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"Whitaker, Robert"
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Without Informed Consent
The discourse around health as a human rights issue usually focuses on access to medical treatment. However, the “right to health” begins with the right to informed consent about the merits of a treatment, which has been lacking as a US-constructed “disease” model of psychiatric care has been exported around the globe. The narrative that supported the adoption of the disease model told of how major psychiatric disorders were due to chemical imbalances in the brain, which could be treated by a second generation of psychiatric drugs that fixed those imbalances, much like “insulin for diabetes.” Randomized clinical trials had proven that antidepressants, antipsychotics, and other psychiatric drugs were safe and effective. However, missing from this narrative of medical progress were three key facts: that investigations failed to validate the chemical-imbalance theory of mental disorders; that studies of long-term outcomes regularly failed to show a benefit for the medicated patients; and that this model of care has led to poor public health outcomes in the United States and other developed countries. The principle of informed consent in medicine can be expanded to include the obligation of a medical specialty to be a reliable narrator of its own research, which provides a framework for understanding the violation of human rights that occurred with the exporting of a disease model of care to a global population.
Journal Article
Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity
The outcome of flourishing and its predictors have not been well documented among US children, especially those who face adversity. Using data for 2016 and 2017 from the National Survey of Children's Health, we determined the prevalence and predictors of flourishing among US children ages 6-17. A three-item index included indicators of flourishing: children's interest and curiosity in learning new things, persistence in completing tasks, and capacity to regulate emotions. The national prevalence of flourishing was 40.3 percent (29.9-45.0 percent across states). At each level of adverse childhood experiences, household income, and special health care needs, the prevalence of flourishing increased in a graded fashion with increasing levels of family resilience and connection. Across the sectors of health care, education, and human services, evidence-based programs and policies to increase family resilience and connection could increase flourishing in US children, even as society addresses remediable causes of childhood adversity.
Journal Article
Stress Relief Techniques: p38 MAPK Determines the Balance of Cell Cycle and Apoptosis Pathways
Protein signaling networks are formed from diverse and inter-connected cell signaling pathways converging into webs of function and regulation. These signaling pathways both receive and conduct molecular messages, often by a series of post-translation modifications such as phosphorylation or through protein–protein interactions via intrinsic motifs. The mitogen activated protein kinases (MAPKs) are components of kinase cascades that transmit signals through phosphorylation. There are several MAPK subfamilies, and one subfamily is the stress-activated protein kinases, which in mammals is the p38 family. The p38 enzymes mediate a variety of cellular outcomes including DNA repair, cell survival/cell fate decisions, and cell cycle arrest. The cell cycle is itself a signaling system that precisely controls DNA replication, chromosome segregation, and cellular division. Another indispensable cell function influenced by the p38 stress response is programmed cell death (apoptosis). As the regulators of cell survival, the BCL2 family of proteins and their dynamics are exquisitely sensitive to cell stress. The BCL2 family forms a protein–protein interaction network divided into anti-apoptotic and pro-apoptotic members, and the balance of binding between these two sides determines cell survival. Here, we discuss the intersections among the p38 MAPK, cell cycle, and apoptosis signaling pathways.
Journal Article
Hurricane season
Based on the true story of basketball coach and mentor Al Collins, who led his team to victory after Hurricane Katrina ravaged their homes and destroyed their spirits. Collins attempts to create a winning basketball team using players from five of the hardest-hit high schools in the area. Takes a look at the disaster and shows how heroes can rise from the most devastating of circumstances.
DVD
Rejoinder to commentary
(2) The Crump study, which assessed early death in Swedish patients with schizophrenia, found that they had an ‘elevated risk of death from ischemic heart disease, stroke, diabetes, influenza/pneumonia, COPD, and cancer.’ [...]after the six-week trials, no placebo patients were entered into the extension phase of the trials. [...]the maximum ‘person-years’ that a single patient could account for was 6/52 of a year. [...]the 26 648 patients in the antipsychotic category racked up 9618 person-years, or roughly four months per individual.
Journal Article
The interaction of adverse childhood experiences and gender as risk factors for depression and anxiety disorders in US adults: a cross-sectional study
Background
Exposure to adverse childhood experiences (ACEs) and being female are distinct risk factors for having a major depressive episode (MDE) or an anxiety disorder (AD) in adulthood, but it is unclear whether these two risk factors are synergistic. The purpose of this study was to determine whether exposure to ACEs and being female are more than additive (synergistic) in their association with MDE and AD in US adults.
Methods
We pooled cross-sectional survey data in the Midlife in the United States study from two nationally-representative cohorts of English-speaking US adults. Data from the first cohort were collected in 2004–2006 and from the second in 2011–2014. Data from both cohorts included the 12-month prevalence of MDE and AD (generalized anxiety disorder or panic disorder) assessed with the Composite International Diagnostic Interview Short Form, gender (here termed female and male), and the count of five categories of exposure to ACEs: physical, sexual, or emotional abuse; household alcohol or substance abuse; and parental separation or divorce.
Results
Of the 5834 survey respondents, 4344 (74.5%) with complete data on ACEs were included in the analysis. Mean (SD) age was 54.1 (13.8) years and 53.9% were female. The prevalences of MDE, AD, and exposure to 3–5 categories of ACEs were 13.7, 10.0, and 12.5%, respectively. After adjusting for covariates (age, race, and current and childhood socioeconomic disadvantage), for those with both risk factors (female and 3–5 ACEs) the prevalence of MDE was 26.9%. This was 10.2% (95% CI: 1.8, 18.5%) higher than the expected prevalence based on the additive associations of the two risk factors. The adjusted prevalence of AD among females with 3–5 ACEs was 21.9%, which was 11.4% (95% CI: 4.0, 18.9%) higher than the expected prevalence.
Conclusions
For both MDE and AD, there was synergy between the two risk factors of exposure to ACEs and being female. Identification and treatment of MDE and AD may benefit from understanding the mechanisms involved in the synergistic interaction of gender with ACEs.
Journal Article
The Association Between Work as a Calling and Turnover Among Early Childhood Education Professionals
Turnover of early childhood education (ECE) professionals negatively impacts program costs, staff morale, and relationships with children. We determined whether the presence of work as a calling was associated with less intention to leave the ECE field. From an online survey administered to 265 ECE professionals in Pennsylvania, a calling score based on the Calling and Vocation Questionnaire was used to create sample-defined tertiles of low (< 38), medium (38–44), and high (> 44) presence of calling. Those intending to leave the ECE field reported that, given the option, they would most likely “find a position or get training in a completely different field,” or “stop work, stay home, or retire.” Analysis was restricted to 194 respondents currently employed in ECE and under age 60, of whom 94.8% were female and 53.9% were non-Hispanic White. After adjusting for race/ethnicity and workplace stress, the prevalence (95% CI) of intention to leave decreased as calling increased, from low (28.6% [17.8%, 38.4%]) to medium (12.2% [4.3%, 20.1%]) to high (9.1% [1.5%, 16.6%]). The presence of call was associated with less intention to leave the ECE field. Identifying, building, and sustaining call among ECE professionals may decrease turnover.
Journal Article