Tag: media outlets

Plenty of People Could Quit Therapy Right Now

[ad_1]

About four years ago, a new patient came to see me for a psychiatric consultation because he felt stuck. He’d been in therapy for 15 years, despite the fact that the depression and anxiety that first drove him to seek help had long ago faded. Instead of working on problems related to his symptoms, he and his therapist chatted about his vacations, house renovations, and office gripes. His therapist had become, in effect, an expensive and especially supportive friend. And yet, when I asked if he was considering quitting treatment, he grew hesitant, even anxious. “It’s just baked into my life,” he told me.

Among those who can afford it, regular psychotherapy is often viewed as a lifelong project, like working out or going to the dentist. Studies suggest that most therapy clients can measure their treatments in months instead of years, but a solid chunk of current and former patients expect therapy to last indefinitely. Therapists and clients alike, along with celebrities and media outlets, have endorsed the idea of going to therapy for extended stretches, or when you’re feeling fine. I’ve seen this myself with friends who are basically healthy and think of having a therapist as somewhat like having a physical trainer. The problem is, some of the most commonly sought versions of psychotherapy are simply not designed for long-term use.

Therapy comes in many varieties, but they all share a common goal: to eventually end treatment because you feel and function well enough to thrive on your own. Stopping doesn’t even need to be permanent. If you’ve been going to therapy for a long time, and you’re no longer in acute distress, and you have few symptoms that bother you, consider taking a break. You might be pleasantly surprised by how much you learn about yourself.

Therapy, in both the short and long term, can be life-altering. Short-term therapy tends to be focused on a particular problem, such as a depressed mood or social anxiety. In cognitive behavioral therapy, usually used for depressive and anxiety disorders, a clinician helps a client relieve negative feelings by correcting the distorted beliefs that he has about himself. In dialectical behavior therapy, commonly used to treat borderline personality disorder, patients learn skills to manage powerful emotions, which helps improve their mood and relationships. Both treatments typically last less than a year. If you start to get rusty or feel especially challenged by life events that come your way, you simply return for another brief stint. Termination is expected and normal.

Read: What’s the smallest amount of therapy that’s still effective?

Some types of therapy, such as psychodynamic therapy and psychoanalysis, are designed to last for several years—but not forever. The main goal of these therapies is much more ambitious than symptom relief; they aim to uncover the unconscious causes of suffering and to change a client’s fundamental character. At least one well-regarded study found that long-term therapy is both highly effective and superior to briefer treatment for people diagnosed with a clinically significant psychiatric illness; other papers have shown less conclusive evidence for long-term therapy. And few studies compare short and extended treatment for clients with milder symptoms.

In fact, there’s reason to believe that talk therapy in the absence of acute symptoms may sometimes cause harm. Excessive self-focus—easily facilitated in a setting in which you’re literally paying to talk about your feelings—can increase your anxiety, especially when it substitutes for tangible actions. If your neurotic or depressive symptoms are relatively mild (meaning they don’t really interfere with your daily functioning), you might be better served by spending less time in a therapist’s office and more time connecting with friends, pursuing a hobby, or volunteering. Therapists are trained to use the tools they’ve learned for certain types of problems, and many of the stress-inducing minutiae of daily life are not among them. For example, if you mention to your therapist that you’re having trouble being efficient at work, he might decide to teach you a stress-reduction technique, but your colleagues or boss might provide more specific strategies for improving your performance.

One of my childhood friends, whose parents were both psychoanalysts, went to weekly therapy appointments while we were growing up. He was a happy, energetic kid, but his parents wanted him and his sister to be better acquainted with their inner lives, to help them deal with whatever adversity came their way. My friend and his sister both grew up to be successful adults, but also highly anxious and neurotic ones. I imagine their parents would say the kids would have been worse without the therapy—after all, mental illness ran in their family. But I can find no substantial clinical evidence supporting this kind of “preventive” psychotherapy.

