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During Robert F. Kennedy Jr.s Senate confirmation hearing for secretary of the U.S. Department of Health and Human Services (HHS), Democratic Senator Tina Smith of Minnesota asked him about his stance on people who take antidepressants. “I know people, including members of my family, who’ve had a much worse time getting off of SSRIs than they have getting off of heroin,” Kennedy responded. While many of Kennedys beliefs are questionable, hes voicing a common misconception around SSRIs, or selective serotonin reuptake inhibitors. Approximately 13% of Americans take SSRIs, which are a type of antidepressant that work by increasing serotonin levels in the brain. To begin with, Dr. Sarah Hartz, a professor of psychiatry at Washington University School of Medicine in St. Louis, points out that there is a difference between being addicted to a substance and taking a medication for a chronic condition. With the latter, your symptoms may come back if you stop taking medicationwhich can be the case for people who have severe anxiety or depression, or high blood pressure. In addition, several medications require patients taper off of them slowly, or theyll experience unpleasant side effects. These include blood-pressure and heart medications, and, yes, in some cases SSRIs. A 2024 analysis of 79 studies encompassing 21,000 patients found that approximately one in 30 patients have severe symptoms when they stop using antidepressants. With SSRIs, people have different tolerances for how quickly they can get off of them. Some people have to taper, some dont, Hartz says. Furthermore, addiction itself is a tricky term to unpack. In the most general sense, addiction means a person cant quit a substance even if they want to. Technically, sugar and caffeine are addictive. So is alcohol. Yet, using them regularly is widely accepted. Likely, when Kennedy compared heroin to SSRIs, he was referring to severe addiction, or what psychiatrists call substance use disorder. Substance use disorder has 11 different criteria, which can be grouped into four categories: Physical dependence: Developing a tolerance for increased amounts of the substance and experiencing withdrawal symptoms when you stop. Risky use: For example, using the substance while driving or continuing to use it despite experiencing mental or physical problems. Social problems: For example, neglecting responsibilities or continuing to use the substance despite it causing problems in relationships. Impaired control: Taking the substance longer than your meant to, having cravings, experiencing an inability to stop, or spending significant amounts of time obtaining, using, or recovering from the substance. Hartz points out that SSRIs dont cause these four categories of problems. While, some people do experience withdrawal symptoms and others need to increase their dose, usually taking SSRIs improves someones ability to functional socially. Furthermore, it takes a few weeks for SSRIs to kick in, so they are less likely to be abused or cause impaired control. You cant get high from SSRIs, says Hartz. You can take five times the recommended dose and you wont get high. Theres no instantaneous mood change so people are less likely to misuse them, unlike opioids or stimulants for ADHD. SSRIs are also accompanied by side effects such as decreased libido, inability to climax, headaches, and nausea. I dont see people taking them when they dont need them, Hartz says. Most people dont want to take a pill they arent getting a benefit from. Hartz notes that Kennedys statements echo existing stigmas around mental health. Psychiatric medications are singled out in a way they shouldnt be, Hartz says. People think mental health conditions such as anxiety and depression arent medical problems. They think its about self-control and behavior so they feel guilty about seeking help. But depression and anxiety can be debilitating and we have treatments for them.”
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A new technology can pinpoint victims of intimate partner violence four years earlier than other detection systems and with 80% accuracy. The Automated Intimate Partner Violence Risk Support System (AIRS) utilizes clinical history and radiologic data to pinpoint patients seen in the emergency room who may be at a risk for intimate partner violence (IPV). Developed over the past five years, AIRS has been rolled out to the Brigham and Womens Hospitals Emergency Rooms in Boston as well as surrounding primary care sites. Currently, the tool has been validated at the University of California-San Francisco Medical Center and is being evaluated by the Alameda Health System for its role in clinical workflow. Data labeling quality is a huge concernnot just with intimate partner violence care, but in machine learning for healthcare and machine learning, broadly speaking, says cofounder Irene Chen. Our hope is that with training, clinicians can be taught how to spot intimate partner violencewe are hoping to find a set of cleaner labels. AIRS is an AI-based program that is run on the Electronic Health Record data. It takes an individual patients EHR dataincluding past radiographic imaging results and patient clinical historyand uses an algorithm to evaluate a patients risk for and severity of IPV. This is followed by a “silent study” where the algorithm makes recommendations for patient care for patients who have been labeled as victims. Both the radiological data and the patient clinical histories have been revealing for Chen and her cofounder Bharti Khurana. For instance, Chen shared that many victims of intimate partner violence who were detected through AIRS had experienced a broken ulna (a bone in the forearm), a defensive injury. When questioned, they had lied that they had fallen down but did not have the instinct to catch themselves, which is more likely to lead to a broken wrist rather than a broken ulna. Ulna fractures signaled an attack by someone from above and were a strong indicator of IPV. AIRS clinical data comes from three sources: patient diagnosis codes (usually intended for billing purposes), whether patients opt-in to hospital resources correlated with IPV (including social workers or legal assistance), and direct interviewing of clinicians to incorporate into the algorithm for AIRS. That latter data source can often prove to be most challenging as many physiciansdespite their years of trainingare not taught to spot IPV. This gap in training is significant: A May 2024 study published in Nature found that only 25% of IPV cases are correctly