Helen H. Moore's Blog, page 107

Overeating? It may be a brain glitch

AP

With springtime comes the desire to shed those few extra pounds, in preparation to don swimsuits and head to the pool. This year, new obesity research is making it easier to find a pathway that is right for us.

There is no doubt that weight loss is a higher priority than ever before. Americans have never been fatter, with close to 40 percent obese and 70 percent overweight. Clearly, wishful thinking that the problem is going to go away is not working. Meanwhile, the risk of those extra pounds is ever more apparent. Even one condition, pre-diabetes — with 84 million Americans currently affected — can be daunting, as well as expensive. Moreover, the annual cost of diabetes in the United States is projected to climb to US$600 billion by 2030.

We want to lose weight and keep it off, but quick weight loss may not be the answer as it can dramatically slow metabolic rates, making weight rebound more likely. Nor is finding the “right diet” the solution as new research has shown that a variety of healthy eating plans all work similarly well, and with dieting rarely producing lasting weight loss, more people are giving up on weight loss altogether.

I am a health psychologist whose neuroscience research has led me to study the underlying causes of overeating and weight regain, specifically how physiologic stress or “brain stress” sets up a myriad of chemical changes that makes overeating and weight regain almost inevitable. I am convinced that much, if not most, of people’s struggles with food are based in the emotional part of the brain, specifically circuits that process stress, or circuits that we can rewire.

Why do people overeat?

One of the primary reasons people overeat and regain lost weight is that they have not changed the underlying behavior that leads them to crave comfort from food. These mechanisms play out mostly in the brain. Studies have shown that they are related to habitual ways of responding to stress that leave us triggered to overeat and awash in the chronic stress that promotes weight regain. It is difficult to overcome physiology with behavior change, medications or surgery, but a new study demonstrated that changing how we process stress changed food behavior without rigid dieting.

The patterns in the brain that control how we respond to stress are “wires.” Whether we reach for a cookie or bury ourselves in overwork, our daily responses to stress are the reactivation of instructions of how to respond that were encoded years or decades before. The hand that dips into the cookie jar is driven by the activation of a wire that was encoded during stress long before and unleashes chemical and electrical impulses that make us overeat in our currently daily life.

Traditional weight loss programs have not focused on changing these stress reactions that trigger overeating and I believe this is one reason their long-term effectiveness has been so dismal: Even if people lose weight, two-thirds of them regain more weight than they have lost.

Focus on the brain’s habits

The good news is that there are promising ways to retrain the brain and to help people change the way they think about food. In developing a neuroscience-based approach to weight loss, which we call Emotional Brain Training, my colleagues at the University of California, San Francisco and I decided to focus on changing the brain’s wiring that triggers stress eating. Our approach was to ask people to focus on something more positive than counting calories or measuring portion sizes: identify moments when they have cravings, indicating the offending circuit is activated and open to rewiring, and use simple emotional tools to process their stress and change the instructions encoded in that wire to reduce their desire to overeat.

This approach give practical application to the long-established stress-weight link. We know that in times of stress, three brain structures: the amygdala (“fear center”), the hypothalamus (“appetite center”) and the nucleus accumbens (“reward enter”), activate a cascade of biochemical changes that increase hunger, slow metabolism and favor fat deposition.

The missing link has been to find practical ways to control “brain stress” and those overreactions that trigger mindless eating, sugar appetites and food binges. The neuroscience-based approach is to focus on changing our stress wiring, the self-regulatory circuits that are triggered in a matter of nanoseconds that control our response to stress (and whether we eat that cookie or go for a walk instead). These stress wires are stored in parts of the emotional brain that activate automatic, unconscious responses. If we could change those wires, behavior change could be easier and, as activation of these wires contribute to chronic stress, lasting weight loss might be possible.

Survival circuits drive overeating

The specific wires that trigger stress eating and other stress-induced emotional and behavioral patters are called survival circuits. They encode instructions about how to feel, what to think and what to do when stressed and, once encoded, reactivate that response automatically. We all have some of these wires as our hunter-gatherer ancestors survived because of these primal instructions: If they ran to a cave and escaped the jaws of a hungry lion in rapid pursuit, a survival circuit was encoded to ensure the automatic replay of their response in a similar stressful situation.

However, there’s a glitch in the way the brain responds to stress in that the survival instructions that enabled our ancestors to reflexively race to a cave to survive a physical threat were generalized to emotional stress. Any random experience of emotional stress, particularly early in life or in adulthood during those inevitable times of stress overload, encodes this survival drive. If we coped by eating sugary, processed treats, the brain strongly remembers that response based on the associative learning of long-term potentiation, a process of encoding recent experience into circuits that control our strongly ingrained, lasting responses. The brain then reactivates that circuit in response to small daily stresses (to be sure that we “survive”) and we find ourselves with strong urges to overeat, as if our life depended upon getting that food.

I call these survival drives “food circuits” and once one has been encoded, dieting becomes very stressful as the circuit tells us that we need to overeat to meet our survival needs (safety, love, protection, security). We can eat healthy for a while, but when stress comes our way, our food circuit fully activates, and we cannot do what we “should” do and stay with our diet. Instead, we surrender to the instructions encoded in our food circuit to eat sugary, fatty foods that cause blood sugar highs followed by blood sugar lows that trigger hunger, stress, lethargy and weight grain. We are caught in a vicious cycle of dieting, weight loss, overeating and weight regain.

Zapping these circuits

What can we do about these wires? Researchers at New York University have opened the doors to using neuroplasticity to erase stress circuits. They found that these circuits could be rewired, but only if we intentionally activate a momentary level of stress that matched the stress level we were in when the circuit was encoded. We cannot relax our way to rewiring these circuits or think our way around them. We needed to learn how to stress activate them in order to change them.

The Emotional Brain Training approach draws upon this research, but involves two steps. Initially, participants target and weaken the circuits. Instead of counting calories, grams or points, they profile the circuits that trigger their overeating. They then use a technique that stress activates the offending drive and reprocesses the emotions stored in the circuit. This changes the wire’s faulty instructions that promote overeating into instructions to eat healthy. Second, after their drives for comfort food fade, they turn their attention to eating healthy and losing weight.