Read: What it’s like to visit an existential therapist

Beginning therapy in the first place is, to be clear, a privilege. Therapy is not covered by many insurance plans, and a very large number of people who could benefit from it can’t afford it for any duration. Only 47 percent of Americans with a psychiatric illness received any form of treatment in 2021; in fact, federal estimates suggest that the United States is several thousand mental-health professionals short, a gap that is likely to grow in the coming years. Stopping therapy when you’re ready opens up space for others who might need this scarce service more than you do.

I do not mean to suggest that a therapy vacation should be considered lightly, or that it’s for everyone. If you have a serious mental-health disorder, such as major depression or bipolar disorder, you should discuss with your mental-health provider whether ending therapy is appropriate for your individual situation. (Keep in mind that your therapist might not be ready to quit when you are. Aside from a financial incentive to continue treatment, parting with a charming, low-maintenance patient is not so easy.) My rule of thumb is that you should have minimal to no symptoms of your illness for six months or so before even considering a pause. Should you and your therapist agree that stopping is reasonable, a temporary break with a clear expiration date is ideal. At any time, if you’re feeling worse, you can always go back.

Psychiatrists do something similar with psychiatric meds: For example, when I prescribe a depressed patient an antidepressant, and then they remain stable and free of symptoms for several years, I usually consider tapering the medication to determine whether it’s still necessary for the patient’s well-being. I would do this only for patients who are at a low risk of relapse—for example, people who’ve had just one or two episodes, rather than many over a lifetime. Pausing therapy should be even less risky: The beautiful thing about therapy is that, unlike a drug, it equips you with new knowledge and skills, which you carry with you when you leave.

Read: The quick therapy that actually works

About a year after my patient and I first talked about ending therapy, I ran into him in a café. He told me that stopping had taken him six months, but now he was thriving. Maybe you, like my patient, are daunted by the idea of quitting cold turkey. If so, consider taking a vacation from treatment instead. It might be the perfect way to see how far you’ve really come.

[ad_2]

Richard A. Friedman

Source link

February 5, 2024
The Republican Lab-Leak Circus Makes One Important Point

[ad_1]

For more than three hours yesterday, the House Select Subcommittee on the Coronavirus Pandemic grilled a pair of virologists about their participation in an alleged “cover-up” of the pandemic’s origins. Republican lawmakers zeroed in on evidence that the witnesses, Kristian Andersen and Robert Garry, and other researchers had initially suspected that the coronavirus spread from a Chinese lab. “Accidental escape is in fact highly likely—it’s not some fringe theory,” Andersen wrote in a Slack message to a colleague on February 2, 2020. When he laid out the same concern to Anthony Fauci in late January, that some features of the viral genome looked like they might be engineered, Fauci told him to consider going to the FBI.

But days later, Andersen, Garry, and the other scientists were starting to coalesce around a different point of view: Those features were more likely to have developed via natural evolution. The scientists wrote up this revised assessment in an influential paper, published in the journal Nature Medicine in March 2020, called “The Proximal Origin of SARS-CoV-2.” The virus is clearly “not a laboratory construct or a purposefully manipulated virus,” the paper said; in fact, the experts now “did not believe that any type of laboratory-based scenario is plausible,” and that the pandemic almost certainly started with a “zoonotic event”—which is to say, the spillover of an animal virus into human populations. That analysis would be cited repeatedly by scientists and media outlets in the months that followed, in support of the idea that the lab-leak theory had been thoroughly debunked.

The researchers’ rapid and consequential change of heart, as revealed through emails, witness interviews, and Slack exchanges, is now a wellspring for Republicans’ suspicions. “All of a sudden, you did a 180,” Representative Nicole Malliotakis of New York said yesterday morning. “What happened?”

Based on the available facts, the answer seems clear enough: Andersen, Garry, and the others looked more closely at the data, and decided that their fears about a lab leak had been unwarranted; the viral features were simply not as weird as they’d first thought. The political conversation around this episode is not so easily summarized, however. Yesterday’s hearing was less preoccupied with the small, persistent possibility that the coronavirus really did leak out from a lab than with the notion of a conspiracy—a cover-up—that, according to Republicans, involved Fauci and others in the U.S. government swaying Andersen and Garry to leave behind their scientific judgment and endorse “pro-China talking points” instead. (Fauci has denied that he tried to disprove the lab-leak theory.)