diagnosed, underscoring the need for more systematic detection methods like AIRS. Suzanne Freitag, director of the Ophthalmic Plastic Surgery Service at Massachusetts Eye and Ear, who has decades of experience treating victims of IPV, cautions against treating AI as a magic font of knowledge that can replace a clinician’s training. While she believes in the pattern recognizing power of AIRS that is a hallmark of radiology, Freitag remains cautious about using patient clinical history as a ground truth for IPV diagnosis. I try to be careful not to stereotype because domestic violence happens to people of all ethnicities, socioeconomic statuses, sexualities, and education levels, Freitag says. Chen and Khurana, for their part, believe that AI can eliminate implicit biases to provide a clearer diagnosis for IPV victimization. The two first connected in February 2020, Khurana saw Chen (then a PhD candidate in electrical engineering and computer science at MIT) deliver a talk on algorithmic bias in medicine at Harvard; shortly afterward, Khuranaan radiology professor at Harvard Medical Schoolapproached Chen to discuss collaborating to apply machine learning to intimate partner violence detection. Five years and one $3.2 million National Institutes of Health grant later, Chen and Khurana have not only built and validated AIRS but are now working to expand its implementation across multiple hospital networks. Social work staff have also been crucial to the implementation of AIRS at Brigham and Womens Hospital, where Chen and Khurana have tapped into records from an existing program called Passageway. A free, voluntary, and confidential resource, Passageway allows patients afflicted by IPV to gain access to social workers and legal representation to seek help. Chenwhile not blinded by imperfections of implementing machine learning in clinical settingsfeels optimistic about AIRS implementation. She points to a 2023 study by the Pew Research Center which found that 38% of a sample of 10,000 Americans believed that AI would improve patient outcomes. While skepticism of AI is alive, Chen feels that it is important not to surrender to it. Annie Lewis OConnor, a nurse practitioner and founder of the Coordinated Approach to Resilience and Empowerment Clinic at Brigham, believes that clinicians and technology must work in tandem to care for patients experiencing intimate partner violence. OConnor, who assists in AIRS prediction model, appreciates its help in diagnosing IPV risk and severity as well as in assisting with clinical decision support. To understand the usability, feasibility, and application of AI and machine learning tools, we must be diligent in gathering evidence on outcomes from the use of such tools, OConnor writes in an email. [AI] is something that compliments and assists the clinician in the care and treatment of patients experiencing IPV.
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The Humane Society of the United States is going global. The nonprofit animal advocacy organization has officially rebranded as the Humane World for Animals to better communicate its existing, broader work. Beyond the local shelters it’s perhaps best known for, the group works on behalf of animals to combat wildlife trafficking, factory farms, and animal testing, among other causes, globally. The new name and look, which its sister organization Humane Society International also adopted, is an attempt to reflect that. Building a brand to communicate international advocacy The rebrand also follows existing international coordination among its former country- and region-based entities. As the Humane Society grew beyond the U.S., these entities were already working closely together, sharing resources, and collaborating on strategy, according to the organization. The switch to a single global brand better reflects how it operates today and “better encompasses our mission and global presence,” Humane World for Animals chief development and marketing officer Alison Corcoran tells Fast Company. “The name immediately conveys our organizations global impact and focus on animals, and it states what we strive to achievea more humane world,” Corcoran says. “It is both a name and a vision. With this evolved brand, were expressing who we are more clearly, compellingly and comprehensively.” Signifying the interconnected relationships of a more humane world From top: The new logo vs. the old [Image: courtesy Humane World for Animals] The group’s previous logo, which it’s had since 2006, used silhouettes of animals to create a map of the continental U.S. The new logo simplifies that concept. The silhouettes of just five, easily identifiable animals are arranged into a globe to communicate the organization’s worldwide mission. Its name is spelled out in big, easy-to-read sans-serif type. “Working with the Humane World for Animals, we always knew the new logo needed to celebrate the brands advocacy for animals across the sky, land and sea,” says Brendán Murphy, global creative director at Lippincott, the agency that worked on developing group’s new name, logo, and brand positioning. “To evoke this message, we evolved the original mark, taking a core set of animals from the original logo and redrawing them to create an emotional connection and drive impact.” The use of interlocking animals in motion, he says, “speak to the dynamic animal ecosystem and our interconnected relationships across the animal kingdom.” Developing a multimodal pattern Lippincott worked alongside the entertainment marketing agency FlyteVu and the production company Nexus Studios for the rebrand rollout, which included billboards in Australia, Canada, India, the U.K., and U.S., television and audio ads, a social media campaign. Sia performs on Jimmy Kimmel Live! [Photo: courtesy Humane World for Animals] The animal silhouette concept has applications outside the logo as well. A repeat pattern of the animal silhouettes, designed by FlyteVu, appeared as the background of an outdoor ad that a tiger’s paw appeared to rip away to reveal messages. Sia wore a dress with the pattern for an appearance on Jimmy Kimmel Live! earlier this month, where she performed a cover of Peter Gabriel’s “Solsbury Hill,” which soundtracks a new public service announcement for the Humane World for Animals. The new streamlined branding and name for Humane World for Animals keeps the ever-important emotional resonance of the previous visual identity intact, but recontextualizes it to communicate a mission that’s more than just animal shelters, and bigger than just one country.
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