Later On

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Archive for the ‘Medical’ Category

The Generic Drugs You’re Taking May Not Be As Safe Or Effective As You Think

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Since the four medications I take are all generic (and thus are inexpensive: a 3-month supply of all four drugs totals US$1.80). I dislike the idea that they are not well vetted. I notice that the GOP has consistently stripped of resources the agencies most important to protecting the public and funding the government: FDA, FAA, IRS, EPA, OSHA, CFPB, FTC, and so on. Republicans seem to be on a mission to destroy the US.

Dave Davies reports at NPR:

As the cost of prescription medication soars, consumers are increasingly taking generic drugs: low-cost alternatives to brand-name medicines. Often health insurance plans require patients to switch to generics as a way of controlling costs. But journalist Katherine Eban warns that some of these medications might not be as safe, or effective, as we think.

Eban has covered the pharmaceutical industry for more than 10 years. She notes that most of the generic medicines being sold in the U.S. are manufactured overseas, mostly in India and China. The U.S. Food and Drug Administration states that it holds foreign plants to the same standards as U.S. drugmakers, but Eban’s new book, Bottle of Lies, challenges that notion. She writes that the FDA often announces its overseas inspections weeks in advance, which allows plants where generic drugs are made the chance to fabricate data and results.

“These plants know that [the FDA inspectors are] coming,” Eban says. “I discovered [some overseas drug companies] would actually … alter documents, shred them, invent them, in some cases even steaming them overnight to make them look old.”

(In a statement to NPR, the FDA said that Americans “can be confident in the quality of the products the FDA approves” and notes it has “conducted a number of unannounced inspections” at foreign plants over the past several years.)

As a result, Eban says, generic drugs sometimes go to market in the U.S. without proper vetting. She describes the FDA as “overwhelmed and underresourced” in its efforts to ensure the safety of overseas drug production.

Eban advises consumers to research who manufactures their generics and look up any problems that regulators have found out about them. But some consumers may find they are not allowed by their health plan to switch to alternatives, because of cost.


Interview Highlights

On why many drug companies moved production overseas

There were a couple of reasons for this surge in globalization in the drug industry. One was environmental regulations. … How are you going to safely dispose of all the chemicals and solvents that you’re using? And … there was less environmental regulation overseas. But another one is: If you move your manufacturing plant to India, you’re going to save a huge amount on labor costs and supplies — ingredients — overnight.

And so what you saw was a huge migration, both of manufacturing to Indian-owned companies, Chinese-owned companies, but also Western- and U.S.-based companies, buying up manufacturing plants overseas and moving their manufacturing there.

On how the 1984 Hatch-Waxman Act changed the generic-drug industry

What it created was a pathway at the FDA, a distinct application process for generics, because prior to Hatch-Waxman, basically the generic companies had to do the same set of tests [and] clinical studies that the brand did, and Hatch-Waxman said, you know what? We’re gonna give you an abbreviated application. You can do the clinical studies on many fewer patients, because we’ve already proven safety and efficacy of this molecule in the human body.

But what Hatch-Waxman did that really ignited the generic-drug revolution is it gave the companies an incentive: The incentive was called “first to file,” and it said if you are the first company to submit your application — and literally first by the minute or the second — and you get approved, you’re going to get six months of exclusivity on the market to be the lead and only generic, and you’re probably going to be able to sell your drugs at about 80 percent of the brand-name price. And that “first to file” really became the difference between making a fortune and making a living.

On how some plants that make generics prevent FDA inspectors from doing thorough inspections

In several instances I documented, the investigators were poisoned in the course of their inspections with tainted water from the tap, which you can’t drink in India. They felt sick during inspections. I mean, this was a way of running out the clock. They were followed. In one instance, an investigator had his hotel room bugged. In some cases that I had heard about, [the plants] were trying to scan passenger lists in airports to try to determine exactly who was coming when. So there were elaborate measures that the plants took to try to protect against bad inspections.

On how the quality of generic drugs can vary depending on where the drugs are being sold . . .

Continue reading.

You can hear the interview at the link.

Written by LeisureGuy

20 May 2019 at 8:45 am

Regarding cardio exercise and brain function

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Also from How Not to Die, by Michael Greger MD:

In a 2010 study published in the Archives of Neurology, researchers took a group of people with mild cognitive impairment—those who are starting to forget things, for example, or regularly repeating themselves—and had them engage in aerobic exercise for forty-five to sixty minutes a day, four days a week, for six months. The control group was instructed to simply stretch for the same time periods.

