School of Medicine in the news

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Professor: Legalization of recreational pot in Michigan resulted in more kids eating edible treats

The legalization of recreational marijuana in Michigan has resulted in a spike in kids eating edible pot treats, according to a professor at Wayne State University. According to a news release from the university, more than half of calls made to the Michigan Poison Center at WSU concerning marijuana exposure through edibles like brownies, chocolate bars, candy and gummies involved children as young as six years old. School of Medicine Associate Professor of Emergency Medicine and Toxicology Fellowship Program Director Andy King said the uptick is likely due to the November 2018 legalization of marijuana in Michigan, leading to a higher availability of substance in homes. Since the beginning of the year, 59 pediatric calls to the Michigan Poison Center related to marijuana exposure involved edibles. “Wherever you start seeing legalization, kids are going to have more access to it by sheer numbers and probability to it,” King said. “A lot of the edibles are so desirable to children. This is the age that they really can’t read, and they’re going to (sneak) a cookie or steal a gummy bear.” King recommends all edibles and substances, including prescription drugs, be kept in a locked box to ensure safety. “A typical marijuana cigarette holds about 10 mg of THC," King said. “That’s what you see in a gummy bear. That’s a dose for a novice person to take to get the psychedelic or enjoyable effects of THC. These edibles can go up to 10 times that amount.”
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Michigan sees spike in children poisoned by marijuana edibles

More children are getting their hands on marijuana edibles in Michigan -- and for toddlers, the effects can be life-threatening. Reports of intoxication in pediatric patients from marijuana edibles to the Michigan Poison Center spiked in 2018, said Dr. Cynthia Aaron, medical director for the center at Wayne State University. That's the year that Michigan saw its first retail sales of medical marijuana products -- and that voters agreed to legalize recreational marijuana. Though commercial sales of adult-use marijuana have yet to launch in Michigan, more and more children are coming into contact with THC-infused products like gummies, cookies and chocolate bars. There were six cases of children who ate a marijuana edible in 2017 -- and 46 cases in 2018, according to data from the Michigan Poison Center. So far this year, 59 children exposed to marijuana edibles have been reported to the center. The reports typically concern two groups: young, toddler-age children and adolescents, Aaron said. The major concern is toddler-age children, Aaron said. "They go unresponsive; many don't breathe," Aaron said. "They're not interacting; they're sleepy… some kids may complain of being dizzy; stumbling around." Though no deaths have been reported from children ingesting marijuana edibles, Aaron said the concerns are serious: some children have spent 24 hours on a breathing machine as a result of exposure. Marijuana edibles are an issue particularly because of the way they are dosed: the package might tell you a dose for an adult is one section of a chocolate bar; or two gummy bears; or half of a cookie. Young children don't see it that way, Aaron said. Aaron said adults should treat marijuana products like any other medication. "This like any other medication in the house -- it really needs to be locked up," Aaron said. "People don't realize how potent they (edibles) are and they don't understand that it's not like smoking or vaping. You don't get your buzz immediately -- it's delayed," Aaron said. "It's a dysphoric trip."
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How flying in a fighter jet affected my mind and body

Arash Javanbakht, director of the Stress, Trauma and Anxiety Research Clinic at Wayne State University, wrote a piece about his perspective, as a psychiatrist, on the mental and physical aspects of flying a fighter jet. “The experience was condensed and fast, affecting so many sensory modalities, and its processing took some time: Part of me was in denial for a couple days, and I repeatedly found myself in awe, telling myself excitedly: Dude, I flew a fighter jet! Overall, it took a couple days for my mind and body to come back to normal; it was a once in life experience, and it was amazing,” Javanbakht wrote.
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Vaping shops will lose in Michigan's e-cigarette ban, but is public health worth it?

