Lily Salter's Blog, page 113

The fight to keep tobacco sacred

(Credit: AP Photo/Altaf Qadri)

Tobacco has become a much-maligned plant in modern society. Cigarettes, which typically contain dried leaves from a tall, hybrid species called Nicotiana tabacum, are blamed for more than 480,000 deaths per year in the United States. And reams of scientific findings indicate that cigarette smoking — inhaling a toxic brew that can contain at least 70 cancer-causing chemicals — harms nearly every organ of the body.

But tobacco itself is not the problem, according to Gina Boudreau. In fact, she considers it sacred. And she is not alone. Many Native American communities, including hers, use the substance in traditional rituals and pass down stories about how and why the creator gave it to them. Yet customs related to growing and respecting tobacco have eroded over time, leaving communities exposed mostly to commercial versions of the plant — and furthering smoking addiction.

Boudreau hopes to change that. She is helping lead a movement within her tribe, the Minnesota-based White Earth Nation, to boost traditional tobacco use. This shift is not just for the sake of rebuilding a vanishing tradition; it is part of a surprising strategy to tamp down the tribe’s high smoking rate. Essentially, the plan is to fight tobacco with tobacco.

Even as smoking and lung cancer rates have plummeted across most of the United States, current intervention strategies have not proved as effective in tribal communities; they continue to have some of the country’s highest smoking rates. In Boudreau’s state, Minnesota, only about 15 percent of the overall adult population smokes — but the rate jumps to nearly 60 percent among tribal members. The U.S. Centers for Disease Control and Prevention says about 32 percent of Native American adults nationwide are smokers. By comparison, smokers make up only about 16 percent of the overall U.S. adult population.

The situation has become so alarming that two years ago the National Congress of American Indians — the country’s oldest and largest organization of tribal governments — passed a resolution designed to tamp down smoking rates and save lives. Among other steps it urged all tribes to create and enforce tobacco-free air policies in indoor workplaces and public spaces (including tribal casinos), and to offer access to high-quality tobacco cessation services.

Boudreau’s White Earth Nation has taken some of these actions, including banning smoking in various government buildings. Those restrictions force smokers to leave public areas — even during Minnesota’s harsh winters. But beyond that, Boudreau and other tribal members say addressing the problem should go beyond rolling out generic advertisements about how bad tobacco is, or pushing “just say no to tobacco” messages. Instead they believe promoting tobacco use in more traditional ways, and rebuilding respect for the plant as a sacred element of Native culture, would have a better chance at making a real difference. “We’re trying to change community norms,” Boudreau says. The White Earth plan is backed by the Minnesota Department of Health, which helps pay for anti-smoking work, including Boudreau’s salary as the tribe’s tobacco prevention coordinator. The state now spends $1 million a year partnering with its tribes to try to drive down smoking rates across tribal communities.

The first step toward this shift, according to Boudreau, is growing an indigenous tobacco species on the reservation. About eight years ago she started planting seeds of Nicotiana rustica, a short and spindly-looking tobacco plant with a long history of growing wild throughout the Americas — and of ritual use by Native American tribes. It typically contains more nicotine than its lush-leafed commercial cousin N. tabacum, a characteristic that makes the indigenous plant’s smoke harder to inhale. N. tabacum is more attractive to commercial interests because it produces more tobacco per plant and its smoke is less irritating, making it a good choice for mass production. N. tabacum and N. rustica both likely originated in South America about 200,000 years ago, and the latter still grows wild there and in Central America. But tobacco companies have modified N. tabacum to enhance certain traits for flavor or growth. So today’s version — much like other commercialized crops — bears little resemble to its ancestors, says Ramsey Lewis, a professor of crop science who focuses on Nicotiana genetics at North Carolina State University. Now, he says, N. tabacum is rarely found in nature.

There are other key differences between industrialized tobacco and the substances used for ritual purposes. The term “traditional tobacco” can refer to other indigenous plants that may not contain nicotine at all, including the dried leaves of bearberries and the bark from red and spotted willows. American tribes also use traditional tobacco in a variety of ways. Often it is not smoked, and when it is, it is usually not inhaled into the lungs. Some tribes place it on the ground or burn it in dish or shell; the smoke is believed to carry prayers to the creator. Dried tobacco may be sprinkled on or near a car to ensure a safe journey. Presenting a gift of tobacco when a deal or contract is being forged can make the agreement more binding. Tobacco is also employed medicinally: Sprinkling it on the bed of an ill family member is thought to protect the patient and serve as a healing agent, as Minnesota-based Chippewa tribal members noted in the American Journal of Preventive Medicine. Practices differ from tribe to tribe, and citizens of the White Earth Nation and the Ho-Chunk tribe in Wisconsin were reluctant to reveal details of their religious rites to a visiting outside journalist. But David Greendeer, a former Ho-Chunk legislator, told me that the complex process of growing actual tobacco itself — talking to the plant and imbuing it with the grower’s thoughts and energy — can be a key part of sacred tradition. The work can be difficult, and produces a relatively small yield: Once the leaves from Greendeer’s personal plot of 150 plants in Wisconsin are harvested and dried, there are only about four medium-sized coffee cans of traditional tobacco to last him and his family throughout the year. So if tobacco is grown and used in the traditional way, Greendeer reasons, it would be challenging to feed an addiction. “We can only grow so much,” he says. “It’s a shitload of work to get that done.”

Boudreau and her allies are now working on growing the plant, teaching community members about traditional use and urging them to quit using cigarettes, or never start. So far interest has been slow to develop — but Boudreau says the ideas are starting to take root. If kids build a relationship with traditional tobacco at an early age by growing it at school, for example, harvesting it and engaging with it in traditional gatherings and ceremonies, they may be less likely to smoke as adults. “It’s about keeping tobacco sacred,” says Dana Goodwin, 53, a White Earth Nation language and culture teacher at the Circle of Life Academy — a Bureau of Indian Education Grant school on the White Earth Nation reservation that offers K-12 education steeped in cultural traditions.

White Earth Nation members say their smoking issues metastasized against a complicated historical backdrop. Until the passage of the Indian Religious Freedom Act of 1978, laws banned many Native American cultural practices, including various traditional uses of tobacco. And in the late 19th and early 20th centuries, churches or the U.S. government routinely took Native American kids from their homes and sent them to faraway boarding schools where tribal cultural and language practices were forbidden. This also contributed to the breakdown in teaching traditional customs, Goodwin says.