Memory tests were performed before and after the study. Researchers found that in the control (stretching) group, cognitive function continued to decline. But the exercising group not only didn’t get worse, they got better. The exercisers got more test answers correct after six months, indicating their memory had improved.

Subsequent studies using MRI scans found that aerobic exercise can actually reverse age-related shrinkage in the memory centers of the brain. No such effect was found in the stretching and toning control groups or a nonaerobic strength-training group. Aerobic exercise can help improve cerebral blood flow, improve memory performance, and help preserve brain tissue.

Written by LeisureGuy

19 May 2019 at 2:32 pm

If states truly want to reduce the number of abortions: Colorado’s Effort Against Teenage Pregnancies Is a Startling Success

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An ounce of prevention is worth a pound of cure. From the article below: “The state health department estimated that every dollar spent on the long-acting birth control initiative saved $5.85 for the state’s Medicaid program, which covers more than three-quarters of teenage pregnancies and births. Enrollment in the federal nutrition program for women with young children declined by nearly a quarter between 2010 and 2013.”

Sabrina Tavernise reports in the NY Times:

Over the past six years, Colorado has conducted one of the largest experiments with long-acting birth control. If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years, state officials asked, would those women choose them?

They did in a big way, and the results were startling. The birthrate among teenagers across the state plunged by 40 percent from 2009 to 2013, while their rate of abortions fell by 42 percent, according to the Colorado Department of Public Health and Environment. There was a similar decline in births for another group particularly vulnerable to unplanned pregnancies: unmarried women under 25 who have not finished high school.

“Our demographer came into my office with a chart and said, ‘Greta, look at this, we’ve never seen this before,’ ” said Greta Klingler, the family planning supervisor for the public health department. “The numbers were plummeting.”

The changes were particularly pronounced in the poorest areas of the state, places like Walsenburg, a small city in southern Colorado where jobs are scarce and many young women have unplanned pregnancies. Taking advantage of the free program, Hope Martinez, a 20-year-old nursing home receptionist here, recently had a small rod implanted under the skin of her upper arm to prevent pregnancy for three years. She has big plans — to marry, to move farther west and to become a dental hygienist.

“I don’t want any babies for a while,” she said.

More young women are making that choice. In 2009, half of all first births to women in the poorest areas of the state happened before they turned 21. By 2014, half of first births did not occur until the women had turned 24, a difference that advocates say gives young women time to finish their educations and to gain a foothold in an increasingly competitive job market.

“If we want to reduce poverty, one of the simplest, fastest and cheapest things we could do would be to make sure that as few people as possible become parents before they actually want to,” said Isabel Sawhill, an economist at the Brookings Institution. She argues in her 2014 book, “Generation Unbound: Drifting Into Sex and Parenthood Without Marriage,” that single parenthood is a principal driver of inequality and long-acting birth control is a powerful tool to prevent it.

Teenage births have been declining nationally, but experts say the timing and magnitude of the reductions in Colorado are a strong indication that the state’s program was a major driver. About one-fifth of women ages 18 to 44 in Colorado now use a long-acting method, a substantial increase driven largely by teenagers and poor women.

The surge in Colorado has far outpaced the growing use of such methods nationwide. About 7 percent of American women ages 15 to 44 used long-acting birth control from 2011 to 2013, the most recent period studied, up from 1.5 percent in 2002. The figures include all women, even those who were pregnant or sterilized. The share of long-acting contraception users among just women using birth control is likely to be higher.

But the experiment in Colorado is entering an uncertain new phase that will test a central promise of the Affordable Care Act: free contraception.

The private grant that funds the state program has started to run out, and while many young women are expected to be covered under the health care lawsome plans have required payment or offered only certain methods, problems the Obama administration is trying to correct. What is more, only new plans must provide free contraception, so women on plans that predate the law may not qualify. (In 2014, about a quarter of people covered through their employers were on grandfathered plans, according to the Kaiser Family Foundation.)

Advocates also worry that teenagers — who can get the devices at clinics confidentially — may be less likely to get the devices through their parents’ insurance. Long-acting devices can cost between $800 and $900.