Dr. Daniel Ouellette, a pulmonologist and senior staff physician at Henry Ford Hospital, applauded the e-cigarette ban. "I think that this is a step forward, and I’m really happy to see that my home state is at the forefront of taking this initiative," said Ouellette, who also is an associate professor at Wayne State University's School of Medicine. "For me, as a lung specialist, I think that the only good thing in your lungs is air." Ouellette said the dangers of vaping still aren't fully known. "We know with cigarettes it can take 15- 20 years or more after having started smoking to have an increased risk of cancer," he said. "If we would extrapolate that same kind of data, it’s going to be a couple of decades before we know this for sure about e-cigarettes. "What we do know is that there are some potential carcinogens in the vapor products. We do know that at least potentially there's a risk. Who would want to be 20 years down the road from now and be faced with an epidemic of lung cancer because we didn't act to control and study e-cigarettes?" But he said it's clear that e-cigarettes are highly addictive — and that's especially true for young people whose brains are more susceptible to addiction — and the contents of the e-cigarette cartridges may contain chemicals that are harmful when heated. "One tank or canister of solution for an e-cigarette contains as much nicotine as a pack of cigarettes," Ouellette said. "So people who use these e-cigarettes are going to get addicted to nicotine. That, by itself, is an adverse consequence. Not only will they be addicted to e-cigarettes but also potentially to other tobacco products. "In addition, these e-cigarettes contain propellants, liquids ... in which the nicotine is dissolved. ... There's also the ability to put in other things," such as flavors, cannabinoid (CBD) products and tetrahydrocannabinol (THC), the primary psychoactive component of marijuana. "So there are a great variety of dangers that can be posed by the use of these e-cigarettes," he said. 
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Vaping may be bad for teens. But will Michigan’s ban hurt smokers trying to quit?

Banning flavoring in e-cigarettes and similar devices might move the products further away from Michigan teens, but some worry that an all-out ban also strips cigarette smokers of a powerful tool to help them quit. Smoldering for years now, the health debate ignited Wednesday when, in a surprise move, Gov. Gretchen Whitmer proposed banning flavoring in e-cigarettes and other vaping devices in the state. Still, others worry about adult smokers trying to quit cigarettes by turning to vaping, which early research suggests is not as dangerous as combustible tobacco. At Wayne State University’s School of Medicine, clinicians are helping smokers shake the tobacco habit through the use of incentives — gift cards, for example, sometimes alongside tobacco cessation products, like the nicotine patch. David Ledgerwood, a clinical psychologist and director of Wayne State’s Nicotine and Tobacco Research Division, said vaping products can indeed be used to help smokers cut down or quit cigarettes. But Ledgerwood also noted that adolescents and teens are easily moved by marketing gimmicks and flavored products. “There’s a lot of stuff going on there around the development of the adolescent brain. Their role at that age is to break away from their parents, and that’s why you get this rebellious stage,” Ledgerwood said. “This is where they’re going to try out new things and make decisions about where their lives are going to head, and they can make some really smart decisions and really risky decisions,” he said.
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Aretha Franklin’s cancer doctors recall her grace, grit

Regardless of her reputation as a performer, Aretha Franklin ‘s cancer doctors say she was no diva as a patient. As the anniversary of her death approaches, two of her doctors relate that the Queen of Soul handled the diagnosis and treatment with grace — and the grit to keep performing for years with a rare type of cancer. Franklin, who died in Detroit on Aug. 16, 2018, at 76, had pancreatic neuroendocrine cancer, which starts in the pancreas but is far different and much slower developing than the more common, aggressive type of pancreatic cancer known as adenocarcinoma. Franklin’s kind is exceedingly rare: Neuroendocrine cancers comprise about 7 percent of cancers originating in the pancreas, according to the Neuroendocrine Tumor Research Foundation. Dr. Philip Agop Philip, a professor at Karmanos and Wayne State University, recalled how she wanted to continue her life as normally — and positively — as possible. “She was full speed — she wasn’t even complaining,” said Philip, who first saw Franklin in early 2011 and was her doctor of record at the time of her death. “That was different than what I expected. ... She never showed signs that she was close to thinking that she may give up ... until the end, close to the end.” Philip saw a patient who didn’t demand star treatment, saying she never made him or his staff “feel that we need to treat her as a celebrity.”
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Wayne State looks to ‘reboot’ urban pediatrics program