But some tribes managed to hold onto their historic practices in hidden or secret ways, such as substituting cigarettes for indigenous tobacco at traditional ceremonies. For example, at funerals among the Ojibwe (a larger tribal distinction that includes the White Earth Nation), ritually grown tobacco would be placed on the ground to offer prayers to the spirit world for the deceased. To continue this custom when traditional tobacco use was prohibited, the tribe instead started passing a birch-bark basket of cigarettes among attendees to smoke as a group, so the prayer tradition survived. Similarly, since tribal members could no longer keep traditional tobacco with them, they started carrying commercial tobacco and using it for daily offerings and ceremonies.

Tobacco companies may also have contributed to the high smoking rates among Native Americans. Historically these companies marketed to tribal communities by appealing to their cultural connections with tobacco — thus becoming one of the few outside groups that strongly supported tribal sovereignty and economic development (internal tobacco company documents, now public, suggest they had also hoped for more access to tribal casinos and stores as places to sell their products). That legacy of apparent support for tribal interests has left some Native American communities with mixed feelings toward these companies, possibly hampering smoking cessation efforts.

The reasons tribal members start smoking remain complex. As is the case in any other community, a person may light up in response to social pressures, to relieve stress, or due to many other factors. Cigarettes remain ubiquitous at some Native American traditional ceremonies. Also, people with lower socioeconomic status generally have the highest rates of smoking prevalence across the United States, and most tribal communities remain disproportionately poor. About 30 percent of American Indians live in poverty compared to 15 percent of the general population, says Brian King, a senior scientist and epidemiologist at the CDC who serves as deputy director for research translation in the agency’s Office on Smoking and Health. There are also education disparities: about 23 percent of Native Americans have no high school diploma or its equivalent, versus 14 percent of Americans nationally, King says, citing census data.

Whether the White Earth Nation’s fight-tobacco-with-tobacco effort will work remains unclear. The quit rate among the small number of people who visit the local smoking cessation clinic reached almost 14 percent in fiscal 2017 — roughly doubling from fiscal 2016, according to the clinic’s preliminary internal numbers. The tribe’s own data also suggests there has been a modest improvement — from a 44 percent smoking rate in 2014 to 38 percent in 2017. And smokers do not appear to be shifting to e-cigarettes, devices which have generally remained unpopular in the community.

Yet on a recent visit to the tribe’s reservation, the immediate prospects for smoking prevention and cessation seemed far from assured. Traditional tobacco plants grow on small plots throughout the community, but there are also constant reminders of commercial tobacco use that could undercut a cultural shift. When I visited the Circle of Life Academy school, a small amount of tobacco had been grown on campus. But kids were dipping their hands in a store-bought bag of loose leaf “Smokin Joes Pipe Tobacco” to put the substance in traditional fabric pouches that would be used in a school ceremony. The plastic bag, still sporting its price tag, featured a picture of a Native American figure wearing a headdress — above the required surgeon-general warning. I also chatted with a small group of nine- and 10-year-old girls, and when I asked them for their thoughts on smoking they all agreed that it was bad for one’s health. But when I asked if they plan to smoke cigarettes when they grow up, one girl quickly said “yes” and another said “maybe.” The latter leaned in and confided, “My cousin smokes. He’s 10.”

For some adults the workplace can also be a hazard when it comes to picking up the habit or being exposed to secondhand smoke. The tribally owned and operated Shooting Star Casino, which is the community’s number one employer, says 50 percent to 70 percent of its 1,000 employees are members of the White Earth Nation. Here, as in many tribally owned casinos across the country, it can be difficult to stay away from cigarettes; many people like to smoke while they gamble, making managers hesitant to bar smoking. Cigarettes are also not taxed at tribally owned stores, which makes the product more affordable than elsewhere.

When it comes to approving or implementing anti-smoking policies in tribal communities, “it’s like gun control across the United States — it’s a touchy subject,” says Clinton Isham, a member of the Lac du Flambeau tribe in Wisconsin, who works to cut tribal smoking rates throughout his state on behalf of the Great Lakes Inter-Tribal Council. Each morning, he says, he uses traditional tobacco grown in his mother’s garden — either placing it on the ground as a sacred offering or smoking it in a pipe. But in his professional smoking-prevention work he has found that even when tribal elders use and promote traditional tobacco themselves, and worry about high smoking rates in their communities, it remains difficult to gain much ground on smoke-free casino policies. The main snag, he says, is that tribes worry that the shift could hurt one of their principal sources of revenue. Tightening restrictions on smoking in other public spaces, he says, is also difficult because such policies could frustrate smokers and feel unnecessarily onerous.

After weeks of reporting on traditional tobacco for this report, I wanted to see some of it up close and speak with someone who grows it at home. That’s when I called David Greendeer and asked him to meet up for lunch. The 38-year-old said he would be happy to make time. But he had a delicate question first: Would I be menstruating? If so, he said, tradition dictated that he could not bring or show me any of the tobacco. Fortunately I was not, so we agreed to convene at a sports bar in Wisconsin Dells, about an hour outside Madison. Over lunch (herbal tea and soup for him, a chicken sandwich and Coke for me) he explained that menstruation is not considered unclean. But tradition holds that growers’ thoughts and intentions are infused into the tobacco, and that a woman on her period is spiritually “very strong” — potentially making her more likely to absorb those unknown thoughts and intentions, which could cause problems for her and also alter the tobacco.

About an hour into a far-ranging conversation that bounced from Greendeer’s current role in helping grow the Ho-Chunk nation’s business side to his tribe’s story about the creation of humans, he pulled out a deerskin pouch of homegrown tobacco, which he asked me not to touch. It looked like oregano or any other dried herb, and did not have the strong smell of store-bought tobacco. Like Boudreau, Greendeer emphasized that to effectively curb smoking rates there needs to be a cultural change — one that stresses “keeping tobacco sacred” — and teaching that to children, he said. So far, he added, there have not been enough efforts to encourage such practices in his community.

But other Ho-Chunk community members told me there are some early indications that may be changing — at least on a small scale. In the last few years Jon Greendeer, the tribe’s recent former president and a relative of David’s, has led efforts to bring more traditional tobacco to community events, and to get others to do the same — fomenting greater awareness about traditional tobacco and what one’s relationship with it should be. Now, Jon Greendeer told me, he brings freshly grown and dried tobacco to community events; before, he would buy four packs of cigarettes to contribute. And although data on smoking cessation efforts within the tribe remains scarce, health surveys Ho-Chunk officials have taken among one significant subset of the community — its diabetic population — suggest their smoking rates are dropping substantially. Anecdotal evidence from Ho-Chunk members I interviewed also suggests fewer people have been smoking in the past few years.

