to an alien premise, the story must reflect true human nature and resonate with the viewer. For this to happen, the story cannot rely on its concept alone, especially when that concept is blatantly absurd. As the film progresses, it must explore new narrative veins and develop characters.

Lucy does not evolve past its premise. It remains quite stagnant, for an action movie (adding another layer of nonsense causing you to question if it is all an elaborate prank of some kind.)

The main character of Lucy does not develop. In fact, the premise strips her of the ability to have any defining characteristics at all; it aims to demonstrate that she loses her humanity as she gains more use of her brain’s capabilities. We first learn that this is the cost Lucy must pay for her power in a scene where she talks on the phone with her mother. As a result of her increased cerebral abilities, she realizes that her humanity is fading away and this transformation cannot be reversed and will probably result in her death. This scene was particularly frustrating, because it highlights its wasted potential and poor decisions.

Firstly, we are reminded that we know little to nothing about Lucy the character. We do not even know her last name. Yes, I get the lack of a last name can allow for her to better encapsulate the “average girl.” The universal character who is at an age where she is trying to figure things out, but letting fun get in the way of that. However, we are provided less than a minute of what Lucy’s life is like before the drama begins. As such, we have no connection to her. This scene in particular was the moment to make the viewer relate with Lucy as something other than an empty vessel whose purpose is nothing more than a justification for showing the next shoot-up sequence. Instead, the scene reads like Proust on a very bad acid trip. In fact, the entire script reflects a tragic attempt at poignant postulation.

In addition to the writing, the directing and overall cinematic style revealed an embarrassing effort to shock and appear innovative. At the very beginning of the movie, Lucy waits nervously in a hotel lobby to deliver a package. The scene cuts back and forth to footage of a cheetah stalking, and then killing, an antelope. Cut back to Lucy, helpless and anxious. The bad guys soon enter the screen, kill someone, and kidnap Lucy. See? Lucy’s the antelope and the bad guys are the cheetah. For those of us only capable of accessing 10% of our brains, that is what sophisticated filmmakers call metaphorical imagery. However, in actuality, such gregarious use of this technique reflects the opposite of sophistication. It reveals a filmmaker with little faith in his own work. He does not trust that the audience will get his point without having it shoved in their faces.

While director Luc Besson has a tendency to use international settings for his films, they typically have a rationale behind the chosen location. Lucy is set in Taipei. Sure, we are told (but never really shown), she’s a student there. (Studying what? I couldn’t tell you, except that it could not have anything to do with the location since she does not speak a word of Taiwanese Mandarin Chinese.)

Why, then, are the bad-guy drug-lords Korean with one British business associate of some sort? None of the story requires Taipei, so why was it picked? Simply put, it looks kick-ass! The plethora of neon, bustling, noisy traffic, flashy Chinese signage, and the vibrant, colorful buildings is perfect for a sci-fi action thriller. But the background is not utilized to further the story, characters or theme. Like the pseudo-science splattered so seriously throughout the film, the background is superfluous: it could have just as well been Atlantic City. This is what particularly irked me about Lucy: so much of it, including the science, seemed random and untied to the characters. Overall the film felt sloppy, and, ironically thoughtless.

On the other hand, my complete befuddlement may be proof that I lack the cerebral acuity to appreciate a masterpiece ahead of its time.

Image via r.nagy / Shutterstock.

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The Hollywood Medical Reporter – Artistic License http://brainblogger.com/2014/08/26/the-hollywood-medical-reporter-artistic-license/ http://brainblogger.com/2014/08/26/the-hollywood-medical-reporter-artistic-license/#respond Tue, 26 Aug 2014 11:00:48 +0000 http://brainblogger.com/?p=16863 What is more important, for a show to be compelling or medically accurate? The answer is not simple.