The field needs more research, but the approach is promising. A recent study showed sustained improvements in physiologic stress in a seven-week controlled clinical trial that EBT but not the behavioral comparison group maintained improvements in the stress that underlies weight regain at 20 weeks. In an observational study conducted at UCSF, researchers followed participants after 18 weekly trainings on the method’s tools and showed sustained weight loss even two years later, the first intervention to avoid the “V” shaped weight loss curve of obesity treament: losing weight during the treatment, then rapidly regaining it thereafter.

Moving from dieting to rewiring

As obesity causes both personal suffering and a budgetary health care crisis, perhaps it’s time to reinvent the wheel. Our relentless pursuit of changing what we eat without changing the brain’s habits that cause the stress that promotes overeating and regain needs updating.

Using brain-based methods to make it easier to push away from the table and eat healthy could help turn around the nation’s obesity epidemic and, on an individual level, make it easier to peel off those extra pounds and enjoy our summer weekends at the beach.

Laurel Mellin, Associate Clinical Professor of Family & Community Medicine and Pediatrics, University of California, San Francisco

Is “girl power” creating a mental health crisis?

Phoebe Jones

When Rachel Simmons was a teen and young adult, she thought if she just did everything the right way she could make her life amazing.

“Life was like a test that I could ace if I only worked hard enough,” she told me in our interview for "Inflection Point."

It wasn’t until Rachel was a Rhodes Scholar studying at Oxford that she realized that in her relentless pursuit of academic excellence, she had denied herself the confidence and wisdom that can only be gained through risk, rejection and failure.

“I came to understand that my whole life and self-esteem had been defined by my accomplishments,” Rachel said. “And at the same time, so obsessed had I become with these accomplishments that I really disconnected from what I cared about.”

Like many American girls raised after the Women’s Movement, Rachel grew up believing that not only could she accomplish anything she put her mind to, but she was also expected to excel at everything.

‘In some ways, ‘girl power’ and all of these incredible wins the girls have achieved have bequeathed a kind of mental health crisis,” Rachel told me.

Rachel writes in her latest book, "Enough As She Is" that an ‘“anything is possible” mentality among American girls has led to unintended consequences: Girls are twice as likely than boys to develop mood disorders like anxiety and depression and are disproportionately affected by eating disorders and self-harming behaviors.

While the exhausting pursuit of perfection isn’t unique to girls, they tend to internalize their fears of failure in ways that end up affecting their sense of self-esteem and ability to advocate for themselves more so than boys. Girls see their failure not only in terms of their own pain, but also the pain or displeasure it causes others. Since girls are socialized to take on the emotional labor in relationships, the optics of potential failure can lead to greater damage than the failure itself.

“If you're expected to in some way please others, let's say at best you're expected to please them, at worst or in the most powerful expression of this you are literally expected to take care of them as a caregiver.” Rachel said. “You are going to naturally attune to ‘how is that person feeling?’ And ‘is that person angry?’ And I would say if someone is upset with you, it begins to get under your skin."

"And we know from research that girls’ self-worth and their sense of themselves are more deeply affected by conflict with others, like they’re porous. It gets under their skin in a really powerful way," she continued. "So there's a very strong relationship between the role that girls and women are expected to play of caregivers and then that worrying and wondering ‘what do other people think of me?’”

This nagging anxiety can follow girls as they pursue more achievements, eventually expressing itself as what Rachel calls “Not Enough Syndrome.”

“So many girls are walking around feeling that they need to be more than they are, and it’s harming them,” she said.

And it doesn’t end in the teen years. These “Not Enough” girls grow into women who take on many roles in their lives — as business leaders, mothers, caregivers and wives — and they feel like they’re not good enough in any of them.

“The reality is, if we as moms are not feeling enough, we will transmit that to our daughters.” Rachel said.

So how can girls and women get to a point where they can say “I am enough, as I am”?

“We have to teach girls to pursue their goals somewhat differently,” Rachel said. “I talk a lot in this book about helping girls understand that in everything they do, there's a process — there's a journey. It's not always about the end point. It's not always about the polished finish. It's about what's the minimum benefit that you got from doing something. It's about trying things where you know you might fail. But we all have to commit ourselves to that every day.”

So, if "girl power" as we know it is leading to a mental health crisis, what does that mean for the feminist movement? Rachel told me, “I think part of what's happening at least in the last year around #MeToo, and more and more girls and women raising their voices around political change is that we're not just seeing the emphasis on achievement, we're seeing more of an emphasis on making a difference and changing the culture. And I actually think that's really healthy for girls because it's connecting them to something bigger than themselves. I think where girls are in trouble is when they believe that achieving equality is more about individual success than being part of something bigger than they are. And I think that anything that we can do to help girls’ striving for success be purposeful is going to make them healthier and is going to make gender equality much more achievable, and certainly something we can be really proud of.”

To hear more about how Rachel came to terms with her own perfectionism and how we can help our daughters feel that they are enough, listen to our conversation on "Inflection Point."

Hear more stories of how women rise up on "Inflection Point" on Apple Podcasts, RadioPublic, Stitcher and NPROne.

“Roseanne” and “Good Times”: A ballad for Becky and Darlene

ABC/Greg Gayne

Tuesday’s episode of “Roseanne,” “Eggs Over, Not Easy,” allowed me to think a bit differently about the series. But that was only after processing it through my memory of another classic sitcom about a working class American family, “Good Times.”

For the most part “Good Times” played no role in my childhood. This was by design: my mother specifically banned her children from watching it. To me this seemed to be an odd decision for a black woman raising kids on the South Side of Chicago, given that the Evans family of “Good Times” also is a black family on the South Side of the Chicago.

They were not us, she explained, and that was that. Her declaration left me befuddled nevertheless, even more so when I matured into adulthood, moved out and finally watched a few episodes for myself.

“Good Times” grappled with subject matter such as child abuse, alcoholism, busing, predatory scams and health problems among poor black families.  (“Roseanne” deals with similar content.) But what hooked viewers was  Jimmie Walker’s rubbery strut, his goofiness and his character’s signature catchphrase “Dy-no-mite.” Three syllables, blurted just so, and the studio audience would come undone.