Read: If the lab-leak theory is right, what next?

Barbed accusations of this kind have only added headaches to the question of how the pandemic really started. For all of its distractions, though, the House investigation still serves a useful purpose: It sheds light on how discussions of the lab-leak theory went so very, very wrong, and turned into an endless, stultifying spectacle. In that way, the hearing—and the story that it tells about the “Proximal Origin” paper—gestures not toward the true origin of COVID, but toward the origin of the origins debate.

From the start, the problem has been that a “lab leak” could mean many things. The term may refer to the release of a manufactured bioweapon, or to an accident involving basic-science research; it could involve a germ with genes deliberately inserted, or one that was rapidly evolved inside a cage or in a dish, or even a virus from the wild, brought into a lab and released by accident (in unaltered form) in a city like Wuhan. Yet all these categories blurred together in the early days of the pandemic. The confusion was made plain when Senator Tom Cotton of Arkansas, a hard-core China hawk, aired a proto-lab-leak theory in a February 16, 2020 interview with Fox News. “This virus did not originate in the Wuhan animal market,” he told the network. He later continued, “just a few miles away from that food market is China’s only biosafety-level-4 super-laboratory that researches human infectious diseases. Now, we don’t have evidence that this disease originated there, but because of China’s duplicity and dishonesty from the beginning, we need to at least ask the question.”

Cotton did not specifically suggest that the Chinese “super-laboratory” was weaponizing viruses, nor did he say that any laboratory accident would necessarily have involved a genetically engineered virus, as opposed to one that had been cultured or collected from a bat cave. Nevertheless, The New York Times and The Washington Post reported that the senator had repeated a “fringe theory” about the coronavirus that was going around in right-wing circles at the time, that it had been manufactured by the Chinese government as a bioweapon. It was hard for reporters to imagine that Cotton could have been suggesting anything but that: The idea that Chinese scientists might have been collecting wild viruses, and doing research just to understand them, was not yet thinkable in that chaotic, early moment of pandemic spread. “Lab leak” was simply understood to mean “the virus is a bioweapon.”

Scientists knew better. On the same day that Cotton gave his interview, one of Andersen and Garry’s colleagues posted the “Proximal Origin” paper on the web as an unpublished manuscript. (“Important to get this out,” Garry wrote in an email sent to the group the following morning. He included a link to the Washington Post article about Cotton described above.) In this version, the researchers were quite precise about what, exactly, they were aiming to debunk: The authors said, specifically, that their analysis clearly showed the virus had not been genetically engineered. It might well have been produced through cell-culture experiments in a lab, they wrote, though the case for this was “questionable.” And as for the other lab-leak possibilities—that a Wuhan researcher was infected by the virus while collecting samples from a cave, or that someone brought a sample back and then accidentally released it—the paper took no position whatsoever. “We did not consider any of these scenarios,” Andersen explained in his written testimony for this week’s hearing. If a researcher had indeed been infected in the field, he continued, then he would not have counted it as a “lab leak” to begin with—because that would mean the virus jumped to humans somewhere other than a lab.

Read: There is no evidence strong enough to end the pandemic-origins debate

Rather than settling the matter, however, all this careful parsing only led to more confusion. In the early days of the pandemic, and in the context of the Cotton interview and its detractors, too much specificity was deemed a fatal flaw. On February 20, Nature decided to reject the manuscript, at least partly on account of its being too soft in its debunking. A month later, when their paper finally did appear in Nature Medicine, a new sentence had been added near the end: the one discounting “any type of laboratory-based scenario.” At this crucial moment in the pandemic-origins debate, the researchers’ original, narrow claim—that SARS-CoV-2 had not been purposefully assembled—was broadened to include a blanket statement that could be read to mean the lab-leak theory was wrong in all its forms.