I certainly believe that absurd inaccuracies in medical dramas, as I discussed in last week’s post on House M.D, have helped produce a public that is tragically and dangerously misinformed. However, I know we must not lose sight of the true purpose these entertainments have. House does not purport to be a factual medical source. It is meant to entertain. Nevertheless, regardless of the shows intention, it must be held responsible for any negative effect it has.

That said, the medical inaccuracies in House were not my big problem with the show. Rather, it was the laughably formulaic structure and overall poor screenwriting choices. It is not the inaccuracies themselves that I took issue with, it was how they were used.

One of the most notable inaccuracies the public has absorbed from television relates to cardiopulmonary resuscitation (CPR). Many studies have shown that television shows drastically sway the public’s understanding on how effective CPR is.

For example, a 2008-2009 study monitored four weekly television shows including: Casualty, Holby City and Grey’s Anatomy. A total of 76 cardio-respiratory arrests and 70 resuscitation attempts were displayed in the reviewed shows. Of the 70 attempts, 46% had an immediate survival rate. In reality, while immediate survival rates are around 40-47%, only 10-21% survive past hospital discharge. These and most all other television shows rarely bother to give screen time to show whether or not a patient made it past CPR.

Now, does this mean I believe that every portrayal of CPR on television must be absolutely realistic? Obviously not. Complete accuracy in television or film should not be suggested if only for the fact that it is impossible to attain.

However, correct and responsible use of CPR (and other things of the like) within a given narrative is what makes any story effective and displays an understanding of their medium’s power to influence. No film or television show can play ignorant to the demonstrable fact that they play a significant role in increasing society’s inaccurate understandings and conceptions that can and do lead to dangerous choices.

Facts that lie at the center and give support to the narrative as a whole must come from a truthful place.

However… On the other hand, if some facts are incidentally used as a plot device to make note of a character trait, or help move the story along without lending much focus to the fact itself, then medical accuracy can legitimately take a backseat to artistic license.

Take Showtime’s Nurse Jackie. Created by Liz Brixius, Linda Wallem and Evan Dunsky, the show stars Edie Falco. Like Dr. House, Jackie has a fondness for narcotic painkillers. Other than also being set in a hospital, I believe the similarities stop there.

In episode two, season one, we see Nurse Jackie step out of the hospital. She sees a recently released patient in a wheelchair failing to get a taxi. Jackie goes over to a taxi she sees, barely ten feet away. She bangs on the window as she yells: “What the f***? Are you gonna pretend you didn’t see her sitting there? It’s your goddamn job.”

Jackie sees that the taxi driver is struggling for air and clearly in need of medical attention. Upon seeing this she begrudgingly pulls the driver out and administers CPR on him. With even more irritation, she begrudgingly gives him her last pill of the day (which she was saving for herself) in order to help with the pain she knows he must be having.

In this example, CPR has no focal point to the story. It is used solely as a mechanism to reveal information about the main character – which, while always important, is even more crucial here, as this is only the second episode – and to move the story forward as well as provide some comic relief. The viewer pays little, if any attention to the CPR itself. Rather, what stands out to us is the fact that this character, when presented with a man in need of her help, her first reaction – which she did not care to hide – was that of annoyance. We are being told this character has the capacity to do the right thing, but really does not want to. As such, the long-term result of the CPR is irrelevant. Its role is no more significant that that of the non-recurring EMT actor who wheels in a sick boy at the beginning of the episode.

Now let us examine an episode of House M.D that uses CPR. In the season finale of season three, House treats Marina, a young woman who fell ill after escaping from Cuba. Well into the story, House orders a cardiac catheterization because Marina’s PET scan revealed a blood clot, and any clot ultimately relates back to the heart. During the catheterization, Marina’s heart rate shoots up, then quickly flat-lines. House administers CPR on Marina, then places her on a cardiopulmonary bypass machine (the same point of CPR, this pump takes over the heart’s pumping action) which they keep her on for the next 3 hours. House takes her off the machine. Marina instantly and miraculously shows a normal healthy heart rhythm.