“There’s no lifeboat with the Affordable Care Act,” said Liz Romer, a nurse practitioner who runs the Adolescent Family Planning Clinic at Children’s Hospital Colorado, which went from giving out 30 long-acting devices a year in 2009 to more than 2,000 in 2013.

The state failed to get additional funding through the General Assembly this spring, a shortfall Ms. Klingler said would slow, but not stop, its progress.

Women’s health advocates contend that long-acting birth control is giving American women more say over when — and with whom — they have children. About half of the 6.6 million pregnancies a year in the United States are unintended. Teenage births may be down, but unplanned births have simply moved up the age scale, Ms. Sawhill said, and having a baby before finishing college can be just as risky to a woman’s future as having one while in high school.

Colorado’s program, funded by a private grant from the Susan Thompson Buffett Foundation, named for the billionaire investor Warren Buffett’s late wife, was the real-world version of a research study in St. Louis (also paid for by the foundation, which does not publicly acknowledge its role). The study came to the same conclusion: Women overwhelmingly chose the long-acting methods, and pregnancy and abortion rates plunged.

“The difference in effectiveness is profound,” said Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University in St. Louis, who ran the study. The failure rate for the pill was about 5 percent, compared with less than 1 percent for implants and IUDs.

The methods are effective because, unlike the pill, a diaphragm or condoms, they do not require a woman to take action to work. And while an early incarnation, the Dalkon Shield introduced in the 1970s, had disastrous results, the modern devices are safe and have been increasingly promoted by doctors. Last fall, the American Academy of Pediatrics published guidelines that for the first time singled them out as a “first-line” birth control option for adolescents, citing their “efficacy, safety and ease of use.”

“There’s been a big shift in the mind-set,” said Dr. Laura MacIsaac, director of family planning for Mount Sinai Beth Israel in New York. “The demand is coming from everywhere now.” . . .

Continue reading.

Why doesn’t Alabama, Georgia, Missouri, et al. try that approach?

Answer: If they were serious about reducing abortions, they would.

Written by LeisureGuy

17 May 2019 at 1:59 pm

Study Finds Ultra-Processed Foods Drive Weight Gain

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This report states one reason I prefer to make my meals from whole foods (the other reason being that I enjoy cooking). Maria Godoy writes at NPR:

Over the past 70 years, ultra-processed foods have come to dominate the U.S. diet. These are foods made from cheap industrial ingredients and engineered to be super-tasty and generally high in fat, sugar and salt.

The rise of ultra-processed foods has coincided with growing rates of obesity, leading many to suspect that they’ve played a big role in our growing waistlines. But is it something about the highly processed nature of these foods itself that drives people to overeat? A new study finds the answer is yes.

The study, conducted by researchers at the National Institutes of Health, is the first randomized, controlled trial to show that eating a diet made up of ultra-processed foods actually drives people to overeat and gain weight compared with a diet made up of whole or minimally processed foods. Study participants on the ultra-processed diet ate an average of 508 calories more per day and ended up gaining an average of 2 pounds over a two-week period. People on the unprocessed diet, meanwhile, ended up losing about 2 pounds on average over a two-week period.

“The difference in weight gain for one [group] and weight loss for the other during these two periods is phenomenal. We haven’t seen anything like this,” says Barry Popkin, a nutrition professor at the University of North Carolina who has studied the role of ultra-processed foods in the American diet but was not involved in the current research.

Dariush Mozaffarian, dean of Tufts University’s Friedman School of Nutrition Science and Policy, agrees that the findings are striking. He says what was so impressive was that the NIH researchers documented this weight gain even though each meal offered on the two different diets contained the same total amount of calories, fats, protein, sugar, salt, carbohydrates and fiber. Study participants were allowed to eat as much or as little as they wanted but ended up eating way more of the ultra-processed meals, even though they didn’t rate those meals as being tastier than the unprocessed meals.

“These are landmark findings that the processing of the foods makes a huge difference in how much a person eats,” says Mozaffarian. That’s important, because the majority of foods now sold in the U.S. — and increasingly, around the globe — are ultra-processed.

And ultra-processed foods include more than just the obvious suspects, like chips, candy, packaged desserts and ready-to-eat meals. The category also includes foods that some consumers might find surprising, including Honey Nut Cheerios and other breakfast cereals, packaged white bread, jarred sauces, yogurt with added fruit, and frozen sausages and other reconstituted meat products. Popkin says ultra-processed foods usually contain a long list of ingredients, many of them made in labs. So, for example, instead of seeing “apples” listed on a food label, you might get additives that re-create the scent of that fruit. These are foods designed to be convenient and low cost and require little preparation.