Much later I asked her my mother why she didn’t let us watch the series. I assumed she didn’t want us to watch a vision created by white writers about what it was like to be poor and black. Other shows that came before “Good Times” did that poorly.

But she explained that “Good Times” had wandered away from its original mandate. She didn’t just want the show to magnify struggles, she said, but also the joy, dignity and spirit of Esther Rolle’s and John Amos’ characters. They were parents like her, and like her parents. It galled her that producers pushed the antics of J.J., the family clown, to the forefront instead.

“What seems to be called for now is a greater relevance among characters and a closer rein on a tendency to slide toward old-time black minstrelsy,” wrote Louie Robinson in a 1975 Ebony article about the series. “And what is being revealed is a healthy awareness on the part of black performers that they are responsible for cleansing the stained image of blacks so long perpetrated on stage and screen.”

“Good Times” was meant to put a human face social issues and the thudding impact policy decisions have on America’s poorest. But save for those who may have watched it religiously and/or recently, Walker’s character may prove to be its most lasting legacy, perhaps second to Janet Jackson’s role in it. “Good Times” remains legendary, and was a hit in its early seasons. But my mother wasn’t alone in her opinion.

All of comedy is subjective; certainly our feelings about “Roseanne,” Roseanne Conner and Roseanne Barr are influenced by how we feel about her politics and how we feel about her. But if the goal is to emphasize how wrongheaded she is, it seems strange for the writers to spend most of these opening episodes making her low-grade discontent and acrimony hilarious.

But this also accentuates why “Eggs Over, Not Easy,” to intentionally co-opt a Trumpian media catchphrase, is the episode where “Roseanne” fully becomes the comedy we used to love.

I don’t say this merely because Tuesday’s episode focuses on Darlene (Sara Gilbert) and Becky (Lecy Goranson) instead of Roseanne, or because it finds its warmth in two similar yet contrasting visions of sisterhood or its ruminations on motherhood and fertility. (Roseanne’s and Jackie’s tag team comedy during a raucous caper at a pet rescue proved that the chemistry between Barr and Laurie Metcalf is alive and kicking).

Rather, “Eggs Over, Not Easy” at last achieves formulaic balance, getting past the specificity of its title character’s outlook and pettiness. The script excavates the wreckage of personal tragedy, a universal experience, while remaining true to its core intent. It proved that “Roseanne” can still live up to its reputation as a great sitcom.

There’s an argument that’s been gaining credence that if there is truly a common concept of “us” to which “Roseanne” is speaking, that vision is realized in Darlene and Becky.

It’s a reasonable position. Roseanne and Dan Conner’s adult, middle-aged daughters are mired in the same financial and emotional swamp in which much of the audience is wandering or sinking. Job loss boomeranged Darlene and her children back into Roseanne and Dan’s threadbare nest, while Becky’s chronic underemployment is the result of clinging to a carefree and mischievous youth that’s all but disappeared in her rearview mirror.

Without a doubt, the only centrist if not totally reasonable voice in a place Becky lovingly refers to as “the Mongolian cock fight that is our childhood home” are these two, women who despite their best efforts couldn’t avoid being smacked around by life. In season 10 we meet them again, only now they’re hanging on to the edge of the cliff by their fingernails. Just like their parents.

Unlike Roseanne and Dan — but mostly Roseanne and Jackie (Metcalf) — they’re also the softest voices in the place. This mirrors our concept of how the national conversation is going, I guess, but it also deflates that optimistic argument about Darlene and Becky. Even when they're speaking from the peak of sensibility they’re drowned out by the booming, stubborn, catty and oh-so-sure-she’s-correct voice from on high that is Roseanne.

Gilbert is an executive producer on “Roseanne,” as is Whitney Cummings, a liberal-leaning comedian. Their close involvement with the reboot’s direction gives critics a sense that this skew is by design and that eventually we’ll see the tables turn on Roseanne. We’ve seen a lot of evidence that Roseanne isn’t the flawless grandma: she’s impetuous and bull-headed, often relying on her weary but endlessly loving husband Dan (John Goodman) to rein her in. Eventually, the argument goes, her entrenched view of how things are and should be will come back to bite her.

Honestly, I wasn’t sold on that perspective until Tuesday’s episode “Eggs Over, Not Easy,” when the series tied a bow on Becky’s barely believable surrogacy quest.

The viewer had to know that Becky’s dubious quest to dupe a rich woman into thinking she was young enough to be a surrogate was doomed from the moment medical science became a factor. That, and her misguided sense of priorities would rebound on her sooner rather than later. Thankfully the writers opted for sooner.

With the foolish get-rich-quick-scheme of surrogacy out of the way, the writers could spelunk into the human fragility driving the desperation more than the economics of it — Becky is a widow unable to shift out of neutral after losing her husband Mark (played by the late Glenn Quinn, who died of an overdose in 2002). She waited too long to have kids or move forward in life while Darlene, despite her best efforts, had the ground snatched out from under her feet. Disillusionment and regret were the themes of the day, along with the also-relatable experience of maternal meddling.

In this regard, the episode also sharpened its focus on a significant stumbling block of these new episodes, one that extends beyond a difficulty of separating the art and the artist, or Roseanne Conner from Barr.

Indeed, the very reason why it’s been hard to hear or notice Becky and Darlene until now, almost halfway through this season, is due to Roseanne’s revamping from wisdom-dealer to a cranky loudmouth who can’t help but be out of step with everyone around her.

The premiere presented her as the voice of Trumpism and of reason. The second established her frustration at Darlene’s depression and Becky’s wasted potential. Moping around is not a luxury the cash-strapped Conners can afford, but they’re not ready to give a potential grandchild to a stranger either.

Subsequent episodes showed Roseanne responding to her teenaged granddaughter’s smart mouth by shoving the kids head in the kitchen sink and spraying her with water, earning hoots and laughter from the live studio audience.

Roseanne is the embodiment to simpler times, the good old days. Her kids may have valid points but she gets the funniest lines. She’s inferred to be the voice of America, and that voice is loud enough to drown out those caught in the middle. And yes, that certainly mirrors the tenor of what’s going on in the real world.

But that also means she’s J.J. Evans with more sense and just as much of a talent of drawing attention away from substantive discussion. She’s  Archie Bunker of “All In the Family,” only here Archie is played as if he were the hero.