Over time, this aggressive phrasing would cause problems of its own. At first, its elision of several different possible scenarios served the mainstream narrative: We know the virus wasn’t engineered; ergo, it must have started in the market. More recently, the same confusion has served the interests of the lab-leak theorists. Consider a report from the Office of the Director of National Intelligence on pandemic origins, declassified last month. American intelligence agencies have determined that SARS-CoV-2 was not developed as a bioweapon, it explains, and they are near-unanimous in saying that it was not genetically engineered. (This confirms what Andersen and colleagues said in the first version of their paper, way back in February 2020.) “Most” agencies, the report says, further judge that the virus was not created through cell-culture experiments. Yet the fact that two of the nine agencies nonetheless believe that “a laboratory-associated incident” of any kind is the most likely cause of the first human infection has been taken as a sign that all lab-leak scenarios are still on the table. Thus Republicans in Congress can rail against Facebook for removing posts about the “lab-leak theory,” while ignoring the fact that the platform’s rules only ever prohibited one particular and largely discredited idea, that SARS-CoV-2 was “man-made or manufactured.” (In any case, that prohibition was reversed some three months later.)

Where does this leave us? The committee’s work does not reveal a cover-up of COVID’s source. At the same time, it does show that the authors of the “Proximal Origin” paper were aware of how their work might shape the public narrative. (In a Slack conversation, one of them referred to “the shit show that would happen if anyone serious accused the Chinese of even accidental release.”) At first they strived to phrase their findings as clearly as they could, and to separate the strong evidence against genetic engineering of the virus—and what Garry called “the bio weapon scenario”—from the lingering possibility that laboratory science might have been involved in some other way. In the final version of their paper, though, they added in language that was rather less precise. This may have helped to muffle the debate in early 2020, but the haze it left behind was noxious and long-lasting.

[ad_2]

Daniel Engber

Source link

July 12, 2023
Now Is the Perfect Time to Role-Play a Pandemic

[ad_1]

In October 2019, just a few months before a novel coronavirus sparked a deadly pandemic, a group of government officials, business leaders, and academics convened in New York City to role-play a scenario in which a novel coronavirus sparked a deadly pandemic. Their imagined virus leaped from livestock to farmers in Brazil, then spread to Portugal, the United States, and China. Soon, it was everywhere. Eighteen months later, 65 million people were dead.

This simulation, known as Event 201, was one of dozens of so-called pandemic war games run in the two decades leading up to the outbreak of COVID-19. In mid-2020, as the world came to terms with its new pandemic reality, media outlets published a flood of articles about these simulations. Some highlighted their prescience, others their blind spots. But the real-world crisis that occasioned this review was only a few months old. Whatever hindsight it provided wasn’t yet in focus, because many of the greatest challenges of the pandemic—new variants, vaccine hesitancy, the hyper-politicization of public health—were still to come.

Almost three years later, we know that the war-gamers whiffed on many of these longer-term outcomes. Pre-pandemic role-plays successfully predicted early events like the overwhelming of the nation’s hospitals, ineffective travel bans, and a lack of coordination across levels of government. But they underestimated the significance of masking policies, the speed at which vaccines would be developed, and the politicized backlash to those interventions. They also failed to account for cascading viral evolution, and did not grasp how long such a crisis could last. “The scenario ends at the 18-month point,” the makers of Event 201 wrote. “The pandemic is beginning to slow due to the decreasing number of susceptible people. The pandemic will continue at some rate until there is an effective vaccine or until 80–90% of the global population has been exposed.” If only.

Read: The next plague is coming. Is America ready?

War-gamers are trying to learn from their mistakes. Long before any public-health authority had declared the acute phase of the pandemic over, officials were already playing out fresh scenarios that better fit the facts. At the Munich Security Conference in February 2022, for example, the Johns Hopkins Center for Health Security helped run an exercise focused on rapid development and equitable distribution of vaccines for an imagined future virus, Tom Inglesby, the center’s director, told me. Later that year, at an annual meeting convened in Brussels by the WHO and the Bill & Melinda Gates Foundation, the same group ran a simulation in which current and former foreign ministers had to grapple with the threats of misinformation and resistance to non-pharmaceutical interventions. Unlike pre-pandemic war games, this one also took into account governments’ attitudes toward expert public-health advice.