The new research, which appears in the journal Cell Metabolism, was led by Kevin Hall, a senior scientist at the National Institute of Diabetes and Digestive and Kidney Diseases. Hall says he was surprised by his findings, because many people have suspected that it is the high salt, sugar and fat content in ultra-processed foods that drives people to gain weight. But “when you match the diets for all of those nutrients, something about the ultra-processed foods still drives this big effect on calorie intake,” Hall says.

To conduct the study, Hall and his colleagues recruited 20 healthy, stable-weight adults — 10 men and 10 women — to live in an NIH facility for a four-week period. All their meals were provided for them.

Participants were randomly assigned to one of two diets for two-week stretches: One group was fed an unprocessed diet full of whole or minimally processed foods like stir-fried beef with vegetables, basmati rice and orange slices. The other group ate an ultra-processed diet of meals like chicken salad made with canned chicken, jarred mayonnaise and relish on white bread, served with canned peaches in heavy syrup. When the two weeks were up, the groups were then assigned to the opposite diet plan.

Even though the study was small, it was also highly controlled. Researchers knew exactly how many macronutrients and calories participants were eating — and burning, because they took detailed metabolic measurements. The scientists tracked other health markers too, including blood glucose levels and even hormone levels. Hall notes that this makes these kinds of studies extremely difficult and expensive to carry out. But the study design also makes the findings that much more significant, Popkin and Mozaffarian both say.

“Putting people in a controlled setting and giving them their food lets you really understand biologically what’s going on, and the differences are striking,” says Mozaffarian.

For one thing, previous studies have linked an ultra-processed diet to weight gain and poor health outcomes, like an increased risk for several cancers and early death from all causes. But these studies were all observational, which means they couldn’t prove that ultra-processed foods caused these outcomes, only that they were correlated. 

Hall says the new study wasn’t designed to see what exactly it is about ultra-processed foods that drives overeating, but the findings do suggest some mechanisms.

“One thing that was kind of intriguing was that some of the hormones that are involved in food intake regulation were quite different between the two diets as compared to baseline,” Hall says.

For example, when the participants were eating the unprocessed diet, they had higher levels of an appetite-suppressing hormone called PYY, which is secreted by the gut, and lower levels of ghrelin, a hunger hormone, which might explain why they ate fewer calories. On the ultra-processed diet, these hormonal changes flipped, so participants had lower levels of the appetite-suppressing hormone and higher levels of the hunger hormone.

Another interesting finding: . . .

Continue reading.

Written by LeisureGuy

16 May 2019 at 1:20 pm

Canada’s new dietary advice is to avoid sugar substitutes. Will U.S. follow suit?

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I avoid sugar substitutes because once I decided to avoid refined sugar, it made sense to me to retrain my taste to prefer savory to sweet. (I do not like artificial foods in general, and that includes artificial sweeteners in spades.)

The gut microbiome can drive food cravings, and cutting sugar and simple starches from your diet quickly results in a change in the gut microbiome population: those microbes that depended on sugar and simple starches give way to others.

To develop a taste for the savory, rather than the sweet try this: after tasting the foods on your plate, construct your “last bite.” That is a bite-size portion of the food(s) in the meal that you want to be the last taste you have of the meal. Cut out and move aside that bite and save it for the end. That bite will be the final taste of the meal.

If you consistently make that last bite savory, you’ll train your taste to prefer to end a meal with something savory—i.e., not with dessert. It will seem natural to enjoy the savory ending, and you won’t want to spoil the last-bite taste. For example, the last bite may be (depending on the meal), a bite of turkey with a little dressing; or a good combination of vegetables and sauce; or a small piece of bacon with a bit of egg; or a bite of steak or chop from the best part; and so on.

If you do want a dessert, go for fruit that is low in net carbs. I thaw mixed berries (raspberries, blackberries, and blueberries) and eat 1/2 cup of that for dessert. See this post for the best low-carb fruits.

Christy Brissette writes in the Washington Post:

As a Canadian dietitian who works and lives in the United States, I like to keep up with health policy in both countries. So, I was quite interested to see that Health Canada, the governmental agency responsible for public health, is charting a new course when it comes to dietary advice, particularly in the area of sugar substitutes. It’s a track that sharply diverges from the one the United States is on.