The counterweight to Archie Bunker is not just the other characters serving as a choir of reason and sensibility but mainstream culture itself, or our understanding of it in that time. Then we were a country falsely assuring ourselves that the civil rights movement had rendered blatant bigotry and small-mindedness Archie espouses unacceptable. He an ugly relic of  the past still kicking around in the present. That makes him the clown, but he’s also the butt of the joke.

Making such a distinction between Roseanne Conner and Barr, however, isn’t so simple. Most people didn’t hate Carroll O’Connor because he was completely different from Archie Bunker. Where “Roseanne” stumbles is in consciously blurring the line between actor and character.

Mind you, the series did the right thing in introducing the malevolent political tribalism that has metastasized on a national level into the family’s Midwestern kitchen (albeit clumsily). The series has always embraced debates about politics and cultural issues, and the electorate’s rift is certainly the top news of the day. Great sitcoms broach uncomfortable conversations by placing them in situations to which the broadest audience possible can relate. Multi-camera comedies in particular have a history of serving as laboratories where national conversations are refined to make bitter concepts palatable. The best ones achieve this by depicting the hard truth that life reminds us of our powerlessness now and then, whether through acts of nature or the will of a few men pandering to their political allies.

Where it falls down is in the scenes peppered with exclusionary humor that isn’t necessary and doesn’t serve the larger story. They may be blips, but a portion of the viewership notices and takes it as a wink at the nastier side of what’s happening in and to our culture right now. They remind us that what lurks underneath the mask isn’t kind or lovely.

Roseanne Conner speaks for a version of “us” who isn’t really all of us, saying what that version of “we” has supposedly always wanted to say. She is the sensible, morally-upright America that wants to view herself as good. She treats her grandson with gender identity issues with love and understanding, and cuddles with her bi-racial granddaughter. She also voted for a political figure who is working to curtail their civil rights.

Yes, “Eggs Over, Not Easy” is still about the economy and the desperation of working folks. What makes this episode more successful and evenhanded than those that came before is that it thrust the humanity of these characters to the front of the stage. We all grieve and we all lose. We all make our best attempts to shelter those we love from making terrible mistakes, and make errors in doing so, meddling where we’re not wanted and failing to intervene where and when we’re most needed. "Good Times" did this quite well when we looked past the facile reaches for laughs. And for once it looks like "Roseanne" might be able to get there too.

“Roseanne” star seeks treatment for her “battles” as revival remains dominant in weekly ratings

ABC/Robert Trachtenberg

Actress Emma Kenney, who plays the eldest child of Darlene in the hit revival of "Roseanne," announced that she is seeking treatment to deal with her "battles."

Kenney, who has been a part of the entertainment industry since she was nine years old, suggested that she has been struggling with childhood fame. "I was running with a really fast crowd. I was being naive and very immature. And I was doing things I should not be doing because it was illegal, and I’m not 21," Kenney revealed to In Touch Weekly.

"It wasn’t healthy, and it was making me feel even worse — anxious and depressed," she continued. "It was just a slippery slope that I did not want to go down, and I knew that I needed to stop it."

Now 18, Kenney has also been a cast member of the critically-acclaimed show "Shameless" since 2011, where she portrays the youngest daughter of star William H. Macy. The Showtime series' next season is scheduled to begin filming in May, and Kenny has been shooting the "Roseanne" reboot while on hiatus.

While Kenney says her "battles" haven't spilled over into the workplace, they have certainly affected her personal life. "I just didn’t know how to deal with stress, so I would have an occasional wild night," she told In Touch. "I would go out to clubs and bars with older friends in Hollywood."

"Now, in treatment, I will work on finding other ways to cope with boredom, find hobbies and better learn how to deal with stress," Kenney added. "I just think I need a mental sanity break and a break from the Hollywood scene."

She did not share what the treatment will consist of, but Kenney tells In Touch Weekly, "I’m going to work through it. I’m going to get help and make better choices."

But Kenney says she is going public about her decision to seek treatment "to send a message to my fans saying that it’s OK to admit that you need help, and it doesn’t make you weak," she said.

"I know I’m making the right choice by going to treatment," she continued. "And I’m going to come out the other side the right Emma, the true Emma that I’ve always been."

Before In Touch's article was published, Kenney took to her Twitter and Instagram accounts to say a temporary "goodbye" from both Hollywood and social media. "This sounds so cliche, but this town/industry can really get to you. Going to re-find my peace happiness," she wrote.

hello & goodbye (for a bit) ive decided to take a break from social media and LA for a minute. this sounds so cliche but this town/industry can really get to you. going to re-find my peace happiness✨✨✨✨✨✨✨✨xo emma

This is not a story about Donald Trump’s love child: It’s a lot more damaging than that

Getty/Chris Kleponis

Donald Trump is the perfect tabloid president: He was literally made famous, in his early years, by the New York tabloids, and has ridden that all the way to the White House, where he keeps on manufacturing tabloid stories.

Trump didn't attract the national spotlight and have shocking success in politics because he knew what ailed America, and had a plan to address the multitude of economic, social and political injustices that plagued the country. He screamed that everything was terrible, and enough people agreed with him that he won the election, despite losing the popular vote by a few million.

So of course people are now talking about a completely unverified and likely untrue report that Trump had a love child born sometime in the 1980s, rather than the systemic pattern of journalistic abuse that has turned the National Enquirer into a tool of Trump's political agenda and a slave to his whims.

The company that owns and operates the National Enquirer, American Media, Inc., went to great lengths to silence someone who was peddling something that was highly suspect, as Ronan Farrow reports in the New Yorker:

A.M.I.’s thirty-thousand-dollar payment to Sajudin [a onetime Trump Tower doorman] appears to be the third instance of Trump associates paying to suppress embarrassing stories about the candidate during the 2016 Presidential race. In August, 2016, A.M.I. paid Karen McDougal, a former Playboy model, a hundred and fifty thousand dollars for her story about a nine-month affair with Trump, and then never published an article about it. (A.M.I. said her story was not credible.) In October, 2016, Trump’s personal attorney, Michael Cohen, paid Stephanie Clifford, an adult-film actress who performs under the name Stormy Daniels, a hundred and thirty thousand dollars to keep her account of an affair with Trump secret. (Clifford’s agreement was distinct from McDougal’s in that it was arranged directly with Cohen. A.M.I. was not party to the contracts between Cohen and Clifford that have been released.)