Accounting for the specific facts of the coronavirus pandemic could make future war games more realistic, experts told me, but it won’t ensure that they have substantive value. These exercises are not meant to predict what will happen in the next pandemic, so much as to prepare for what might happen. Bringing games into alignment with recent experience matters only insofar as it conduces to the latter.

War-gamers often draw a distinction between tabletop exercises and functional exercises. In the former, participants sit around discussing what they would do in a given scenario; in the latter, participants actually do it. They might transport stockpiled resources, distribute personal protective equipment, or care for pretend patients at a hospital. The Pentagon moves real forces around the world as part of its simulations. This real-world practice is sorely needed for pandemic scenarios, too, says Jennifer Nuzzo, the director of Brown University’s Pandemic Center. “When I look back at COVID, many of the failings stemmed from the fact that we didn’t functionally exercise enough of the capacities that we supposedly had.”

Pandemic exercises could also be made more challenging, Inglesby said. Too many are set up to prevent participants from feeling demoralized, he said, as opposed to “exercising to the point of failure.” This principle can be taken too far, though, Nuzzo told me. If the exercise is too intense, people get overwhelmed and disengage. Real pandemics, of course, are highly overwhelming, but if you’re trying to train someone to bench-press their weight, you can’t just drop a 200-pound barbell on their chest and shout “Go!” They have to build up strength over time.

Read: The boardgames that ask you to reenact colonialism

Coming through an actual pandemic is a form of training, too, but that experience doesn’t make war games useless. In fact, they may be more important now than ever, experts told me. Before COVID, pandemic role-plays were meant in part to raise awareness—to show participants and the public alike that a pandemic could really happen. Now, obviously, few people need to be persuaded of the risk. Post-COVID, the exercises serve a very different function: They remind us that the next pandemic might look nothing like the one we’ve just experienced. It could have a far higher case-fatality rate. It could disproportionately sicken children rather than the elderly. Its symptoms could be neurological instead of respiratory. “Just having lived through COVID doesn’t prepare us for all future events,” Inglesby said. Experience is an infinitesimal sliver of possibility.

We try, through war games, to internalize this. It is not always easy. Event 201 notwithstanding, pandemic simulations have traditionally focused too much on influenza and not enough on other pathogens, perhaps because of how many outbreaks the former has caused in the past. It would be just as wrong to focus only on coronaviruses now, and leave influenza behind. At the simulation in Brussels, Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security, told me, some participants struggled not to default to recent memory: “They kept coming back to, ‘Well, in COVID we did this,’ or ‘In COVID we did that.’” It’s a delicate balance to strike: to learn from experience without being constrained by it.

[ad_2]

Jacob Stern

Source link

May 30, 2023
The Inflated Risk of Vaccine-Induced Cardiac Arrest

[ad_1]

During this week’s Monday Night Football game, the 24-year-old Buffalo Bills safety Damar Hamlin collapsed moments after making a routine defensive play. Hamlin seemed to have suffered a blow to his chest shortly before losing consciousness from cardiac arrest, and his condition is grave. The source of his illness remains unclear. A study of sudden cardiac events in U.S. athletes from 2014 to 2016 found that structural abnormalities of the heart muscle or arteries and faulty electric rhythms were the most common causes; traumatic chest injuries have also been linked to such incidents, in a rare condition called commotio cordis. Still, the availability of these hypotheses did not stop online activists from blaming Hamlin’s health crisis on vaccines.

Anti-vaccine influencers have been fomenting fear about a supposed rise in COVID-shot-induced athletic deaths for a while. Fact-checkers have repeatedly assessed these claims and found them to be without merit. Jonathan Drezner, a sports-medicine physician who studies sudden deaths in athletes, told media outlets last year that he was “not aware of any COVID-19 vaccine-related athletic death.” The National Center for Catastrophic Sport Injury Research, which systematically tracks sports-related fatalities, identified 13 medical deaths during football-related activities in 2021 among players participating at all levels of competition, eight of which were caused by cardiac arrest. The same researchers had found 14 medical deaths two years earlier, 10 of which were heart-related. These incidents remain tragic and scarce.