Sara Peterson, the Ho-Chunk’s health and wellness coordinator, says several factors could explain declining numbers. New policies (such as banning smoking in public spaces) have been imposed; more smoking cessation education is available; the price of cigarettes has continued to rise; and more community leaders have started speaking publicly about quitting, along with other healthy lifestyle choices. Amy DeLong, a physician who sees many of the tribe’s members, says she now talks with each of her patients — regardless of the reasons for their visits — about quitting smoking or making sure they never start. Perhaps the combination of all those actions may help explain the decline, Peterson surmises. Moreover, one of the tribe’s largest casinos went smoke-free in August 2015 — making it the only such casino in the state to do so. The casino actively advertises its smoke-free status and has not lost revenue. Several community members I interviewed speculated that the public discourse that swirled around that decision may have influenced people’s thinking.

Even with these possible improvements, however, members of both the Ho-Chunk and White Earth Nation tribes cautioned that progress will likely be slow, and many expect an uphill battle in the years ahead. Smoking is no different than other issues that disproportionately affect Native Americans’ health, Isham reminded me in Wisconsin. Pointing to the high diabetes rates, he said, “At many of our traditional events, a standard cultural food has become fry bread served with taco meat on it, and we jokingly call it an ‘Indian taco.’” Tribal members know it contributes to high obesity and diabetes rates, but the tacos are also an example of how the community adapted and remained resilient despite colonization. “When [tribes] were pushed onto reservations we were given some foods we had no familiarity with,” Isham says. “We created new foods from them in order to survive — like this fry bread. So now Indian tacos contribute to our problems, yes, but they are also a sign of our perseverance. Really, it’s the same thing with commercial cigarettes.”

Federal Government suggests marijuana-laced fentanyl is a concern

(Credit: Getty/OpenRangeStock)

Not only is the federal government still trying to convince American’s youth that marijuana is a gateway drug, but also that it is laced with dangerous opioids that can prove fatal. This is what Secretary of Health and Human Services Alex Azar told a group of Millennials earlier this week at the White House. He says black market shenanigans have allowed marijuana to become one of the leading culprits in the opioid epidemic.

“These are very sophisticated operators, and they are lacing other illegal drugs with fentanyl to get you hooked on opioids and bring you into their system,” Azar said in response to a question regarding marijuana being equally as dangerous as prescription drugs. “Marijuana laced with fentanyl, all kinds of other products laced with fentanyl.”

What is true is that fentanyl is a dangerous synthetic opioid that packs a punch around 50 times stronger than heroin. It a prescription drug, which is often used to treat cancer patients who are experiencing severe pain. It was designed to quickly take the edge off for those patients suffering through the worst of the worst. Of course, fentanyl has found its way into the black market, but because of its high potency, tens of thousand of people all over the United States have reportedly died as a result of an overdose.

Reports suggesting that marijuana-laced fentanyl was on the rise began to surface last year. But that didn’t turn out to be the case. What was happening is that coroners in places like Ohio, which has been rocked by opioid addiction, were finding traces of marijuana in the corpses of people who died from opioid overdoses. Come to find out that the user(s) had consumed the two substances separately. But the initial reporting suggested that the mixture might be the latest trend in the arena of street drug commerce.

To date, there are no confirmed cases involving marijuana-laced fentanyl. In fact, if this is happening at all, it is by the users own volition. This is not something that dealers are pushing.

In ways, the stories of marijuana being dosed up with fentanyl are similar to the latest horror show involving bizarre drug mixtures, including marijuana, spice and banana leaves being doused in household bug spray.

Since the days of pot-laced with PCP, drug users have pushed the limits in search for new, interesting highs. But not even the most ruthless dope pushers are out there slinging potentially fatal products to unsuspecting customers. This practice would not be good for business.

Even representatives of the U.S. Drug Enforcement Administration admit that fentanyl-laced marijuana is not a thing. “In regard to marijuana, I’m not familiar with that,” DEA spokesman Melvin Patterson told the Cincinnati Enquirer. At the time of the interview, he hadn’t seen any cases of this, but admits, “There could be.”

Record-breaking number of women running for office in 2018

"Told Me" — Amy McGrath for Congress Announcement Video (Credit: Youtube/Amy McGrath for Congress)

In case you haven’t heard, women are preparing to grab the reins of America’s flailing democracy. The future is looking bright.

The Associated Press reported that on Thursday the number of women running for the U.S. House of Representatives topped a previous record from 2012. According to data analyzed by AP News, 309 women from both political parties have filed to run for the House — a number calculated since Virginia revealed its candidate list on Thursday. The last record was set in 2012 when 298 women filed to run for candidacy in the House. Data was analyzed dating back to 1992 from the Center for American Women and Politics at Rutgers University.

Currently, Congress is male-dominated. Specifically, in the U.S. House of Representatives, four out of every five members are men. According to the Center for American Women in Politics, in 2017, only 20 percent of the Senate was comprised of women; 19.3 percent of the House is, too.

It might be a challenging road to unseat incumbents in various states, but more women around the country are saying they’re up for the fight. There’s no doubt this surge of women running for office has been inspired by Donald Trump’s presidency. Erin Loos Cutraro, founder and CEO of She Should Run—a non-partisan 501(c)3 that provides women with the tools they need to run for office told Salon there’s been “an increase in numbers and an increase in determination” of women seeking to assume government positions.

“As the only organization that serves as a starting point for with women at all levels and all political stripes, our growing community is a clear indication that the enthusiasm is real and the determination is not going anywhere,” Cutraro said. “The record number of women stepping up to run for office now shows that women know their perspectives and experiences are needed and that their participation will make our democracy strong.”

The trend isn’t only exclusive to seat in the House though, as the AP News reported.

Amy McGrath, a former Marine fighter pilot, is one of the many women running for Congress this year. She’s running as a Democrat in the sixth Congressional district of Kentucky and vying to unseat Republican Andy Barr. McGrath explained that the 2016 elections did inspire her run in a recent episode of Salon Talks.

“It was the 2016 elections that made me really take a step back and look at our country and look at how I needed to serve my country,” McGrath said. “I’ve served my country my entire adult life, and this for me was a second service.”

McGrath knows a thing or two about being patronized by the patriarchy. At the age of 13 she was told that she couldn’t fly in combat in a letter from her Congressman at the time.

“He said Congress thought that women ought to be protected and not allowed to serve in combat,” McGrath explains in one of her inspiring campaign commercials.

The former Lt. Col. in the Marine Corps., and the first woman to fly an F-18 in combat emphasized that political space today needs people who can get along with each other, despite their opposing political ideologies. Her husband, who has also served 20 years in the Navy, is a Republican, and she uses their relationship as an example of how Congress needs to work together despite differing being in different political parties.

“In the military, we focus on the mission,” McGrath explained. “We don’t look to you or the person next to us, the marine next to us, and say ‘Are you a democrat or are you a Republican? Oh, I’m not going to work with you.’ We work each other because we’re Americans.”

