Tumgik
#the previous CEO and on two separate instances were meant to be CEO and now the weak man you married publicly betrayed you TWICE
brookheimer · 11 months
Text
okay. i need to rewatch the episode probably but i think my current feeling is that i like most of it a lot (rome, ken, the siblings not getting ceo, etc), think the tom ceo makes sense from a logical/character perspective but not sure how i feel about it from a broader more thematic lens (altho i'm leaning towards fine with it), and am very mixed on shiv's ending because i think it's well-conceived and meaningful from a broader thematic lens (shiv becomes her mother, the cycle always repeats, etc) but doesn't quite make sense to me from a logical/character one -- it could've worked, it could've worked brilliantly, but it was far too rushed and forced. it makes sense as an ending for shiv, but not her next step. i'm largely talking about her decision to return to tom, not her decision to vote against kendall (which i think should've been executed better and given more space but can understand given her character, mostly). i'm fine with it as an ending for shiv, but what i'm struggling to stomach is the way it played out -- it didn't feel like a choice the shiv we know would've made. it's an ending that makes sense thematically and for her character arc, but not a decision that makes sense for her character at present. that's kinda where i'm at right now
#long shiv post talking ab this upcoming lol#bc so far i haven't seen like any shiv takes i've actually agreed with#it's either entirely anti ending or pro ending#whereas like. to me the ending works as an ending for the character. it's tragic dark devastating but it works and works well#but shiv making that choice does not make sense for where she is right now. it was rushed writing that forced an ending on her#that would be a satisfying ending but not a satisfying character choice and thus NOT a super satisfying ending#could've been EXTREMELY satisfying. but shiv wasn't there yet. her fatal flaw is blowing up good situations when she feels she's being#disrespected -- she's respect > power when it comes down to it#even tho she thinks she wants power more she NEEDS respect and is unable to stay quiet or make the smart choice in the face of disrespect#or men thinking they're superior etcetcetc. so her making a choice that allots her power (wife of CEO) but is the singular least respecting#outcome imaginable (meekly returning to your husband who betrayed you and stole the job you've been fighting for your entire life right out#of your grasp alongside your closest ally/flirt guyfriend who tapped him to do it explicitly to fuck you over because you're a pregnant#woman and thus inferior to the man who inseminated you -- and EVERYONE KNOWS ALL OF THIS! everyone knows you're the daughter of#the previous CEO and on two separate instances were meant to be CEO and now the weak man you married publicly betrayed you TWICE#but you still meekly return to him and place your hand in his and have his baby like the good pawn you are...)#that does not make sense for shiv. if we saw some development on the power > respect front or had a few more scenes or episodes developing#shiv as someone who would choose to become her mother (powerful and rich yet a disrespected pawn) over literally anything else#given her fundamental fear of being disrespected than maybe this would've made sense. it could be a great meaningful devastating ending#but it's one that just does not track for shiv as we know her right now.#ok tags got long as always sorry LOL i'm gonna write a longer thing explaining my hashtag thoughts bc i haven't seen much i agreed w on thi#front yet oops. ok bye 4 now tee hee#succession#succession spoilers#casey shut the fuck up about shiv roy
47 notes · View notes
digital-strategy · 5 years
Link
https://ift.tt/30f15au
Tumblr media
Photo-Illustration: Intelligencer. Photos: Getty Images
On the third Friday in August, Jesse Angelo, the longtime News Corp executive hired in June as president of global news and entertainment at Vice Media, gathered the staff of the company’s nightly news show to deliver their fate. Vice News Tonight had run on HBO for three years, until the network canceled it this spring — the final episode aired last Friday — and the 200-person Vice News staff had spent the summer waiting to see if another premium platform (Hulu? Amazon? Showtime?) might pick up the show. Angelo told the staff that he and Nancy Dubuc, Vice’s CEO, had just returned from a company board meeting in Los Angeles with news of the show’s destination: They’d been given orders to bring it home. VNT would now air on Viceland, the company’s cable channel.
The switch to basic cable was better than the total dissolution of the show and everyone losing their jobs, but since Viceland’s inception in 2016, it has struggled to find a meaningful audience (it averages under 100,000 viewers), and the news was met with skepticism. “The commonly held assumption is that this was the last resort,” one Vice News employee told me. “This is what everybody was afraid of.”
HBO’s cancellation hadn’t come as a shock, especially after AT&T’s purchase of Time Warner, the network’s parent company, and the subsequent departure of CEO Richard Plepler. VNT won awards — it was nominated for 19 Emmys this year, more than any other nightly news broadcast — and had steady, if modest, ratings on HBO. But the show had been unable to break through the noise with its fresh take on the nightly news, aside from a viral segment covering the 2017 white-supremacist rally in Charlottesville, hosted by the Peabody Award–winning reporter Elle Reeve. The show’s exit from its prestige-network host was disappointing to journalists and producers who had come onboard as much to work for HBO as for Vice. Dubuc had kept the cancellation news from the VNT staff, including Josh Tyrangiel, who ran the show, for several weeks; Tyrangiel resigned a few days later, and a trickle of other employees have left since. Earlier this week, Reeve announced she was leaving to join CNN — the very network Shane Smith, Vice’s boisterous co-founder, had long insisted that Vice would someday replace.
Those who remained were now learning that the show would be fundamentally changing, and Angelo did his best to temper the disappointment. HBO had been a “lovely garden,” he said, according to a recording of the meeting shared with New York, but “it was an extremely walled garden,” and they would now be able to share their content more easily online. Most significantly, the team would no longer be producing just a half-hour show: All three hours of the network’s prime-time block, from 8–11 p.m., would now be built by the Vice News team.