The mRNA shots by Pfizer and Moderna are associated with a very small risk of heart inflammation, called myocarditis, which can lead to cardiac arrest. This risk is most pronounced in teenage boys receiving a second dose of the vaccine, but even in that scenario only about one in 10,000 recipients is affected. (Most professional athletes are in their 20s, not teens, so the risk to them is lower.) Myocarditis is a potentially fatal condition, but the version that occurs after vaccination is much less deadly than the heart inflammation induced by many viruses, including SARS-CoV-2. A recent analysis identified only a single death in 104 cases of vaccine-induced myocarditis. In comparison, for every 100 people who get myocarditis from a virus, about 11 will die.

Read: The selfishness of Novak Djokovic

The mere fact that mRNA shots can lead to heart problems has been exploited by conservative commentators and politicians to exaggerate the risks to young people. Last month, per a news release, Florida Governor Ron DeSantis promised to look into “sudden deaths of individuals that received the COVID-19 vaccine,” and called for a grand jury to investigate alleged wrongdoing by the vaccine manufacturers. His petition to the Florida Supreme Court justified the investigation by pointing out that “excess mortality from heart attacks rose significantly during the COVID-19 pandemic, especially among individuals ages 25 to 44.” Yet the rise in youth heart attacks actually began in 2020, before vaccines were available. That’s because increased cardiac fatalities during the pandemic have mostly been due to the coronavirus itself. Heart-disease deaths in the United States have been observed to rise and fall in near lockstep with waves of COVID deaths, suggesting that most of these cases—97 percent, according to one estimate—are the result of undocumented SARS-CoV-2 infection.

DeSantis’s crusade against vaccines is backed by his surgeon general, Joseph Ladapo, who is a staunch opponent of inoculating young people against COVID. (He has encouraged the use of ineffective therapies such as hydroxychloroquine and ivermectin, though.) In October, Ladapo’s department produced an anonymous, non-peer-reviewed analysis suggesting that COVID shots were causing an increase in cardiac fatalities in young men. This report was modeled on a study by the U.K. government, which came to the opposite conclusion about vaccines but did find that COVID infection was associated with a sixfold increase in youth cardiac death. Given the lack of detail provided in the Florida study, it’s hard to know how to reconcile its contradictory result. This week, a group of University of Florida physicians and scientists released a report that strongly criticized the work’s methodology.

The COVID vaccines are among the most widely used medical interventions. More than 13 billion doses have been administered, at least 1 billion of which relied on mRNA technology. In analyzing this trove of real-world data, researchers have occasionally identified potential safety issues. A lack of perfect consistency across their studies is expected, and only confirms that the scientific dialogue about this new technology has been transparent. Scientists know that findings made outside a clinical trial are prone to spurious associations, so they examine how well each analysis has been performed and interpret it in the context of prior research.

Read: The core lesson of the COVID-19 heart debate

Vaccine skeptics prefer to cherry-pick supportive studies while ignoring others that contradict them. Ladapo, for example, has cited a Scandinavian report showing a potential increase in post-vaccine blood clots and heart attacks. Yet the study authors themselves cautioned readers against relying too heavily on their results, because the finding was observed in only some age groups and time periods but not others. Ladapo also failed to mention that similar studies out of the U.K., France, Scotland, and elsewhere had not found a meaningful increase in blood clots or heart attacks with mRNA shots.

A careful recitation of facts can take one only so far in combatting anti-vaccine claims. Activists use ambiguous anecdotes such as Hamlin’s cardiac arrest and the sudden death of the soccer journalist Grant Wahl during last month’s World Cup to make the alleged risks of the shots more visceral. Sports are much less dangerous than SARS-CoV-2, but when unexpected tragedies do occur, they lead to an outpouring of mourning and reflection. Collective trauma can easily give way to collective speculation, and partisans on all sides will be happy to tell us what really happened. Yet convenient scapegoats will not be enough to mend our grief.

[ad_2]

Benjamin Mazer

Source link

January 4, 2023