Kelda Roys is another woman running for office this year as a Democratic gubernatorial candidate in Wisconsin. Currently, there are only six women state governors in the country. In a separate Salon Talks interview, she explained the barriers women frequently face when it comes to running for office.

“Politics, unfortunately, today does require a lot of money,” she told Salon. “And women sometimes have less personal wealth than men, or less flexibility in their jobs because maybe they took time off to care for children, then when women actually do step up and run for office there’s a whole other set of challenges.”

Those challenges, Roys explained, include appearances–and unfair double standards that are held almost exclusively to women at times. Roys agreed that the 2016 election likely inspired many women, including herself, to run for office. However, Roys previously served as a representative in the Wisconsin State Assembly. She ran for office in the open 2nd Congressional district of the state, but lost to Mark Pocan.

“I think that women after 2016, we just decided that we’re not going to sit back and let this happen to our country where someone who is repeatedly accused of sexual harassment and assault can occupy the highest seat in the land.”

In these dark political times, it’s inspiring that so many women are stepping up and putting their names in the proverbial hat.

“Throughout history, women have been a catalyst to change,” Cutraro said.

You can watch the full interview with Amy McGrath here:

The zen of Henry Winkler, star of HBO’s “Barry”

Henry Winkler in "Barry" (Credit: HBO)

Henry Winkler has welcomed me, a stranger, into his orbit. The setting is a hotel room at a press junket, and yet, he treats it like his living room. Welcome, he says. He gestures to a fruit platter on a table, invites me to sit where I’d be most comfortable, and would I like another pillow? A blanket?

This is the man I knew as The Fonz, hero of “Happy Days,” Jumper of Sharks. Now he’s co-starring on HBO’s black comedy “Barry,” a project co-created by “Saturday Night Live” alumnus Bill Hader airing Sundays at 10:30 p.m. And he just may be the nicest, most contented man in Hollywood.

Hader plays the title role of “Barry,” an assassin attempting to find his humanity again through an acting class run by Winkler’s Gene Cousineau, a drama teacher given to pulling extremes out of his students.

After Hader, Winkler is the second most recognizable actor on the series and is the series’ most frequent scene stealer. Surprisingly, though, he had to audition for “Barry” just like anything else.

Winkler imbues every word of that story with tension and portent, and as much care as he assigns to welcoming a stranger into his home away from home.

“It turned out to be the plum role of the year,” he effused.

“Barry” defies simple description. It’s a weird, funny, dark work that eventually devolves into full-midnight tragedy. All the while Winkler’s drama teacher maintains his loony devotion to his sense of gravity and vainglory. In the world of Gene Cousineau every moment bursts with import, every act is part of the great drama of life.

This is also true of Winkler, a man whose enthusiasm and sense of good fortune vibrates in every word he says. Gene’s motivation is fame and a bathing in the cult-like worship of his students, and that’s the difference. Gene feeds on fandom, while Winkler is a fan and devoted to kindness. He tweets. He loves pop stars. And he loves meeting people.

This is why a recent conversation that was ostensibly supposed to be about “Barry” soon turned into an inspirational reflection on life philosophy and the dividends yielded by being kind, revealing much more about the actor than the bombastic character he plays. Bear that in mind as you continue reading this conversation that has been lightly edited for clarity.

Let’s talk about “Barry” and Gene Cousineau . When you came into this, how much were you able to kind of shape Gene?

You’re able to shape a character because you bring your imagination, and you bring your energy, and you bring your knowledge of acting class. But here it is. These two men, two halves, make a circle that is so clear and so perfectly round. If it is not in the writing, it doesn’t exist. You can try, you can ad-lib, you can wear pink underwear, it’s not gonna be great.

These guys know what they want. They are open and allow me to try things that just come out of my mouth. And then they know that they want it done a very specific way in another area. And it is the perfect combo. It’s cashmere. It’s like putting on a cashmere sweater, as opposed to a blend.

I’m proud of myself for that analogy, myself. I’m loving it!

Now —

I’ve never actually said that before!

— Gene Cousineau is such a larger-than-life character, and yet very thoughtful and devoted to what he does and where he is. This is set against and in complement with Bill Hader’s character, this kind of soul-searching assassin.

I still don’t know how these men have an acting class comedy, a romance, a teacher who has a romance with the cop, and a shoot-’em-up, a dark, deadly shoot-’em-up, and how that gets squeezed into a half an hour. I have no idea. I think it’s like spirits in the forest. I think it’s alchemy. I don’t know what they did. I’m just so grateful to be part of it.

How did they approach you for this?

My agent called, said, “Would you like to go in and read for Bill Hader?” Bill Hader? I love Bill Hader. I’ve watched Bill Hader. We watch him every Saturday night. I said, “Who’s on this list? Because if Al Pacino is on this list, I’m not going in. Because I don’t have a shot!”

It really does surprise me that you would think, “Well, who else is on there because if so and so is on there, I’m not going to get it.” From an outsider, that does not compute for me.

Yeah, I know. But on the inside, that is no joke. I literally had that thought. If I heard yes, I would not have gone . . . I am now, at 72, becoming the actor I talked about and wanted to be at 27. I’m a late bloomer.

Interesting. What do you think it is that brought you to where you are now, in terms of your current abilities as an actor?

That I have grown up as an emotional person. I thought I was a person, but who I thought I was, was not the reality. And it took looking and reading and talking and . . . to get there. You know? I read . . . I was a negative thinker, and there is a disciple of a philosopher from Armenia. And out of this big book, “Don’t put a period on the end of a negative thought that comes into your head.” If you finish the thought, it will grow and stump you.

You just say, “Move it out.” And move in something you like. I like chocolate cake without frosting, like a bundt cake. I think of a good chocolate bundt cake. Rearranges your thinking, and you keep moving, and then we’re sitting here talking.

One of my favorite stories about you that I have heard is that when people come up to you and say, “Hey!” as Arthur Fonzarelli, each time you treat the person nicely. And you always explain, “Remember for you it’s the 500th time, but for that person it’s the first.”

Yes, that’s right. Not only that, if a human being is gonna give you a half an hour every week for 10 years, and then they come and they meet you and they want to say hello, and you say, “I am so sorry, I’ve got no time for you,” you are a liar. You are a liar. Because if you look at somebody, a fan on the street, and you look for three seconds in their eyes, they think they’ve met you. How hard is that? Especially if they’ve paid money for your ticket, they’ve come to see you on Broadway, they have your books for their children, and they watch you on television.

And you need them to watch you on television. You don’t do this just because it’s like — it is a great job, I love my job — but I need them to watch. I need them because if they don’t watch, I go home.

I think that that’s one of those things that people don’t quite understand. And when I say people, I mean people who are celebrities, but also fans. I think that there are so many reports now of people who have these interactions with people who are on TV or in movies, and maybe they’re kind of seen like, “Oh, maybe I should stay away from that person.” But the fact that there’s a humanity in the story about you is what resonates.