Two of the former A.M.I. employees said they believed that Cohen was in close contact with A.M.I. executives while the company’s reporters were looking into Sajudin’s story, as Cohen had been during other investigations related to Trump. “Cohen was kept up to date on a regular basis,” one source said. Contacted by telephone on Wednesday, Cohen said that he was not available to talk. Subsequent efforts to reach him were unsuccessful. On Monday, F.B.I. agents raided Cohen’s hotel and office. The Times reported that the agents were looking for records related to the payments to McDougal and Clifford, as well as correspondence between Cohen, Pecker, and Dylan Howard, A.M.I.’s chief content officer.

It isn't just that the National Enquirer apparently went to extraordinary lengths to conceal what was likely a tall tale about Trump. The publication also tried to silence women who came forward with allegations against him. During the Republican primary campaign of 2016, the Enquirer served as an outlet to publish disreputable stories against Trump's opponents, most notably Texas Sen. Ted Cruz. On one occasion, the Enquirer published an article alleging that Cruz had "five different mistresses." (Which the senator vigorously denied.)

In response to the story, Trump went on the morning news shows, where he was able to capitalize on a story he likely colluded with the Enquirer to promote — and used the Enquirer story to attack his political rival even more.

Railing against the Enquirer in 2016, Cruz accused the outlet — correctly, in retrospect — of being in the bag for Trump.

“What is striking is Donald’s henchman Roger Stone had for months been foreshadowing that this attack was coming. It’s not surprising that Donald Trump’s tweet occurs the day before the attack comes out,” he said at the time. Cruz was referring to this tweet from Trump:

Lyin' Ted Cruz just used a picture of Melania from a G.Q. shoot in his ad. Be careful, Lyin' Ted, or I will spill the beans on your wife!

— Donald J. Trump (@realDonaldTrump) March 23, 2016

What may have looked at the time like a one-off piece of especially scurrilous tabloid reporting now seems like a sign of a much larger trend. Since Trump can't keep his mouth shut, either on Twitter or in real life, he often gives away information that he shouldn't. Recall the infamous June 2016 press conference in which Trump stood in front of reporters and issued the famous line: "Russia: If you’re listening, I hope you’re able to find the 30,000 emails that are missing."

That came at a time when Trump may already have known that Russian hackers had made attempts to gain access to Hillary Clinton's emails. It was after Donald Trump Jr.'s now-famous Trump Tower meeting with a group of Russians who had promised "information that would incriminate Hillary and her dealings with Russia and would be very helpful" to the Trump campaign.

At the core of Farrow's report on the National Enquirer, it has nothing to do with a highly dubious tale about a love child (something that the Trump campaign tried to attach to Bill Clinton in 2016). It's really about whether a media outlet was paying tens of thousands of dollars to do Donald Trump's dirty work, in probable violation of campaign finance law.

As the New Yorker article makes clear, one big unanswered question is what Donald Trump or his campaign may have promised the Enquirer in exchange for its efforts to kill all these stories about Trump's private life. Similarly, the payoff agreement with adult film actress Stormy Daniels isn't about whether or not Trump ever slept with a porn star. It's about whether, in the days leading up to the presidential election, Trump consigliere Michael Cohen was ordered to write her a big fat check, perhaps on the orders of the candidate or his campaign. If Trump is ever forced to testify about these events under oath, the consequences could be devastating: The cover-up is almost always bigger than the crime.

Former top EPA official: Scott Pruitt engaged in “unethical and potentially illegal actions”

AP/Pablo Martinez Monsivais

Environmental Protection Agency administrator Scott Pruitt directed staffers on several occasions to book expensive hotels against U.S. Embassy recommendations, and insisted on flying on an airline not approved by the government in order to earn frequent flier miles, a former top deputy of his alleged in a statement to congressional investigators.

The allegations, made by the agency's former deputy chief of staff Kevin Chmielewski, are merely the latest against Pruitt, who has repeatedly come under fire for unethical actions and taxpayer abuse. His allegations revealed both new details and corroborated information that had previously been reported.

The accusations became public in a letter to Pruitt and President Donald Trump on Thursday, which was sent by Democratic lawmakers in the House and the Senate who requested he turn over all related documents that would verify the allegations.

"The new information provided by Mr. Chmielewski, if accurate, leaves us certain that your leadership at EPA has been fraught with numerous and repeated unethical and potentially illegal actions on a wide range of consequential matters that you and some members of your staff directed," the letter read.

Pruitt, who still owns a home in Oklahoma where he was the state's attorney general before his EPA appointment, insisted that staffers find him "something to do" so he could spend weekends there, Chmielewski told lawmakers.

In planning trips to Italy and Australia, Chmielewski alleged that Pruitt "refused to stay at hotels recommended by the US. Embassy, although, the recommended hotel had law enforcement and other US. resources on-site."

Instead, Pruitt "chose to stay instead at more expensive hotels with fewer standard security resources, and to bring your security team with you, at taxpayer expense," according to the letter.

The EPA brass also refused to fly airlines other than Delta, despite the fact that Delta was "not the federal government's contract carrier for the route" so that way Pruitt could "accrue more frequent flyer miles."

"Mr. Chmielewski said he observed that your travel destinations are often dictated by your desire to visit particular cities or countries rather than official business, and that you tell your staff to "find me something to do [in those locations]?" to justify the use of taxpayer funds," the letter detailed.

Chmielewski, a supporter and campaign aide to Trump, said he was marginalized at the agency as a result of his pushback against Pruitt. He alleged to congressional investigators that every time he tried to find out about something, he would get in trouble. Chmielewski has since been on unpaid leave.

"He [Chmielewksi] said that he watched as others were punished, demoted, and retaliated against when they tried to resist inappropriate directions that came from you or through your favored staff.

The letter was by Democratic Sens. Tom Carper of Delaware, Sheldon Whitehouse of Rhode Island, as well as Democratic Representatives Elijah Cummings of Maryland, Gerald Connolly of Virginia and Don Beyer of Virginia.