In a significant departure from the past as well as from the U.S. approach, Canada’s new food and dietary guidelines, released this year, say zero-calorie or low-calorie sugar substitutes are neither necessary nor helpful. “Sugar substitutes do not need to be consumed to reduce the intake of free sugars,” the guidelines say, adding that, because “there are no well-established health benefits associated with the intake of sweeteners, nutritious foods and beverages that are unsweetened should be promoted instead.”

In contrast, the 2015-2020 Dietary Guidelines for Americans(DGAs), issued by the U.S. Agriculture and Health and Human Services departments, suggest sugar substitutes may have a place in helping people consume fewer calories, at least in the short term, though “questions remain about their effectiveness as a long-term weight management strategy.” The guidelines neither encourage nor discourage their usage.

The differences may seem subtle, but dietary guidelines in each country shape what is served at public institutions such as schools and influence the recommendations made by health-care professionals. Language matters. But before we try to explain the difference in advice, let’s have a quick primer on sugar substitutes.

What are sugar substitutes?

Sugar substitutes include many categories, such as high-intensity sweeteners that are at least 100 times as sweet as sugar. They can be “artificial,” such as aspartame and saccharin, or “natural,” such as stevia and monk fruit. They can contain a negligible number of calories or be classified as low-calorie sweeteners, such as sugar alcohols.

In much of the research and in most policy documents, sugar substitutes are often discussed as a single category rather than a heterogenous group of compounds. This makes it challenging to know whether certain types are preferable.

Most concern seems to focus on artificial sweeteners. Six are approved by the U.S. Food and Drug Administration as ingredients in foods and drinks and as table sweeteners people can add themselves. The most ubiquitous is aspartame (sold as brand names NutraSweet or Equal), which is found in more than 6,000 food products, followed by sucralose (Splenda), acesulfame K (Sweet One or Sunett) and saccharin (Sweet’N Low or Sugar Twin), and the lesser-known neotame and advantame. You’ll find artificial sweeteners in a range of foods and drinks, including light yogurt, diet sodas, protein bars and chewing gum as well as baked goods and frozen desserts. Carbonated drinks are the top source of artificial sweeteners in the American diet.

What does the research say?

Research suggests that stevia and monk fruit, the natural sugar substitutes, are safe for human consumption, though it’s not clear that they lead to weight loss. There has been conflicting research, however, about the safety of artificial sweeteners. Some studies have suggested that artificial sweeteners could increase the risk of Type 2 diabetes, heart disease, kidney disease and cancer, and may have a negative influence on the microbiome and mental health.

For example, research based on data from 37,716 men from the Health Professional’s Follow-up study and 80,647 women from the Nurses’ Health study published in Circulation last month found that consuming artificially sweetened beverages is associated with a greater risk of death as well as death from heart disease. The risk was found specifically for women consuming four or more servings of artificially sweetened beverages a day. The authors say this finding needs to be confirmed by future research, but it does raise questions about whether artificial sweeteners are necessary — or should be recommended at all.

As for the U.S. contention that sugar substitutes might help people cut back on calories and sugar to improve their health or lose weight — that seems doubtful.

review by the nonprofit research foundation Cochrane, conducted for the World Health Organization, examined 56 studies into the effects of sugar substitutes on health. It found that there is no evidence sugar substitutes provide any benefit — and that they may even have some risks.

An analysis of U.S. dietary intake from 2003 to 2004 shows that people tend to add artificial sweeteners to their diets rather than using them to replace sugary foods and beverages.

The same seems to be true for children. This month, researchpublished in the Pediatric Obesity journal revealed that in U.S. children, drinking artificially sweetened beverages is associated with consuming more calories and sugar.

Why the difference in advice?

U.S. and Canadian health officials are looking at the same research and have populations with similar health issues. So why the difference in guidelines regarding sugar substitutes?

The new Canadian approach seems to be that if a food or beverage doesn’t have a demonstrated health benefit, it doesn’t belong in your diet. Their 2019 guidelines suggest that people’s taste buds will adapt to less-sweet tastes when they reduce their consumption of sweetened foods and beverages — and using high-intensity sweeteners delays that process.

This is a marked change from Canada’s last dietary guidelines, released in 2007, which advised the general population to consume sugar substitutes in moderation and cut back on them if they noticed any digestive symptoms such as gas and bloating.