We tell stories. . . . I enjoy that a lot. I love meeting people that I like to watch. I watch a lot of television. It helps me relax. I do a lot of different jobs. And when I see somebody on a show that I like, I become a 14-year-old girl. I become a screamer. I get so excited. I’m not kidding.

I met Sia the other day. I mean, I walk into a grocery store, and Judd Apatow is there. And I know him, but I don’t really know him. And I went up and shook his hand, and a woman comes up and says, “I’m Sia.” Because I tweet about her. I talk about her. I love her. “I’m Sia.” And I’m speechless and all I can do is hug her. And then the three of us spent like half an hour talking, chatting. I said, “I know I can’t take a picture of you because you always wear the –” She said, “No, I’m gonna make an exception.” I took a picture with Sia.

And you have that close to your heart?

I do. I have a signed picture from Bruno Mars. I love Bruno. I do. I get crazy when I meet people I like. I, of course, met Elton John and said, “John, I had — I’m just gonna leave now because I called you John and your name is Elton.”

How much of a fan of Bill Hader’s were you before you?

Every Saturday night. “Trainwreck.” “Skeleton Twins.” And here I am, he’s my friend, and my boss, and my acting partner.

That’s pretty extraordinary.

Pretty great! . . . If you let it happen, life will unfold in the most magical way. But, it doesn’t just come out of the thin air. You have to prepare yourself and train yourself and put yourself out there. And here’s the thing. You didn’t ask, but here it is: The anticipatory fear of something is worse than the actual doing of it. I think that is like one of the most important things I’ve learned in my life.

At this local Alaska bar, there’s always a free ride home

(Credit: Getty/Theanthrope)

Although one of the smallest states in the U.S. in terms of population, Alaska has one of the highest alcohol-induced mortality rates in the country. Nationally, alcohol induced deaths occur at a rate of 8.5 percent per 100,000 residents; in Alaska, that statistic nearly triples to 22.7 percent.

At The Homestead Lounge in Eagle River, bar manager Dan Graeber took matters into his own hands and started offering a free shuttle from the bar to any home in the Eagle River area.

“When I first had the idea, there was no cab service out here,” Graeber explained. “So it was a big issue; if someone needed a ride home they’d have to call one from Anchorage and it was too expensive.”

Graeber originally contracted the shuttle out to a man running a business called the Eagle River Shuttle. Later, he purchased his own pair of shuttles for the bar to keep on site. “I’ve had my shuttles now almost four years, so I’ve been [running a shuttle bus] for almost seven years,” Graeber said.

The Homestead is one of two bars in Eagle River, but the busiest on the weekends. The shuttle runs full-time Thursday through Saturday, and as needed during the rest of the week. In general, if someone asks, Graeber will make sure they get home.

“Everybody needs to be a little more responsible. It’s the only thing I can do from my end that’s easy,” he said.

When he first moved to Alaska from Wyoming, Graeber worked at the now defunct Pines Club, a bar he described as “rough and tumble.” But The Homestead is different, Graeber said. “People here are easy. I have my little share of problems. I’ve got girls and boys and whiskey, so you’re gonna have a problem sooner or later, but not very much.”

When it comes to the cost of running a free shuttle, Graeber said purchasing the used buses was the cheap part. “Keeping them up and the gas, it costs you a pretty good penny by the time the year’s over, and it’s becoming more popular even more over time,” he said.

Graeber, who’s been running bars for 50 years, says the main difference now is the amount of rules and regulations there are to follow. “It’s tougher. When I first moved up here you’d go downtown and everybody was six-packin’ you; they’d serve you if you could hold your head up above that bar,” he recounted. “Those days are over. You just have to be more responsible about being in the business. And if you’re not gonna be, then you’re not gonna last.”

In the state of Alaska the average cost of a person’s first DUI is $24,265. It’s not just the bar that loses out on a customer, Graeber said, but a customer who ruins their life with one bad decision. “God forbid you hurt somebody or somebody gets hurt,” he said. “That’s the worst case scenario.”

Bernie Sanders’ MLK comments anger Barack Obama supporters

Bernie Sanders (Credit: Getty/Tasos Katopodis)

Sen. Bernie Sanders, I-Vt., has once again aroused controversy, this time after he made comments about President Barack Obama at an event honoring Dr. Martin Luther King, Jr. that critics claimed disparaged the first African-American president and supporters insist was taken out of context.

On Wednesday, during an event in Jackson, Mississippi honoring King’s legacy on the 50th anniversary of his death, Sanders discussed the future of the Democratic Party with members of the audience.

“The business model, if you like, of the Democratic Party for the last 15 years or so has been a failure,” Sanders told the audience, according to BuzzFeed. “People sometimes don’t see that because there was a charismatic individual named Barack Obama, who won the presidency in 2008 and 2012.”

Sanders added, “He was obviously an extraordinary candidate, brilliant guy. But behind that reality, over the last 10 years, Democrats have lost about 1,000 seats in state legislatures all across this country.”

Many on Twitter took umbrage with Sanders’ remarks, viewing them as at best tone deaf and at worse outright disrespectful toward America’s first black president at an event meant to honor one of the African-American community’s most iconic civil rights leaders.

It might be a different, hippie-flavored brand of white supremacy from Trump's, but it's still ultimately what makes someone as overall unaccomplished as Bernie Sanders believe he can speak patronizingly about Barack Obama.

— Stephen Robinson (@SER1897) April 5, 2018

I'm used to Sanders attacking Democrats.
I'm used to Sanders attacking Obama & Hillary.
I'm even used to Sanders using MLK.
What upset me tonight was Sanders attacking Dems & Obama on MLK50 while that racist monster is in the White House.
If it didn't upset YOU, ask yourself why.

— Victoria Brownworth (@VABVOX) April 5, 2018

I just have one question for Bernie Sanders…

While Democrats and the charismatic Barack Obama were "failing" all over the place for the past 15 years…

What the fuck were YOU getting accomplished?

— MLK never marched with Bernie Sanders (@BravenakBlog) April 6, 2018

Y’all can defend Bernie all you want. On #MLK50 his lack of self awareness and arrogance in dismissing #44, is wild.

Bernie 2020 died 4/4/18. https://t.co/W6gKZ9dUO4

— Bakari Sellers (@Bakari_Sellers) April 5, 2018

But there were some tweeters who defended Sanders, claiming that the audience had responded positively to his remarks or arguing that they were being taken out of context.