A separate letter sent by Carper and Sen. Jeff Merkley, D-Ore., on Tuesday requested that the EPA's Office of Inspector General investigate at least four email accounts reportedly used by Pruitt. "We respectfully request that you open an investigation into whether he is complying with the Federal Records Act and Records Management Policy when using these accounts," the letter read.

It continued, "Since early 2017, the EPA has received thousands of Freedom of Information Act (FOIA) requests from the public asking for email records, including those from Administrator Pruitt. With the use of multiple secret email accounts or addresses, we are concerned that the Office of the Administrator may be withholding information from the public in violation of valid FOIA requests."

Revelations about Pruitt's "unethical and potentially illegal actions" exemplify a recurring pattern of blatant abuse and corruption from within the Trump administration. Several top administration officials have been caught abusing taxpayer funds or engaging in other unethical actions. One of the key themes of Trump's campaign was his repeated promise to "drain the swamp" in Washington D.C., but it's evident that staffers across his administration have conducted themselves in the exact opposite fashion.

Gayle King grills Paul Ryan on GOP’s incredible whiteness

YouTube/CBS This Morning

House Speaker Paul Ryan sat down with CBS This Morning co-host Gayle King one day after news broke that Ryan will be stepping down from Congress. During their interview, King didn’t hesitate to call out the Trump administration for the remarkably homogenous demographics of its leadership.

Specifically, King asked about a photo that Trump tweeted on Tuesday night.

“Honored to have Republican Congressional Leadership join me at the @WhiteHouse this evening,” he said in his tweet. “Lots to discuss as we continue MAKING AMERICA GREAT AGAIN!”

Honored to have Republican Congressional Leadership join me at the @WhiteHouse this evening. Lots to discuss as we continue MAKING AMERICA GREAT AGAIN! pic.twitter.com/b9z5Nfdkcl

— Donald J. Trump (@realDonaldTrump) April 11, 2018

The photo, which Ryan was in, also included Vice President Mike Pence, Attorney General Jeff Sessions, Majority Leader Kevin McCarthy, and more.

“When I look at that picture, Mr. Speaker, I have to say, I don't see anyone that looks like me in terms of color or gender," King said to Ryan. "You were one of the main people who said you want to do more for the Republican Party to expand the base. Some say this President really doesn't want to expand the base."

"So when I look at that picture, I have to say, I don't feel very celebratory, I feel very excluded," she said.

"I don't like the fact that you feel that way," Ryan responded. He added, "We need more minorities, more women in our party and I've been focusing on that kind of recruitment."

Ryan then pointed to Rep. Mia Love, R-Utah, whom he mentors.

“The person I’ve been a mentor to is Mia Love, literally, technically, I became a mentor to, her name is Mia Love, she’s somebody I recruited in the primary to come to Congress,” Ryan said. “There are a lot of candidates like Mia that we're recruiting all around the country.”

Ryan continued to say that even though he is retiring he was going to "keep being involved and focusing on inclusive, aspirational politics."

Ryan assured King that just because he is leaving, that does not mean he is leaving the public.

“I’m going to keep fighting for the things I believe in and that’s among the things I want to do,” he said. “I’m going to spend a lot of time with my friend Bob Woodson on poverty initiatives, those are the things I care a great deal about that frankly I have not been able to spend time on because of a pretty busy day job.”

King went on to ask him he if was “jumping ship” from the Republican party.

Ryan responded, “not at all.”

The Republican Party’s diversity problem has been under extra scrutiny since Trump became president. From Trump’s immigration plan to his almost exclusively all-male leadership picks, diversity has not appeared to be a priority for the administration.

In January 2017, a Pew Research Center report stated that the 115th Congress set a “new high for racial [and] ethnic diversity.” However, Pew noted that in the House, the increased diversity largely originated within newly-elected Democrats. According to the report, there had been an increase from 56 to 83 minority representatives since 2001—in the Democratic party. In the Republican party, there was an increase of eight representatives over the same time period.

In 2016, Ryan shared a photo on his Instagram page and Twitter and said that it was the "most number of Capitol Hill interns in a single selfie.” The racial diversity in the photo was almost non-existent. This likewise led to a lot of criticisms and discussions regarding diversity in politics, and indeed, the photo led to the creation of the hashtag #GOPSoWhite, a play on the #OscarsSoWhite.

Why did @SpeakerRyan make the black intern take the picture? #smdh pic.twitter.com/RKJe9HXmnb

— Clay Aiken (@clayaiken) July 17, 2016

Then there was the time Ryan tweeted—then quickly deleted—a message that praised a public high school secretary told AP News that she received a $1.50 weekly pay raise after the GOP tax cut bill passed—an extra $78 a year.

“A secretary at a public high school in Lancaster, PA, said she was pleasantly surprised her pay went up $1.50 a week… she said [that] will more than cover her Costco membership for the year,” the message said.

Many thought the tweet epitomized Ryan’s inability to comprehened the struggles of the working class.

As my colleague Matt Rosza wrote, Speaker Ryan may have tried to be a principled conservative in his early days, but he is likely to leave an unimpressive legacy.

“Even if one sets aside Ryan's willingness to toss aside his own principles by working with a demagogue, the House speaker has also been derided for revealing himself to be inept by not even selling out in the name of some kind of substantive legacy,” Rosza wrote. He continued: “After all, unlike his predecessor Nancy Pelosi, Ryan didn't manage to work with a president from his own party to pass (or repeal) a number of landmark bills. Instead his success was limited to a tax reform law that many expect will significantly worsen the budget deficit that Ryan has long vowed to rein in.”

Pressure mounts on Missouri governor to resign

AP/Jeff Roberson

Missouri Gov. Eric Greitens is facing calls for his resignation from members of both parties as more horrifying details come to light about the sexual misconduct accusations against him.

A St. Louis hairdresser told a committee in the Missouri House of Representatives that Greitens beat her, coerced her into sexual activity and threatened to blackmail her in his basement in March 2015, according to the Kansas City Star. The Star's description of how Greitens allegedly treated the anonymous woman is harrowing:

The woman told the committee that Greitens had led her down to the basement, taped her hands to pull-up rings, blindfolded her, spit water into her mouth, ripped open her shirt, pulled down her pants and took a photo without her consent.