The new Canadian recommendations may seem tougher, but I see them as being clearer and something for people to aspire to. (Canada’s latest Food Guide takes a stand on several other divisive nutrition issues. For example, it promotes whole grains as the only grains to put on your plate, while the U.S. guideline is that at least half your grains be whole grains.) The U.S. view seems to be focused on encouraging health behaviors that are thought to be more achievable.

Alice H. Lichtenstein, a professor of nutrition science and policy at Tufts University and member of the 2015-2020 DGA committee, seems skeptical of an all-or-nothing approach to sugar substitutes. She expressed her stance in an editorial in Circulation, responding to the study that said consuming artificially sweetened beverages is associated with a greater risk of death. “To a certain extent, as a community, we can take the high road about beverage recommendations: Drink water (or flavored water) in place of [sugar-sweetened beverages]. However, continuing this simple approach would be disingenuous because we know that it has not worked well in the past and there is little reason to expect that it will work well in the future.”

Over email, Lichtenstein said: “For some people, I suspect the use of high-intensity sweeteners is helpful in avoiding excess energy intake. For others, it might not be helpful.”

2018 advisory from the American Heart Association also takes a more middle-ground approach to sugar substitutes than Canada’s, stating that they can play a role in helping people to reduce the amount of sugar-sweetened beverages they’re drinking. The advisory also says that beverages containing low-calorie sweeteners could be especially useful for people who are used to sweetness and find water unappealing at first.

For insight, I turned to Marion Nestle, a renowned American author and professor emerita of nutrition, food studies and public health at New York University. She said over email: “What we know about artificial sweeteners is for sure that they are not necessary. On a population basis, they do not seem to help people lose weight, but they may help some individuals. So, both approaches are valid. Personally, I follow a food rule not to eat anything artificial, so these sweeteners are off my dietary radar.”

When I asked what she thought was the reasoning behind the differing approaches to sugar substitutes taken by the U.S. and Canadian governments, she responded, “One can only speculate that the lobbying for artificial sweeteners worked better in the U.S. than in Canada.”

Whatever the reason for the disparate approaches, I found one hint that the viewpoint in the United States might be changing.  . .

Continue reading.

Written by LeisureGuy

15 May 2019 at 9:41 am

The Gray Rock Method for dealing with narcissists

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If you’ve not encountered a narcissist, count yourself lucky. If you have had some sort of relationship with a narcissist (student, teacher, co-worker, boss, subordinate, friend, relative, spouse), then you probably know the difficulties attendant on such a relationship—for example, gaslighting is a typical narcissist practice. This post lists some telltale signs that mark someone as a narcissist. Dave Murray on Quora points out an excellent summary of an effective way of dealing with a narcissist: the Gray Rock Method:

There is a narcissist in your life. It’s unfortunate and you no doubt wish it were not the case, but it is. There is a narcissist in your life and you have little choice but to interact with them.

Are you doomed to live the rest of your life as a pawn in their never-ending game? Do you have to endure their abuse? Will they always have a hold over you?

No. No. Most definitely no.

The narcissist may be in your life, but they do NOT have to be in your head. The method below requires practice and you won’t get it right first time, but, when used consistently, it will put distance (mostly emotional, but also physical to some degree) between you and your abuser.

It is known as the Gray Rock Method. The basic idea is that you embody all the thrill and excitement of exactly that: a gray rock. The type of rock that you wouldn’t look twice at. The type of rock that remains ignored and unnoticed as you walk on by.

The phrase “Gray Rock Method” was first coined by blogger Skylar in this article on her website: https://180rule.com/the-gray-rock-method-of-dealing-with-psychopaths/ after a fateful conversation she had with a complete stranger. You should definitely go and read that article after you’ve finished here.

Who Should Use The Gray Rock Method?

The most effective way to deal with a narcissist is to go no contact. Cut them out for good and prevent any form of contact whatsoever. Change your number, your email, block them on social media, and even move home if you have to.

Unfortunately, things aren’t always that simple. There are times when cutting the narcissist out altogether just isn’t practical.

If you find yourself in any of the following predicaments, Gray Rock is likely to be your best option:

  • you have a child or children with a narcissistic ex
  • you have a narcissist colleague or boss in a job that you feel unwilling or unable to leave at the present moment in time (although you should make it your long term goal to find work in a different company or department)
  • you have narcissist parents or family members who you will have to see occasionally at family events

Why Does Going Gray Rock Work?