I just watched the full clip of Sanders remarks. He explicitly praised Obama, and then went on to note that Dems have lost lots of elections. I don't get how anyone can view this as "dismissing" Obama. Watch the clip for yourself: https://t.co/4wiTElM8fW https://t.co/gS2jABOqV6

— David Sirota (@davidsirota) April 5, 2018

From the audience, I watched the crowd of a 85% black city give Bernie Sanders a standing ovation both before & after his remarks. The crowd responded positively to Sander's point that the Democratic party has failed to retain seats – even w/ a leader as charismatic as Obama. https://t.co/VCP94nKTq0

— Optimistic Populist (@briebriejoy) April 5, 2018

I've been following the anti-Sanders press for some time now, so this is no surprise, but the enormous gulf between how I saw people respond to him in that room and how twitter is reacting is genuinely galling. However I am heartened at the end. Because the people get it.

— Optimistic Populist (@briebriejoy) April 5, 2018

And for the record, there was spontaneous applause from the audience after Sanders said that the business model of the Democratic party is a failure. But I suppose some Democrats believe that loosing 1000 seats in 8 years is a mark of success. Which explains some things.

— Optimistic Populist (@briebriejoy) April 5, 2018

Sanders himself also chimed in to comment on the controversy, arguing that he had actually recognized “the historical significance of the Obama presidency” and implying that his remarks had been mischaracterized by the media.

It's unfortunate that some have so degraded our discourse that my recognition of the historical significance of the Obama presidency is attacked. https://t.co/rRc2KVl8Cl

— Bernie Sanders (@BernieSanders) April 5, 2018

There is also a heated debate over the racial composition of that audience, with Jackson Free Press describing it as “predominantly white” and a Twitter user who attended claiming that it was “about 50/50.” As of the 2010 census, roughly four out of five citizens of Jackson, Mississippi were African-American.

At the core of this controversy, though, is the tension between Sanders’ campaign and the social justice wing of the Democratic Party, one that has championed causes important to many members of the African-American community. During the 2016 presidential election, there were Black Lives Matter protests at some of Sanders’ rallies, many of which seemed to be directed at the perceived racist behavior of his supporters as well as at Sanders himself. During a president debate in March 2016, Sanders also was criticized for seeming to generalize the African-American community when he answered a question about his own racial blind spots by saying, “When you’re white, you don’t know what it’s like to be living in a ghetto, you don’t know what it’s like to be poor.”

Since the election, Sanders has also been criticized for comments that seemed to have minimized the importance of racial justice issues in order to win over Trump voters.

For instance, in the weeks after Trump’s upset victory over Hillary Clinton, Sanders encouraged supporters to “go beyond identity politics,” according to The Guardian. According to Sanders, “The working class of this country is being decimated — that’s why Donald Trump won. And what we need now are candidates who stand with those working people, who understand that real median family income has gone down.”

In April of last year, Sanders again made controversial remarks that seemed to downplay the role of racism in Trump’s victory.

“Some people think the people who voted for Trump are racists and sexists and homophobes and deplorable folks. I don’t agree, because I’ve been there,” Sanders told an audience in Boston, according to The Guardian.

If nothing else, it is clear that both Sanders and his supporters will need to do a lot of work to build a solid bridge between their cause and that of their social justice critics, regardless of whether you feel the most recent criticisms of Sanders are valid. The Democratic Party depends on high turnout from African-American voters in order to win elections, and a candidate whose views on racial issues is suspect is one who could very well struggle to connect with one of the party’s core constituencies. In the 2016 presidential election — when the Clinton campaign hoped that black turnout would be stimulated by Trump’s long history of racist comments — black turnout fell to 59 percent, compared to 65 percent in the 2008 presidential election and 66 percent in the 2012 presidential election.

If Sanders wants to not only be the Democratic presidential nominee but America’s next Democratic president, he will have to resolve this issue.

Elizabeth Warren: “I am not running for president”

Elizabeth Warren (Credit: AP/Carolyn Kaster)

Sen. Elizabeth Warren, D-Mass., has just taken a major progressive player out of the race for the White House in 2020: herself.

“Yes, that’s my plan. I’m running for the United States Senate in 2018. I am not running for president of the United States. That’s my plan,” Warren told reporters on Thursday when asked if she would serve for a full term if re-elected in November, Politico reported.

The question, which was posed to Warren during a moderated town hall event on Thursday evening at the Boston Teachers Union, came amidst a campaign for reelection that is sure to be followed throughout the country. Because of her outspoken progressivism and reputation as an articulate and cerebral legislator, Warren has become a champion to many on the left, fueling hopes that she would seek the presidency in the 2020 election cycle. Because she is running for re-election to the Senate, however, it’s prompted one of her possible Republican opponents, state Rep. Geoff Diehl, to claim that Warren is “more focused on running for president than doing her job.”

Warren had also made moves in her Senate career that some observers believed foreshadow a presidential run. Most notable among them was her request to join the Armed Services Committee, which was uncharacteristic of her given that she normally focused on labor issues and regulating Wall Street. The perception among political insiders was that she was trying to beef up her foreign policy credentials so as to have a stronger resume if she chose to run for president in 2020. Sen. Bernie Sanders of Vermont, an independent who made a strong showing in the 2016 Democratic presidential primaries, was often criticized for his lack of foreign policy chops.

The Massachusetts senator also became something of a feminist icon when she was forcibly silenced by Senate Majority Leader Mitch McConnell during a speech criticizing Trump’s appointment for attorney general, then-Senator Jeff Sessions of Alabama. The language that McConnell used to justify his decision — “Sen. Warren was giving a lengthy speech. She had appeared to violate the rule. She was warned. She was given an explanation. Nevertheless, she persisted.” — soon became infamous, with many on the left interpreting it as an attempt by a powerful man to silence an eloquent woman speaking truth to power. Warren hadn’t even been speaking her own words at the time; she had been reading from a letter written by Coretta Scott King, the widow of Dr. Martin Luther King, Jr.

Yet there were also potential pitfalls to a Warren candidacy. The most notorious one was that Warren had claimed to be of partial Native American ancestry despite being unable to prove it, even going so far as to list herself as the member of a minority group in a law school directory. Her decision to do this had become the source of considerable derision, with President Donald Trump giving her the derogatory (and, some would argue, racist) nickname “Pocahontas.”

“I get why some people think there’s hay to be made here. You won’t find my family members on any rolls, and I’m not enrolled in a tribe,” Warren admitted on February.

She added, “And I want to make something clear: I respect that distinction. I understand that tribal membership is determined by tribes — and only by tribes.” She also insisted that she had “never used my family tree to get a break or get ahead. I never used it to advance my career.”

Warren also stuck by her claim of being part Native American, saying that “my mother’s family was part Native American” and that the story of her parents’ getting married despite her father’s opposition to the relationship “will always be a part of me. And no one — not even the president of the United States — will ever take that part of me away.”