He threatened to make the photos public if she ever told anyone about their encounter, and called her "a little whore," the woman told lawmakers.

After her hands were freed, she said she felt she had no other choice but to perform oral sex if she was going to get out of the basement.

The woman claimed that there were other sexual encounters with Greitens in 2015, with some being consensual and others being non-consensual. She also claimed that he hit her on some of those occasions.

Greitens has insisted that, contrary to his accuser's accusations, he simply engaged in a consensual affair, and has refused to resign despite a call from Missouri Attorney General Josh Hawley for him to do so. The House committee to which the woman testified — which contains five Republicans and two Democrats — concluded that her testimony was credible, perhaps because they also spoke with two of her friends (who both claimed that she had relayed this story to them at the time) and the woman's ex-husband.

Missouri House Speaker Todd Richardson also said that the "beyond disturbing" testimony was enough that a special session should be called to consider disciplinary actions that could include impeachment.

"The power given to the Missouri General Assembly to take disciplinary action or remove elected officials from office is one of the most serious and consequential powers the Constitution grants the legislature. We will not take that responsibility lightly. We will not act rashly, but we will not shrink from it," Richardson declared in light of the testimony.

Rep. Ann Wagner, a United States Representative from Missouri, has joined in the calls for Greiten's resignation.

"This is a sad chapter in our history that should never have come to pass. Two months ago, after the disturbing allegations against the Governor came to light, I called for an immediate and transparent investigation. The transcripts paint the picture of a vulnerable woman and a man who preyed on that vulnerability," Wagner explained in a statement in which she also declared that Greitens was "unfit to lead our state."

The story of Greitens' alleged transgression broke in January. One month later, the governor was taken into custody after being indicted by a federal grand jury on one count of felony invasion of privacy charge. At the time, Greitens insisted "there was no blackmail, there was no violence, there was no threat of violence, there was no threat of blackmail, there was no threat of using a photograph for blackmail. All of those things are false."

The woman's testimony painted a very different story, according to CNN.

"You're not going to mention my name. Don't even mention my name to anybody at all, because if you do, I'm going to take these pictures, and I'm going to put them everywhere I can. They are going to be everywhere," he said, according to her testimony, "and then everyone will know what a little whore you are." The governor previously denied that he had ever blackmailed or threatened the woman.

His wife also urged the public to look past the scandal, characterizing it as an affair for which she had already forgiven him.

"We understand that there will be some people who cannot forgive—but for those who can find it in your heart, Eric asks for your forgiveness, and we are grateful for your love, your compassion, and your prayers," Sheena Greitens explained in a statement.

Parkland teacher who pushed for arming teachers left a loaded gun unattended

AP/John Minchillo

A chemistry teacher at the Florida high school where 17 people were fatally killed on February 14 has been arrested. Authorities say he left a gun in a public bathroom, where a drunk homeless man picked it up and fired it. The gun was loaded.

No one was injured, and the teacher at Marjory Stoneman Douglas High School was charged with failing to safely store a firearm, a second-degree misdemeanor punishable by a maximum of 60 days in jail. The weapon belonged to Sean Simpson, who teaches chemistry, according to the Broward County Sheriff's Office. Simpson posted a $250 cash bond and was released.

Simpson told deputies he'd left his gun in the restroom by accident, the sheriff's report says. By the time Simpson realized his mistake, the Glock 9mm was already in the hands of the vagrant, Joseph Spataro, who had picked it up and fired. The bullet hit a wall.

Simpson was able to grab the handgun away from Spataro, who was charged with firing a weapon while intoxicated and trespassing. He told deputies he'd fired the gun to see whether it was loaded. The bullet didn't strike anyone and was later recovered by officials, who were alerted to the incident by a witness running from the scene.

"There was a reasonable likelihood that the firearm could have ended up in the hands of a child or the discharge of the firearm could have wounded another person or child," officials wrote in the arrest report.

The students at Douglas, who started the Never Again movement to advocate for gun control in the aftermath of the Valentine's Day shooting, expressed disappointment and frustration at the situation.

"I've spoken with Mr. Simpson before, never thought there would be that amount of negligence from a Douglas teacher," Ryan Deitsch, a senior at Douglas and one of the leading voices of the Never Again movement, told Salon.

Another senior, Chris Grady, said, "This is precisely why [arming teachers] is a horrible idea. If he forgot it at the pier, what’s to stop him from leaving it out during a class and anybody could find it?"

Samantha Deitsch, a freshman and Ryan's sister, said Simpson shows a "lack [of] responsibility in owning that weapon."

"God forbid he left it in the restroom at school or on his desk, or anywhere accessible to students," she continued. "The outcome could be horrific." Deitsch added that the incident points to the work of the Never Again movement, which she said seeks "to promote background checks and common procedures to make sure responsible and eligible people can own a gun."

In addition to teaching chemistry, Simpson is known for being the teacher at Douglas who said he would be willing to arm himself while on the job to protect the high school.

"I know there are some of us that are willing to take the training if it was offered and probably be another line of defense," Simpson said during an interview with MSNBC, when asked about the prospect raised by President Trump of arming teachers. "But again that is a complicated subject and I'm not sure if it's the answer. I think it's easier to get these types of weapons out of the hands of people that aren't meant to do anything but kill."

On Tuesday, the Broward School Board unanimously rejected Florida's new program to arm school staff, part of a new law the state's legislature passed in the wake of the February 14 shooting.

WPLG-TV contacted Simpson, who would not comment but did say carrying a weapon around did not violate school board rules. He continues to be employed, and no disciplinary action is expected to be taken against him, added the station.

Simpson, who supervised student activist Emma Gonzalez on a science project and appeared in a short documentary made by David Hogg before the shooting in which he is referred to as a "Problem Solver," has been supportive of the students' fight for gun control and attended the March For Our Lives rally, a worldwide crusade to demand government action on gun control, in Washington, D.C. on March 24.

The science can no longer be ignored: Legal cannabis access reduces opioid abuse and mortality

AP

Scientific data is growing exponentially in support of the notion that legalized cannabis access can significantly mitigate opioid use and abuse.