Wayne State University has created a new practice plan called Wayne Pediatrics, according to Dr. Herman Gray, chair of the new Wayne Pediatrics department. Gray says the department is taking advantage of this opportunity to reimagine how care is delivered to children and their families in an urban setting. As part of that effort, Wayne Pediatrics has created the Urban Children’s Health Collaborative, an initiative to connect urban kids with better health care. Gray also talked about the wider health care disparities that exist, both in Detroit and around the country. “Certainly, poverty and racism are pretty much universally acknowledged as the foundational components of societal disparities,” says Gray. “We believe that being minimized, being disrespected, being uncertain of your place in society induces toxic stress.”
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Anti-smoking advocates fear new age-21 law won’t curb teen tobacco use

Legislators and public-health officials are celebrating a recent rise in Ohio’s smoking age as a triumph in the battle against teenage smoking. Anti-smoking advocates, on the other hand, worry that the new age limit will discourage cities and towns from adopting the strict regulatory approach that they argue is more effective in the fight against teen tobacco use. Advocates worry that police, with bigger problems to handle than smoking among youths, will leave age limits on tobacco purchases unenforced. Jeff Stephens, government relations director in Ohio for the American Cancer Society’s Cancer Action Network, approved of the state raising its tobacco age, but he said the risk of a retailer losing its license is the best way to keep stores from selling to young people. There is research to support both approaches. Yale University health policy professor Abigail Friedman conducted research that found underage smokers often acquire tobacco and vaping products from adult friends. Other studies came to similar conclusions, said Wayne State University School of Medicine professor Daniel Ouellette, who has reviewed research on teen smoking. That suggests that raising the age limit is a good way to deter smoking by minors, he said.
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Wayne Pediatrics recruiting heats up, plans to occupy former Hospice of Michigan building

The future of newly formed Wayne Pediatrics and restructured University Physician Group, two affiliates of the Wayne State University School of Medicine, is becoming clearer with a planned occupancy in October of the former Hospice of Michigan building at 400 Mack Ave. in Detroit. In late June, UPG signed a two-year lease with an option to purchase the 55,000-square-foot, five-story building, across the street from the Detroit Medical Center campus. Wayne Pediatrics also has committed to sublease an unspecified amount of space for its new administrative and clinical offices. On Oct. 1, 75-80 UPG administrative staff will move into the practice's new headquarters and clinic, said UPG CEO Charles Shanley, M.D.
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Can experts determine who might be a mass killer? 3 questions answered

Wayne State University Assistant Professor of Psychiatry Arash Javanbakht answered some questions about mental illness, mass murder and whether it’s possible to prevent horrific shootings. Is a person who commits mass murder mentally ill? What is the difference between extremism and mental illness? And, are there ‘red flag’ behaviors that can indicate risk? According to Javanbakht, the good news is that, to prevent a violent person from access to firearms, we do not need an established diagnosis of a mental illness. The history of unreasonable violence itself is enough. These measures may not prevent some of the mass shootings, but they can help with a lot of murders and deaths by suicide.”
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Guns and mental illness: A psychiatrist explains the complexities

Arash Javanbakht, assistant professor of psychiatry, wrote a piece for The Conversation talking about the complexities of mental illness and guns. “President Donald Trump called for reform of mental health laws on the heels of two deadly shootings that claimed the lives of at least 31 people and left a grief-stricken country in disbelief. The president, saying that “hatred and mental illness pulls the trigger, not the gun,” also called for better identification of people with mental illness and, in some cases, “involuntary confinement” of them. These sentiments are similar to comments that Trump and a number of other politicians have made previously…In this debate, many questions arise that those discussing mental illness and gun violence may not even think about: What do we mean by mental illness? Which mental illness? What would be the policies to keep guns away from the potentially dangerous mentally ill? Most of these questions remain unanswered during these discussions.”
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Michigan doctors reach out to LGBTQ community to narrow health disparities