In this example, CPR was essential to the plot itself, and not simply a device. The CPR was employed as an element of the narrative to show what House’s decisions were for the case and how he ended up saving the patient. If it were not for this remarkable and ridiculously unethical and incorrect use of CPR we would not be so amazed at House’s genius and relieved at his client’s survival. Because the culmination of the entire episode is that House’s medical efforts succeed and the patient lives to walk out of the hospital, the effectiveness of the CPR is highlighted to the viewer. This absurd and irresponsible portrayal of CPR impresses upon the average viewer’s understanding of CPR.

Going back to my opening question – whether a show should be medically accurate or compelling – I would think it foolish to argue one is more important than the other. Instead, we should ask ourselves why each is important.

More and more reputable scientific/academic studies constantly reveal the growing power the media has on viewer’s understanding and subsequent actions. As such, their screenwriting and production choices carry great weight. For example, the choice to use gritty medical details in both dialogue and cinematic techniques draws attention to the medical facts themselves (regardless if they are accurate or not) and maks these “facts” a crucial element that the entire narrative relies upon. These choices are meant specifically to gain trust from the viewer which can be used to decieve.

An issue so complex, impactful and significant as health care, must demand responsible handling even when portrayed through a creative lens.

Image via sfam_photo / Shutterstock.

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The Hollywood Medical Reporter – House M.D http://brainblogger.com/2014/08/14/the-hollywood-medical-reporter-house-m-d/ http://brainblogger.com/2014/08/14/the-hollywood-medical-reporter-house-m-d/#respond Thu, 14 Aug 2014 11:00:32 +0000 http://brainblogger.com/?p=16860 Unless you’ve been distracted by an opiate-induced cloud, you’ll be familiar with Dr. Gregory House and his Sherlock Holmes-like ability to riddle his way through a web of peculiar symptoms to find the right, and usually unbelievable, diagnosis.

By season three (out of eight, spanning from 2004-2012), House M.D had reached its peak Nielson rating with an average of 19.4 million viewers and ranked 5th out of the entire U.S. television market. Even as the show’s ratings began to slip by season five, it remained Fox’s most popular show after American Idol.

I liked the show mainly as background noise, or what is sometimes to referred to as a “household soundtrack.” Snarky witticisms and sexual banter proved to be the perfect sounds to mindlessly distract myself from mundane chores. It is a formulaic show, one that you can start watching at any point in the series (or within a given episode for that matter) without missing anything of substance.

House, like many, if not most, procedural dramas, has a very precise recipe that guarantees satisfaction.

We begin with the tantalizing teaser. Terminal Jill (AKA whoever the guest patient of the week is), suddenly falls to the ground after sneaking out to meet her bad-boy boyfriend.

After the dramatically haunting opening credits roll we enter the hospital where Dr. House greats us with his lovely scowl and some Vicodin. He interrupts Wilson – who was just in the middle of both treating and falling in love with his dying female patient – to “borrow” a thousand dollars and promise to stop making prank police reports under Wilson’s name.

Before you can ask yourself why the hell Wilson is his friend, House explains that the reason he cannot take Terminal Jill on as a patient is because he must first solve the mystery of why Cuddy’s skirt shows no visible panty-lines. Cuddy agrees to cut House’s clinic hours if he agrees to treat the patient.

House and his team go over Terminal Jill’s symptoms on the white-erase board. They all disagree on a diagnosis, but know it is not lupus. House orders some expensive and invasive tests.

House says, even though he hasn’t met her yet, Terminal Jill is lying about something. House tells Foreman that since he is black he should be the one to break into Terminal Jill’s house and search for clues.

Cameron, Chase and Foreman’s pagers all go off at once. They rush to Terminal Jill’s bedside. Terminal Jill seizes violently as she proceeds to vomit everywhere. Terminal Jill’s mother fearfully asks Cameron what this means. Cameron slowly turns to the mother and says: “It means it’s not asthma.” We fade to commercial.