On Monday, the esteemed Journal of the American Medical Association, Internal Medicine published a pair of persuasive new studies reinforcing this opinion.

In the first study, investigators from the University of Kentucky and Emory University assessed the relationship between medical and adult-use marijuana laws and opioid prescribing patterns among Medicaid enrollees nationwide. Enrollees included all Medicaid fee-for-service and managed care enrollee — a high-risk population for chronic pain, opioid use disorder, and opioid overdose.

Researchers reported that the enactment of both medicalization and adult-use laws were both associated with reductions in opioid prescribing rates, with broader legalization policies associated with the greatest rates of decline.

“State implementation of medical marijuana laws was associated with a 5.88 percent lower rate of opioid prescribing. Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38 percent lower rate of opioid prescribing,” they concluded. “[T]he further reductions in opioid prescribing associated with the newly implemented adult-use marijuana laws suggest that there were individuals beyond the reach of medical marijuana laws who may also benefit from using marijuana in lieu of opioids. Our finding that the lower opioid prescribing rates associated with adult-use marijuana laws were pronounced in Schedule II opioids further suggest that reaching these individuals may have greater potential to reduce the adverse consequences, such as opioid use disorder and overdose.”

In the second study, University of Georgia researchers evaluated the association between the enactment of medical cannabis access laws and opioid prescribing trends among those eligible for Medicare Part D prescription drug coverage. Researchers reported that medicalization, and specifically the establishment of brick-and-mortar cannabis dispensing facilities, correlated with significantly reduced opioid prescription drug use.

“This longitudinal analysis of Medicare Part D found that prescriptions filled for all opioids decreased by 2.11 million daily doses per year from an average of 23.08 million daily doses per year when a state instituted any medical cannabis law. Prescriptions for all opioids decreased by 3.742 million daily doses per year when medical cannabis dispensaries opened,” they concluded. “Combined with previously published studies suggesting cannabis laws are associated with lower opioid mortality, these findings further strengthen arguments in favor of considering medical applications of cannabis as one tool in the policy arsenal that can be used to diminish the harm of prescription opioids.”

The new findings should come as little surprise to those paying attention. State-specific data from cannabis-access jurisdictions have consistently established that in regions where medical cannabis access is permitted, patients routinely decrease their opioid intake. For instance, according to data published last month by the Minnesota Department of Health, among patients known to be taking opiate painkillers upon their enrollment into the program, 63 percent “were able to reduce or eliminate opioid usage after six months.”

Minnesota’s findings are hardly unique. 2016 data gathered from patients enrolled in Michigan’s cannabis access program reported that marijuana treatment “was associated with a 64 percent decrease in opioid use, decreased number and side effects of medications, and an improved quality of life.” A reviewof state-registered patients from various northeastern states yielded similar results, finding 77 percent of respondents acknowledged having reduced their use of opioids following cannabis therapy. A significant percentage of respondents also reported decreasing their consumption of anti-anxiety medications (72 percent), migraine-related medications (67 percent), sleep aids (65 percent), and antidepressants (38 percent).

A 2017 assessment of medical cannabis patients in Illinois revealed that participants in the state-run program frequently reported using marijuana "as an alternative to other medications c most commonly opioids, but also anticonvulsants, anti-inflammatories, and over-the-counter analgesics." New Mexico patient data reports: compared to non-users, medical cannabis enrollees "were more likely either to reduce daily opioid prescription dosages between the beginning and end of the sample period (83.8 percent versus 44.8 percent) or to cease filling opioid prescriptions altogether (40.5 percent versus 3.4 percent)."

Two just-published clinical trials from Israel (where medical cannabis use is legally permitted) further affirm this phenomenon. In the first study, which assessed cannabis use among the elderly, investigators reported that over 18 percent of the study's participants "stopped using opioid analgesics or reduced their dose.” They concluded, "Cannabis can decrease the use of other prescription medicines, including opioids." In the second trial, which assessed the safety and efficacy of cannabis in a cohort of over 1,200 cancer patients over a six-month period, scientists reported that nearly half of respondents reported either decreasing or eliminating their use of opioids during treatment.

Another recently published clinical trial provides insight into explaining the physiology behind this relationship. Investigators from Columbia University assessed the efficacy of low doses of inhaled cannabis and sub-therapeutic doses of oxycodone on experimentally-induced pain in a double-blind, placebo-controlled model. Researchers assessed subjects’ pain tolerance after receiving both substances separately or in concert with one another. While neither the administration of cannabis nor oxycodone alone significantly mitigated subjects’ pain, the combined administration of both drugs did so effectively.

Authors determined, “Both active cannabis and a low dose of oxycodone (2.5 mg) were sub-therapeutic, failing to elicit analgesia on their own; however, when administered together, pain responses . . . were significantly reduced, pointing to the opioid-sparing effects of cannabis.” They concluded, “Smoked cannabis combined with an ineffective analgesic dose of oxycodone produced analgesia comparable to an effective opioid analgesic dose without significantly increasing cannabis’s abuse liability.”

Growing evidence also indicates that patients’ alternative use of cannabis is associated with declining percentages of opioid-induced mortality among adults residing in legal access states. Data published in 2017 in the American Journal of Public Health reported that adult use marijuana sales in Colorado were linked with a 6.5 percent decrease in monthly opioid deaths. A 2014 study published by a team of investigators from the University of Pennsylvania and the Johns Hopkins Bloomberg School of Public Health in Baltimore reported an even stronger correlation. They determined, “States with medical cannabis laws had a 24.8 percent lower mean annual opioid overdose mortality rate compared with states without medical cannabis laws.” A 2015 examination by investigators at the RAND Corporation similarly determined, “[S]tates permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not.” A follow-up paper published by these same researchers in February further acknowledged, “[M]edical marijuana laws reduce the misuse of prescription opioids, as reflected in treatment admissions and overdose deaths, primarily through the allowance and opening of dispensaries.”

Despite claims to the contrary from the Trump administration, the available data is consistent and clear. For many patients, cannabis offers a viable alternative to opioids. It is time for the administration to stop placing political ideology above the health and safety of the American public, and to acknowledge the well-established efficacy of medical marijuana in the treatment of chronic pain.