Roughly 1 in 6 LBGTQ people nationwide report being discriminated against when visiting a doctor or health clinic, while 1 in 5 say they’ve avoided health care because of discrimination fears, according to a 2017 survey of  lesbian, gay, bisexual, transgender, and queer adults. That, in turn, deepens health disparities over a lifetime as patients skip screenings and get less help for chronic conditions and poor health habits, according to an overview of health research by the U.S. Office of Disease Prevention and Health Promotion. From public health clinics to large hospital systems, Michigan’s health care industry is reaching out to close such disparities, from updating forms to accommodate genders beyond “male and female” to adding LGBTQ-specific services. Among the most tangible efforts is the Corktown Health Center in Detroit, which opened in 2017 as Michigan’s first nonprofit health center with a focus on LGBTQ patients. It’s also one of only a few dozen such centers nationwide. As vice chair of education at Wayne State University’s Department of Internal Medicine, which helped establish Corktown Health Center,  Dr. Diane Levine is helping Wayne State’s medical school incorporate coursework, clinical teaching, and even residency slots at Corktown so that medical students today are more aware of the needs of LGBTQ patients tomorrow. The curriculum will mean that new medical students will go from “about two hours” of focus on LGBTQ health in the classroom, to about two dozen hours, she said. Among her presentations, she said, is the genderbread person, to prompt discussion on the interplay of the mind, heart, and reproductive organs. Understanding these basics, she said, is a first step in understanding a patient, she said. “And that,” she said, “is really Doctoring 101.”
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Wayne State researchers look to curb nicotine, tobacco use

A new research division at Wayne State University will focus on ways to improve health by reducing the use of nicotine and tobacco. The unit at the School of Medicine's Department of Psychiatry and Behavioral Sciences launched this month and it's called the Nicotine and Tobacco Research Division. It offers Wayne State researchers a hub to enhance research communication, collaboration and educational opportunities. Dr. David Ledgerwood, an associate professor of Psychiatry and Behavioral Sciences, is director of the division. The division will encourage multidisciplinary collaboration among scientists who are studying nicotine and tobacco use as well as in the broader academic community. It also will seek to heighten the profile of nicotine and tobacco research by showcasing studies and scientific programs.
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In the lab: Ovarian cancer cells show mutation from talc exposure

Dr. Ghassan Saed, associate professor of obstetrics and gynecology at Wayne State University, wanted to see the link between talcum powder and ovarian cancer for himself. His lab focuses on studying how ovarian cancer cells evolve and become cancerous, and why they eventually become resistant to chemotherapy. “I heard the talcum powder ads about increased risk of ovarian cancer and thought, ‘is there a link?’” Saed said. In February 2019, Saed and his team conducted and published a study to Reproductive Sciences confirming the link between the powder and ovarian cancer. WSU’s findings are the first to confirm the cellular effect of talc and provide a molecular mechanism to previous reports linking genital use to increased ovarian cancer risk. Women who have used talcum powder are at a higher risk of developing ovarian cancer and should receive special medical attention, said Saed.
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Politicians admit mental health struggles

Presidential candidate Rep. Seth Moulton, D-Mass., and Sen. Tina Smith, D-Minn., recently delivered confessions that are rare for members of Congress: They once struggled with and were treated for mental health conditions, he for post-traumatic stress disorder and she for depression. Discussing such problems out loud is a gamble in politics, and over the years few others in Congress have been forthcoming, but the chances are high that a number of politicians have faced mental health problems. An estimated 47 million people in the U.S. in any given year struggle with conditions such as anxiety or depression. Of those, 11 million have more serious conditions such as bipolar disorder or schizophrenia, according to the National Alliance on Mental Illness. Among the members of Congress who have shared their diagnoses are Rep. Ruben Gallego, D-Ariz., who started speaking openly about his PTSD after he was elected in 2014, and former Rep. Lynn Rivers, D-Mich., who shared in 1994 that she was successfully being medicated for bipolar disorder. "People use anything they can find against their opponent," said Arash Javanbakht, assistant professor of psychiatry at Wayne State University School of Medicine. Most insults, he said, are "rooted in ignorance or misinformation." He added, however, that he believes substance abuse or having a personality disorder would be most worrisome for a leader because they impair judgment.
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Multiple sclerosis cases on the rise nationally