Warren’s announcement that she will not run for president in 2020 has major implications for the Democratic presidential race that year. The only candidate as famous and beloved by progressives as herself who is still a possible contender is Sanders, who will be 79 on Election Day 2020. Although Warren could renege on her statement and run for president in 2020 anyway, the declarative nature of her statement would make it difficult for her to avoid being accused of lying in order to get re-elected.

The community knew the man, but the cops who pulled their triggers didn’t

Hundreds rally to protest the fatal police shooting of Saheed Vassell, April 5, 2018, in Brooklyn. (Credit: AP/Bebeto Matthews)

On, Wednesday, April 4, as the nation mourned the 50th anniversary of Rev. Dr. Martin Luther King Jr.’s assassination, another black man was killed by the police. His name was Saheed Vassell. He was 34 years old and known to be living with a mental illness in his Crown Heights, Brooklyn community. Police say they fatally shot Vassell after he pointed what they thought was a gun at them. The object turned out to be a metal pipe with a knob on it, resembling a shower head. Four officers, including three in plainclothes, fired 10 shots in total, including one to his head and two to his chest, according to the city’s Medical Examiner’s Office.

The script feels all too familiar, as the killing comes less than three weeks after police shot and killed unarmed black man Stephon Clark in his own backyard in Sacramento, Calif., after authorities say they mistook a cellphone for a gun. He was struck eight times. But with Vassell, who was known widely by residents of his community as both mentally ill and safe, police say they responded to three 911 calls by people who alleged Vassell was threatening people with a silver gun. Beyond the horrific reality of the police in this country who are criminally quick to fire and kill black people — and often unarmed — Vassell’s death also points to the violence of gentrification.

Given the prevalence of police violence in black communities, “one of the worst things white people can do when gentrifying black neighborhoods is be all too quick and/or happy to call the cops,” Brooklyn resident Mel Flannery wrote on Instagram.

Last year, NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health surveyed black residents in various communities about discrimination. The survey found that “the expectation of discrimination from the police also led many of the people surveyed — about 3 in 10 — to say they avoided calling the police when they were in need. (Low-income respondents were more than twice as likely to say they avoided calling the police.) That finding dovetails with recent research that found that high-profile local instances of police violence — and the subsequent erosion of trust in the police — makes people less likely to call 911.”

In the wake of his death, many longtime Crown Heights residents spoke of their familiarity with Vassell. The New York Times reported that a woman who worked at a beauty salon in the neighborhood “described Mr. Vassell as a quiet man who often sat outside near a barbershop and sometimes worked odd jobs at her beauty salon for a few dollars.” The Times continued: “Rocky Brown, 45, who knew him for years, said he was a friendly man who was mentally ill. ‘He’s harmless,’ Mr. Brown said. ‘A very willing guy, a very nice guy, a good guy.'”

Similarly, Doreen St. Felix of the New Yorker reported:

Many people on the street had facts about his life. His nickname was Sy. He lived with his family just up the block from where he was killed. He had a teen-age son named Tyshawn. He did odd jobs and errands for neighbors and, sometimes, worked as a welder. He was a neighborhood character, handsome and helpful. At some point he had been diagnosed with bipolar disorder. Residents told me that they believed that the police knew about the diagnosis, and, according to the Times, ‘officers had classified him as an emotionally disturbed person in previous encounters.’

Thursday, the NYPD released partial transcripts of some of the 911 calls about Vassell. “There’s a guy walking around the street,” one said. “He looks like he’s crazy, but he’s pointing something at people that looks like a gun. And he’s like popping it as if, like if he’s pulling the trigger.”

But had this caller asked any number of people in the community who the man was or why other residents were hesitant to call the police, perhaps Vassell would still be alive. Of course, unfamiliar newcomers to a neighborhood not calling 911 won’t end the epidemic of police killings of unarmed black men and women, but as the Chicago Reader puts it, “Some incidents of police violence could be prevented if people reconsidered the knee-jerk response of dialing 911 whenever they feel uncomfortable.”

Thursday, New York State Attorney General Eric Schneiderman’s office opened an investigation into Vassell’s death. “We’re committed to conducting an independent, comprehensive and fair investigation,” a spokeswoman for the Schneiderman’s office said. Thursday evening, hundreds of people gathered in Crown Heights for a march and vigil to mourn Vassell and protest how police violence that disproportionately affects black and brown communities.

“He was my lifelong neighbor who’d offer to walk me home if I was coming home late,” Maya Paul, who lives in the home next door to the one Vassell shared with his family, said to the Village Voice. “The reason we’re here is because we all know who he was,” 18-year-old Amandre Taylor also told the outlet.

Just as Vassell’s death is all too familiar, so is its aftermath. The NYPD has not released the names of the officers who gunned Vassell down — nor any footage of the killing. And only partial transcripts of the 911 calls have been published.

Hortencia Peterson, aunt of Akai Gurley, an unarmed black man who was fatally shot by an NYPD officer in 2014, spoke directly to New York’s gentrifiers. “You are visitors in our communities,” she said during Thursday’s rally, according to the Village Voice. “Stop calling 911. Blood is on your hands.”

Blue wave gains strength: Even more Republicans are vulnerable in 2018

Paul Ryan (Credit: Getty/Win McNamee/AP/Pablo Martinez Monsivais)

A blue wave is expected to sweep in Congress in the midterm elections and recent polling data shows the tide is still rising.

13 congressional districts have shifted in the Democrats favor ahead of November’s midterm elections, according to the Cook Political Report, with Rep. Sean Patrick Maloney’s New York district and Rep. Dave Loebsack’s Iowa district moving from likely Democrat to solid Democrat.

This is yet another sign that the blue wave could look like a tsunami in 2018.

While President Donald Trump’s approval rating has risen in recent weeks, ticking up from 38 percent to 40 percent since January. Trump’s popularity boost is likely due to a shift in focus from deeply unpopular Republican proposals on health care and taxes to the economy, tariffs and Stormy Daniels. That is in addition to Republicans closing in on Democrat’s early lead in generic polling on the question of which party voters would support for Congress.

Still, though, Trump’s popularity is historically low at 40 percent — the lowest of any modern U.S. president — and Republicans continue to trail Democrats on the generic ballot by eight points, which the Cook Political Report says is enough to erode the GOP’s advantage from favorably drawn districts and endanger their majority.

Here are some reasons Democrats could win the race for Congress:

The Enthusiasm Gap

A new report suggests Democrats enjoy a wide voter enthusiasm gap. According to a new CNN/SSRS survey, 51 percent of Democrats and Democratic-leaning voters said they were “extremely” or “very” enthusiastic about voting in November, compared to 36 percent of Republicans and Republican-leaning voters. Young voters, Trump’s weakest age group, have a significant interest in the 2018 midterm elections, and overwhelmingly disapprove of Trump.