We return to see House ignoring Cuddy as she yells at him for ordering a dozen costly tests and procedures without getting permission. In fact, not only has Terminal Jill fallen into a coma, but also her parents are threatening to sue the hospital.

House sees a woman carrying a baby out of the corner of his eye. Now he’s got it!

House reveals that Terminal Jill has acute disseminated encephalomyelitis. He explains that he knew Terminal Jill was lying about not having a job when he saw the watch her boyfriend was wearing and assumed she bought it for him as a 3 month anniversary gift. She obviously acquired this as a result of an immunization shot that she got in order to start a babysitting job that she lied to her parents about because they are the leaders of the anti-immunization movement in town… see? Everyone lies, but the House always wins.

Forget for a second whether or not the diseases are real or procedures and tests were accurate. Sure, House has medical inaccuracies; in fact it is full of them. But before I bore you with a list, lets first look at the manner in which House came to his brilliant diagnosis, and his general actions along the way.

No, it is not his fondness of narcotics I care about.

House’s hunt for a rare disease and administration of numerous expensive tests and painful procedures labels him, what is known in the medical lexicon as a “zebra hunter.” Essentially, this is when a doctor ignores the first lesson taught in med school for identifying diseases, “When you hear hoof beats, think horses, not zebras.” Meaning, “common things are common.”

While it is possible for a patient to have a rare disease that presents itself in an unusual manner, it not possible for a single doctor to harbor all the knowledge necessary to rule out all common and rare conditions possible and confidently come to the correct diagnosis.

The illusion of the all-knowing zebra-hunting doctor is quite dangerous. Many doctors, including Dr. Scott Morrison, a family physician who reviewed the show on his own blog, report how more and more patients come in saying they think they have a disease they saw on House.

Such patients demand the same series of obscure tests they saw on the show. Morrison says this is just one example of the “House effect” putting him and other doctors in a bad situation. Not only are ill-informed patients self-diagnosing, they come in with unrealistic notions and expectations. This misunderstanding of the true limits of modern medicine can not only crush one’s expectations for a miracle, but also prove unnecessarily expensive.

Image via WOLF AVNI / Shutterstock.

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The Hollywood Medical Reporter – Medics in the Media http://brainblogger.com/2014/08/02/the-hollywood-medical-reporter-medics-in-the-media/ http://brainblogger.com/2014/08/02/the-hollywood-medical-reporter-medics-in-the-media/#respond Sat, 02 Aug 2014 11:00:33 +0000 http://brainblogger.com/?p=16857 In 1984 Vicks aired a commercial for their new Formula 44 cough syrup. The spokesperson, Dr. Rick Webber gave a glowing recommendation for the product. The reason this commercial is so memorable: there was no Dr. Rick Webber.

It was actually an actor, Chris Robinson, who played Dr. Rick Webber on the daytime drama General Hospital. The commercial opened with the now famous line: “I’m not a doctor, but I play one on TV.”

This was not the first, and certainly will not be the last, example of direct-to-consumer (DTC) advertising for a medical product. In fact, DTC ads have been among the most controversial, and impactful, by-products of the media’s reach.

The images of medical professionals have been used to sell products for years. Some of the most notorious examples of this practice have been the use of doctors (or the images of doctors) in cigarette advertisements. The 1950 Camel commercial “What Cigarette Do you Smoke, Doctor?” contends a survey showing that doctors of all stripes preferred Camels. We are shown images of physicians in surgery, in front of a hospital, at their desks… all puffing away happily. And then, as if to drive home the point, we are shown a checklist of all medical professionals – surgeons, diagnosticians, general practitioners, and so on.

In 1970, the government passed the Public Health Cigarette Smoking Act after seeing the overwhelming statistics that showed cigarette advertisements significantly increased cigarettes sales and, with that, disease and death.

DTC advertisements are, by definition, blatant in their intent and targeted influence. It may therefore be difficult to accuse them of subliminal manipulation. However, there has been a distinct shift in how television influences the medical world. Today it is the indirect advertisements that are just as influential – if not more so – than your basic commercial.