A recent study shows that the number of people living with MS is on the rise. A recent MS Prevalence Study funded by the National Multiple Sclerosis Society shows that in 2010 the estimated 10-year prevalence of adults in the U.S. was 727,344 cases, not the 400,000 that had previously been thought. In addition, the study shows the prevalence of MS cases from 2000 to 2017 is now estimated at 913,925 cases, though that number may be as high 1,000,000. Dr. Robert P. Lisak, who specializes in neuroimmunologic diseases at Wayne State University School of Medicine, said that an initial increase in the numbers of people with MS was thought to be because of better diagnostic tools and more awareness of the disease. "But over the last 10 to 20 years we think there are more cases," Lisak said, though nobody knows why. The problem is if you don't know the cause of the disease you can speculate all you want, but you don't really know," he said. "But there is probably no one single cause or one single risk factor," Lisak said. Lisak said there are new medications out that delay or even prevent progression of the disease. But researchers still need to find out what ultimately causes MS — the mechanisms of what causes attacks, what causes attacks to shut off and what causes progression. Until that is known it is hard to develop therapies, he said. "We need to get more basic knowledge in order to make further progress."
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Wayne State develops novel geocoded map to improve health outcomes

If you live in southeast Michigan, your ZIP code may determine how long you live. Live in the 48236 ZIP of Grosse Pointe and at birth you can expect to live to an average of 82 years. Just a few short miles away, however, if you’re born and live in the Detroit ZIP of 48201, you can shave 13 years off that respectable mark. The 13-year loss can be attributed to numerous factors, including a lack of access to healthy food, health care and safe places to exercise. Resource limitations and socioeconomic disparities in the 48201 ZIP code also contribute to soaring levels of toxic stress and poor health. That stress often manifests in the form of disproportionate levels of high blood pressure, which, if uncontrolled, brings on a host of illness guaranteed to shorten lifespan. That’s the bad news.
The good news, as attendees of the Detroit Regional Chamber’s annual Mackinac Policy Conference heard Thursday morning, is that a radically new form of mapping health data by census tract may give policymakers, researchers and health care providers the information they need to design targeted efforts to improve health in areas with a long history of worse outcomes. The goal, said Phillip Levy, assistant vice president of Translational Science and Clinical Research Innovation for Wayne State University, is to develop a precision approach to population health, guided by data provided by drilling down as far as possible, perhaps even to individual neighborhoods.
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Howard Stern talks childhood trauma, trauma psychiatrist talks about lasting effects

Arash Javanbakht, assistant professor of psychiatry, wrote a piece for The Conversation about the growing interest in trauma and childhood trauma. “A child’s brain is a sponge for learning about how the world works and who they themselves are. We humans have an evolutionary advantage in having the ability to trust the older and learn from them about the world. That leads to cumulative knowledge and protection against adversity, about which only the experienced know. A child absorbs the patterns of perceiving the world, relating to others and to the self by learning from adults. But when the initial environment is unusually tough and unfriendly, then a child’s perception of the world may form around violence, fear, lack of safety and sadness. Brains of adults who experience childhood adversity, or even poverty, are more prone to detecting danger, at the cost of ignoring the positive or neutral experiences.” Javanbakht continued: “Childhood trauma is more common than one would think: Up to two-thirds of children experience at least one traumatic event. These include serious medical illness or injury, firsthand experience of violence or sexual abuse or witnessing them, neglect, bullying and the newest addition to the list: mass shootings.