Your narcissist is an actor; one who wears many masks and plays many roles. The people in their life – including YOU – are the supporting cast in their own, personal soap opera.

It’s part romance, part drama, part action, part thriller, part comedy (the joke’s always on you), and even part horror (in which they are the scary monster and you are their terrified victim).

Every scene in this live action soap opera must keep the narcissist interested and engaged. They will write the storylines and direct the other actors via manipulation and coercion so that they are thoroughly entertained.

They will ensure that they – the star of the show – receive their fix of attention, adoration, or praise from the other characters.

Whether you play a big role such as a partner or family member, or a smaller part such as an occasional acquaintance, adopting the Gray Rock method is an effective way to get yourself written out of the series altogether.

Just imagine watching a scene from a show or film in which one character gives nothing in the way of emotion or interesting dialogue. How boring would that be? You’d probably switch over to something else, right?

Well, the narcissist is the same. If your scenes together can’t provide them with that level of excitement, they will be forced to look elsewhere for it.

By remaining emotionally unresponsive to the narcissist’s bait and prompts, you reduce your worth in their eyes. They want Oscar-winning performances while your scenes end up on the cutting room floor.

Eventually, they will feel the need to turn you into nothing more than an extra; someone who flits in and out of the background with barely a speaking part at all.

They may still try to engage with you from time to time in order to see if you have what it takes to become one of their co-stars again, but as long as you remain boring and rock-like, you’ll never make it past the audition stage.

This is just another way to frame the concept of narcissistic supply. Paraphrasing from the article linked above:

…you and the attention you provide are addictive; they have to receive a “fix” every now and then in order to satiate their ego. […] If you continue to give them what they want, they will continue to subjugate you to their needs and wishes.

To relate this to our soap opera analogy: a narcissist wants you to be a character who brings drama and excitement into their life, and if you continue to play this role, they will continue to write storylines for you.

How Do You Go Gray Rock?

There’s an old saying that is quite relevant here: you can’t get blood from a stone.

In this case, you are the stone (or rock) and the blood is any behavior that provides the narcissist with the supply they crave.

Keep dialogue to an absolute minimum. If you don’t have to talk to them, don’t. Stay in the car when you drop your kids off at their house. Sit at the other end of the table for family meals. Ask to move desk away from them at work. Avoid interacting with them as much as possible. But don’t make a big thing out of it as this will just give them ammunition.

When you do have to talk to them, stick to tedious subjects like the weather. If they ask questions, give short, uninspiring answers that can’t possibly lead to further conversation.

They ask, “how are you?” and you respond “fine, thanks.”

They ask, “what did you do at the weekend?” and you respond “I did my laundry and mowed the lawn.”

If they respond with “you’ve become boring,” just nod and smile in agreement (they don’t have to know that you disagree wholeheartedly with that statement).

A simple yes and no will suffice where appropriate, but sometimes you won’t want to commit to an answer if it means giving an opinion. In these cases a non-binding “hmmmm,” “maybe,” or “we’ll see” will do.

Never talk about your personal life, even the smallest details. They will hook their claws into any morsel of information you provide and use it to try and further the conversation and extract narcissistic supply from you. They want to know what you value in your life now. They envy what you have (regardless of what it is), and if they can’t have it, they will seek to take it from you somehow. Don’t give them the chance; remain secretive about your new life without them.

Never tell them how well you are doing (as much as it might please you to rub their noses in it). Remember, they are driven by their egos, and any suggestion that you are better off without them or that they are in some way inferior to you will be seen as an affront to their identity. They see themselves as above everyone else in every regard, and if you imply that you are doing better than they are, it will enrage them.

Do not ask them questions. Even if it seems like harmless small talk, as soon as you engage with them and ask them about their life, it gives them the green light to reel off a list of their recent accomplishments (whether true or fabricated) to belittle you. Or they might rant about a mutual acquaintance to see if you’ll react in any way. Don’t give them a platform. Don’t pander to their need for attention.

Try to stick to facts wherever possible. Parents’ evening is at 7pm on Wednesday. The doctor has given them (your son/daughter) antibiotics to take every 8 hours. We have 5 new clients this month. Statements that the narcissist will struggle to challenge because they are not subject to interpretation. The last thing you want to do is get into a debate with them.