Television and movie narratives have a unique capability to connect with viewers on a powerful level. As such, dramatic depictions of medical scenarios can offer an even stronger effect on audiences than documentaries and medical journals. They are designed to evoke emotional and sensory responses on a visceral, even unconscious level.

Examples of subtle medical/scientific inaccuracies, intentional or not, in film and television are endless. One of the most impactful is the depiction of cardiopulmonary resuscitation (CPR). While so many film and television shows use CPR with immediate great success, in reality, only 10-21% of people survive past hospital discharge after being revived with CPR.

Medical shows frequently have indirect consumer advertisements, typically when a character, usually a doctor, gives a not so subtle shout out for a particular medication (see my review for Black Box “Kiss the Sky” episode for a specific example). Some programs go as far as to have “doctors” give detailed arguments for why their choice of prescription drug is the best.

While I obviously wag my finger at those types of manipulations, I am not quite as irked as when a story’s core relies on medical inaccuracies. I hate myself for using the following example with this particular show (which I love)… but I feel I must.

Aaron Sorkin’s The West Wing portrayed the character of President Bartlet, (Martin Sheen) as having multiple sclerosis (MS). To its credit, the show did certainly attempt to not simply use the topic of MS as a mere plot device. In a 2000 episode, the President, with a fever of 103, passes out, breaking a priceless glass pitcher.

In reality, fever is not a true risk for those with MS. Nevertheless, in this dramatic scene, the President’s wife, physician and staff rush to the President’s aid and we are told how life threatening a fever can be for someone with MS. The creation of mood and depiction of character and illness is dramatically vivid. As such, the issues discussed in the scene (i.e the nature and symptoms of MS) can unconsciously resonate as quite truthful to the viewer, despite the fact that they have been funneled through a creative lens that has distorted medical truths.

Countless other television shows and films employ this dramatic tactic: explicitly depicting medical symptoms and/or procedures to give the impression of truthfulness. They use gory details to make it look real, honest and accurate. Then they throw in facts, statistics and socioeconomic issues about the illness, to make it appear as if the explanation is as “truthful” as the bloody depiction of the illness or treatment. This technique heightens the verisimilitude of the drama, and shapes it as not only factual, but objective.

Some argue that endeavors to incorporate health messages, subtle or otherwise, are intended to positively educate and inform. Leaving aside the history of Hollywood’s objectives (like a bear is constantly looking for its next meal, some would argue that Hollywood is constantly looking for its next dollar), one thing is incontestable: the entertainment world’s use of the medical field has little monitoring or oversight.

The unfortunate byproduct has resulted in a misinformed society.

Like it or not, television is arguably the primary source for public health education today. In 2000, the Centers for Disease Control and Prevention conducted a survey of prime time television viewers and found 52% trusted medical/health information they receive from prime time programming to be accurate. One in four (26%) said that television shows were among their top three sources for health/medical information. 90% claimed to learn something about diseases, which in turn, affected their health care decisions. A staggering 48% claimed that a television show about a health issue would affect their real life medical decisions in one or more ways; this included a willingness to relate their TV-acquired knowledge to others.

These statistics are alarming, considering how drama tends to trump accuracy in the entertainment media. One of the ways to change negative impact that inaccurate messages give is forums like this, to make viewers more sensitive to how they are being manipulated.

Image via gpointstudio / Shutterstock.

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The Hollywood Medical Reporter – To Care or Not to Care? http://brainblogger.com/2014/07/24/the-hollywood-medical-reporter-to-care-or-not-to-care/ http://brainblogger.com/2014/07/24/the-hollywood-medical-reporter-to-care-or-not-to-care/#respond Thu, 24 Jul 2014 11:00:45 +0000 http://brainblogger.com/?p=16855 The Hollywood Medical Reporter’s purpose is to examine the influence that film and television has had, and continues to have, on the medical conscious of society. It will do so using a perspective of medical proficiency and media expertise. The first question you may ask is: why?