This enthusiasm gap has been glaring in off-year and special elections all cycle, including last month in Pennsylvania’s 18th Congressional District, where Democrat Conor Lamb won a special House election in a district Trump had carried by nearly 20 percentage points in 2016. Turnout was especially high in Pennsylvania’s special election: about 228,000 votes had been counted. That equals 62 percent of the 370,000 votes cast for presidential candidates in the district in 2016, according to data from Daily Kos Elections and analyzed by FiveThirtyEight’s Nate Silver.

Turnout was equally high in December’s special Senate election in Alabama, in which 64 percent of presidential-year turnout sent turned the Yellowhammer State blue for the first time. That was an impressive win for Democrats, though one with extenuating circumstances.

A surge of Republican retirements make the GOP map tougher

Retirements are often a strong indicator for which direction a party is heading, and so far, the field continues to go downhill for Republicans, who will be defending twice as many open seats this fall as Democrats.

There are at least 38 districts where Republicans have announced they are retiring, running for another office, or resigning outright, including 12 at serious risk of falling to Democrats, according to the Cook Report. Only 18 Democrats are exiting, and just four represent seats at serious risk of falling to the GOP, the Cook Report said.

Pennsylvania’s new court-ordered congressional map

Pennsylvania’s new court-ordered congressional map was another strike for Republicans. Under the previous map, Republicans won 13 of the state’s 18 congressional districts in 2016, when President Trump carried 12 of the 18 states. The new map — along with the retirements of two GOP incumbents — gives Democrats the chance to pick up four to six seats.

“This is pretty close to a Democratic wet dream,” Christopher Nicholas, a Republican consultant based in Pennsylvania, said of the new map to Politico.

The positive news for Democrats comes as former Democratic Governor Phil Bredesen has a double-digit lead over Republican Rep. Marsha Blackburn in Tennessee — an indication that a blue wave is on its way to hit another deeply red state. Despite the positive forecast for Democrats, only two of the 50 states have held their primaries so far, guaranteeing neither party will sail smoothly across 2018, so even though the blue wave is starting to look more like a tsunami now, it may end up a ripple.

 

Tele-monitoring can reduce medical appointments for low-risk pregnancies

(Credit: AP)

When Allison Matthews was pregnant with her first child four years ago, her obstetrics clinic scheduled frequent appointments to make sure everything was proceeding normally.

“I was taking time off work and it wasn’t doing a lot for me,” said Matthews, who was considered at low risk for complications like pregnancy-related high blood pressure, also known as preeclampsia. “I kind of felt like I was almost doing it more for the clinic’s benefit than for myself.”

When she got pregnant again early last summer, the obstetrics practice at the Mayo Clinic in Rochester, Minn. gave her the option of coming in for just eight clinic visits rather than the usual 12 to 14. Matthews is a clinical services designer at the Mayo Clinic.

As part of its OB Nest program for low-risk expectant mothers, she would monitor her weight and track her blood pressure and fetal heart rate at home with equipment provided by the clinic. If she had abnormal results or any questions or concerns, she could contact her nurse online or by phone.

If she wished, she could join a social media group of other OB Nest patients monitored by clinic nurses.

Matthews loved the idea. The approach fit with her wish to treat pregnancy as a normal, healthy process rather than a medical illness that required frequent clinical interventions.

Doing the tests at home also made monitoring the baby’s progress a family event with her husband, Marc, and 4-year-old son, Gus, who could listen to his sister’s heartbeat.

“It was something we explored together rather than having it done for us,” said Matthews, 35. Their daughter, Lottie, was born about a month ago.

Technology increasingly allows clinicians and patients to connect online, via video or remote monitoring rather than face-to-face. But most obstetrics practices continue to follow the traditional model that includes at least a dozen in-person office visits over the course of an average 40-week pregnancy, with lab work and ultrasounds at intervals along the way.

According to the American College of Obstetricians and Gynecologists, the standard pregnancy visit schedule is once every four weeks up to 28 weeks, every two weeks until 36 weeks, and weekly after that.

Although prenatal care is important for healthy outcomes, how much low-risk pregnancies need is debatable, health researchers say.

A study published in the Journal of Perinatology in 2016 found that babies born to women with uncomplicated pregnancies who had more than 10 prenatal visits were no healthier than those born to women with fewer, based on outcomes such as admission to the neonatal intensive care unit, low scores on the Apgar test that evaluates a newborn’s wellbeing, and death. Women with more than 10 prenatal visits, were, however, more likely to be induced or have a cesarean section delivery, the study found.

Patients at the Mayo obstetrics clinic in Rochester, many of whom, like Matthews, are employees of the medical center, can still go the traditional route. They can also opt for OB Nest or have joint appointments with other pregnant women in a group.

“Our goal is that OB Nest care becomes the model for low-risk women,” said Dr. Yvonne Butler Tobah, a Mayo obstetrician and health sciences researcher. Most pregnancies are low-risk, and if more patients choose OB Nest, which was added as a standard option for patients in 2016, it frees up time for doctors and midwives to focus on patients with high-risk pregnancies, she said.

But fewer visits may not translate into out-of-pocket savings on health care costs for women, since professional service fees for pregnancy, labor and delivery and postpartum care are typically bundled if the woman uses the same physician or physician group, said Katy Kozhimannil, an associate professor of public health at the University of Minnesota who studies women’s health care policy.

Women find savings in other ways, said Butler Tobah.

Many patients say the convenience helps save time and money, Butler Tobah said. “If it was their second or third child, patients [with an appointment at the clinic have] to pay for parking, get child care and wait in the doctor’s office, only to be told after a 15-minute visit that their pregnancy was fine.”

The potential of programs like OB Nest to make care more convenient and easily accessible to women who don’t live in urban areas is very appealing, said Kozhimannil. Although Mayo offers the program only in Rochester, it is moving ahead with plans to offer OB Nest to patients outside the Rochester area, said Butler Tobah.

Other obstetrics practices are experimenting with remote-monitoring programs for low-risk expectant mothers, said Dr. Nathaniel DeNicola, co-chair of the telehealth task force for the American Congress of Obstetricians and Gynecologists.

At the George Washington University Medical Faculty Associates in the District of Columbia, where he works, they’re one of several practices nationally using an app called Babyscripts to educate expectant moms, who can also transmit their weight and blood pressure data to the practice via a Wi-Fi connection. Some expectant mothers who use the app have fewer clinical appointments compared with the standard, he said.

A crucial element of these emerging remote-monitoring programs is that they’re closely integrated with the work of clinical staff, DeNicola said.

“All the remote monitoring is a way of augmenting traditional care, not replacing it,” DeNicola said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.