Avoid mention of the past at all costs. You don’t want to revisit those dark times even if they do. By bringing up your history, you risk the resurfacing of old wounds and arguments. You’ll also be faced with the blame game which is never a game you can win.

If this should happen, one tactic which can help to diffuse the situation is to publicly accept responsibility for the problems you faced together (even if you don’t accept it on the inside). Any attempt to apportion some of the blame on them will only be met with denial, defensiveness, and attacks on you.

The Gray Rock Method is not always easy, but it is often effective. You might want to scream at them at times, but by biting your tongue and not flinching when they try to get a response, you will starve them of the drama they feed off. Rather than go without it (which is simply not an option for them), a narcissist will look elsewhere for a new source of supply.

Other essential narcissist reading (article continues below):

Going Gray Rock In Appearance

In addition to your interactions with the narcissist, you can also try to mimic a gray rock in terms of what you look like and what parts of your lifestyle are visible to them.

If the narcissist is an ex-partner, try to appear as plain as possible when you have to see them. Narcissists have a very superficial eye, so by making yourself less physically attractive, you will fly under their radar more easily. . .

Continue reading.

I suggest you also read the comments to the Quora post of the article.

Written by LeisureGuy

14 May 2019 at 2:33 pm

To What Degree Did Physicians Drive the Opioid Crisis?

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Alex Tabarrok writes at Marginal Revolution:

It’s well known that the opioid crisis started with prescription abuse but how much abuse was driven by patients who fooled their physicians and how much was driven by physicians who responded to monetary incentives with a nod and a wink? Molly Schnell provides some evidence which even a hard headed rationalist like myself found startling.

In August of 2010, Purdue Pharma started selling a new, anti-abuse version of OxyContin. The new version was just as good at reducing pain as the old but it was more difficult to turn it into an injectable to produce a high. If physicians are altruists who balance treating their patient’s pain against their fear of patient addiction and downstream abuse then they should increasetheir prescriptions of new Oxy. From the point of view of health, the new Oxy is simply a better drug and with less abuse to worry about altruistic physicians should be more willing on the margin to prescribe Oxy to reduce pain. So what happened? Prescriptions for Oxy fell immediately and dramatically when the better version was released.

Now, to be fair to the physicians, patients who wanted to abuse Oxy stopped demanding it after the new version was released and physicians might not have realized how many of their prescriptions were being abused or sold on the secondary market. The aggregate data, which is a combination of supply and demand shifts, can mask individual physician behavior. Schnell, however, has data on the prescribing behavior of about 100,000 individual physicians who prescribed opioids.

Schnell finds that nearly a third of physicians behaved exactly as the altruism theory predicts. Namely, when new Oxy was released these altruistic physicians increased their prescriptions of Oxy and they maintained or reduced their prescriptions of other opioids. In fact, the median altruistic physician doubled their prescriptions of the new and improved Oxy. But almost 40% of physicians in Schnell’s sample behaved in a decidedly non-altruistic manner. Beginning in August of 2010, these non-altruistic physicians halved their prescriptions of new and improved Oxy and increased their prescriptions of other opioids. It’s difficult to see how attentive and altruistic physicians could decrease their demand for a better drug.

Schnell also finds that some parts of the country had fewer altruistic physicians and the consequences are evident in mortality statistics:

…. these differences in physician altruism across commuting zones translate into significant differences in mortality across locations…a one standard deviation increase in low-altruism physicians is associated with a 0.33 standard deviation increase in deaths involving drugs per capita. While this association is reduced conditional on observable commuting zone characteristics (including race, age, education, and income profiles), a significant and large association between the share of low-altruism physicians and drug-related mortality remains. Furthermore…this relationship persists even conditional on the number of opioid prescriptions, suggesting that the association is driven by the allocation of prescriptions introduced by low-altruism physicians rather than simply the quantity.

The less-altruistic physicians increased prescriptions for other opioids after new Oxy was introduced but perhaps even this was better than the non-prescription alternatives like heroin and street fentanyl. Indeed, Alpert, Powell and Pacula show that the introduction of improved Oxy led to more deaths because people switched to more dangerous, illegal alternatives. So was it a bad idea to introduce a better drug? . . .

Continue reading.

Emphasis added.

Written by LeisureGuy

7 May 2019 at 10:25 am

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