In my introductory post, I touched on the fact that the industry is filled with screenwriters who write about doctors, nurses, hospitals and medical conditions. Most of these writers (both aspiring and professional) have not gone to medical school, and do not have available adequate consultation by professionals. As a result, these writers can – and frequently do – fill our television and movie screens, as well as our minds, with medical inaccuracies.

But why should we care?

To be fair, the stuff we’re talking about is intended to be, first and foremost, entertainment. Or at least that is the typical heading given. I would guess that, when asked the question, “Do you care or do you not care about medical inaccuracies in film and television?” the average viewer would respond with a resounding “hell no!”

After all, one of the primary reasons people turn to film and television is to escape reality, particularly realities involving their own medical conditions. Frequently, illness and treatments cause true misery. The entertainment media has always been a vehicle to help people escape from reality. (Just look at the very healthy movie ticket sales during the Great Depression!)

There are those who argue that certain channels of media, such as news articles or even current affair shows on television, may affect their audience’s beliefs and actions relating to health care and medicine… But how can a sitcom or TV drama have the same affect? People know not to take them seriously, don’t they?

However, this argument presupposes that viewers are able to distinguish fact from fiction in whatever they may be watching.

Let me be clear: to say that many of us lack this ability is not a statement about our intelligence. Rather, it is an acknowledgement of what the entertainment media has been expert at since its inception: the business of affecting what we think and how we feel.

If presented with a scene where a surgeon asks for a certain tool in the middle of surgery, then stops, pulls off his surgical mask and kisses the nurse beside him, most would instinctively perceive this as unrealistic. However, few of us would ever stop to think whether or not the surgical tool the surgeon has asked for is the right tool to use. Or if it’s a real tool to begin with. Or if the type of surgery being conducted is accurately portrayed.

While most viewers are not watching a show to learn about such things, whether they like it or not, they will leave it with certain pieces of information that have been internalized on conscious and/or subconscious levels.

This is simply how the brain works. And it’s how entertainment works.

In order to be effective on any level, a film or television show must resonate with viewers. Even in the most fantastical of fictional universes, there is an allusion of truth that must be created so viewers can relate and continue to watch. Despite being set “long ago, in a galaxy far, far away,” Star Wars continues to connect with audiences. This is because of its ability to insert relatable, real life human emotions into a world filled with death stars, self-aware robots and a wise, green Furbee/Pikachu who speaks in anastrophe.

The familiar, timeless battle between good and evil and the painful relationship of a father abandoning his son are examples of relatable conflicts that serve as a bridge from reality to a fictional world in the Star Wars films. They use pieces of reality to seduce you into a willing suspension of disbelief. In other words, they manipulate you into believing things – at least temporarily – that you know are not to be believed. But this is a fantasy, and the filmmakers and the audiences are all in on the game.

Many, if not most, medical dramas make no such effort to distinguish itself as fiction. On the contrary, they use the “reality” of relatable medical conditions to give weight to the drama.

In 2002, the Henry J. Kaiser Family Foundation issued a report that attempted to quantify the effect of the television drama ER’s health content. More than 35,000 regular ER viewers were surveyed between March 1997 and April 2000. The survey found that a bit more than half said they spoke with family and friends about health issues based on how those issues were portrayed on the show. One-third said that the show actually influenced their choices relating to their own, or their family’s health care decisions.

These disturbing findings highlight the power and influence that popular entertainments can have on society.

That’s why this topic is important. That’s why we need to look more carefully at how health care is being portrayed, and what influence it may have on us.

And so, to quote the bard: Medical accuracy in media…

…To care or not to care? That is the question.

Yes.

That is the answer.

I’ll go into further detail about this next week. And I promise… no more lame Shakespeare references.

Image via Fer Gregory / Shutterstock.

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