What three hours a day of Vice News will look like remains a question. (Getting the essentials out of the way, one employee asked Angelo whether they could still say “fuck” on basic cable.) Angelo presented the unfilled airtime as an opportunity for creative thinking, and said he expected it to be made up of pretaped shows and live reports, which generated murmurs and questions about whether this meant an investment in the infrastructure required to do that. Earlier this year, Viceland tried to fill two of its prime-time hours with Vice Live, a nightly live variety show shot in the lobby of its Williamsburg office; the show lasted just six weeks. One employee asked Angelo if this meant Vice was trying to compete directly with the prime-time talking heads on CNN or MSNBC. “We’re not gonna look like anybody else,” Angelo said. “But all of those people, in my book, are on notice that Vice News is coming.”
Angelo said the new plan would require “a lot more people,” while deflecting a question about who would pay for it all. According to multiple people with knowledge of the show’s budget, HBO had spent $42 million a year on VNT, while A&E, which co-owns Viceland, is planning to allocate roughly $56 million for the new three-hour block. While VNT employees admit that the show was sometimes more expensive than it needed to be, it was unclear how a 33 percent bump in resources would cover a 500 percent increase in airtime. “Even in some Mxyzptlk alternate universe where AT&T didn’t buy Time Warner, and Richard was still running HBO, and the show was renewed on HBO, here’s a newsflash for everybody: It was gonna be renewed at a much lower price point. Period,” Angelo told the staff. “There is no universe where the Willy Wonka Golden Ticket that was given to this newsroom was ever gonna happen again.”
“Making do with less” has become a theme not just at Vice News, but across the company. (As it has across the news industry in general.) Last year, the Wall Street Journal reported that Vice was on track to lose $50 million and to post revenues of between $600 and $650 million — less than it made two years earlier, and far less than the $1 billion Shane Smith, the company’s co-founder, had promised it would be making by now. In February, Vice laid off 10 percent of its employees. (Tyrangiel told his staff at the time, “The pursuit of growth was everything for the previous ten years and on Friday we closed offices that — I gotta be honest — I did not know existed.”) In April, the company’s reported web traffic dropped 49 percent when it stopped counting traffic generated by an affiliate network that included low-rent sites like Ranker.com. In May, Disney wrote down its entire $400 million investment in Vice — a declaration that it believed its investment to be worthless.
That month, Vice also raised $250 million in debt from investors. Paying freelancers and fixers on time has long been a problem at Vice, but employees in various departments say the cash-flow issues became more prevalent this year. Producers found themselves unable to take out petty cash for video shoots. Several senior employees had charges to their corporate credit cards inexplicably declined; one employee who left Vice this spring is still being hounded by debt collectors because Vice has not settled the roughly $3,000 left on a corporate card assigned to their name. Many current employees I spoke to lamented the diminishing quality and quantity of the in-office snacks — soda had disappeared, donuts were no longer included in Bagel Fridays — with opinion split on whether this was a budgetary issue or an attempt at improving employee health. (“People are saying things like, ‘This is sugar shaming,’” one employee told me.) “I was told by the accounting department that we couldn’t pay all of our bills,” a senior employee who left Vice earlier this year said. “I would get emails from businesses we had partnered with saying they hadn’t been paid, and the accounting department would say, ‘We don’t have the cash, and we have to decide who to pay.’” In one instance, a stock-photo company complained that Vice owed it tens of thousands of dollars.
All of this was happening as the company worked to consolidate itself into “One Vice,” as the internal corporate-speak goes. Earlier this year, Vice combined its various digital brands (Noisey, Broadly, Munchies, Motherboard, and so on) under the umbrella of Vice.com. Tyrangiel had walled off Vice News from the rest of the company, to the happiness of his employees and the frustration of people elsewhere in the company; Vice.com has a “News & Issues” desk that has operated separately from the Vice News team.
This departmental consolidation is occurring under Angelo, a seasoned news executive — if not, precisely, in the Vice mold. Before his current position, Angelo was best known for working throughout various parts of Rupert Murdoch’s News Corp empire, as a reporter and editor at the New York Post, then editor of The Daily — not the New York Times podcast, but Murdoch’s failed early-2010s attempt to create a newspaper exclusively for the iPad — and most recently back at the Post, as publisher, until leaving the company in January. In his meeting with the Vice News staff, Angelo talked about “leveraging across multiple platforms and products” and said he’d be thrilled if Vice News reporters started contributing to, say, a podcast in another part of the company. (Angelo, like every other media executive, has expressed a particular eagerness for podcast ideas.)
The Vice News integration into the rest of the company began just before Labor Day, with roughly 15 layoffs of Viceland employees in preparation for the network’s pivot to news. The company is now unrecognizable to many of the people who joined in the 2000s, the vast majority of whom are gone. In July, a few months after Vice folded Broadly, its women’s site focused on gender and identity, into Vice.com, the Wall Street Journal reported that Vice was in talks to acquire Refinery29, a women’s site whose tone and audience could hardly be more different from the one Vice employees thought they were targeting. Katie Drummond, who joined Vice from Medium in March to run its digital operation, including the consolidated Vice.com, told a group of Vice.com employees shortly after she arrived that she didn’t really like Vice.com, and rarely read it before joining the company.
As many have observed, the lawlessness that characterized an earlier era of Vice, which remains a key component of the brand’s appeal, has also given way behind the scenes to the kind of rigid human-resources apparatus of a company looking to be taken seriously. This spring, as part of Vice’s annual Weed Week around 4/20, a Vice producer came up with the idea to make a video in which Lil Yachty, the rapper, would try to set the Guinness World Record for rolling the world’s heaviest blunt. The idea was approved, but the amount of weed that was purchased and sent to the Vice office was enough to qualify them as a marijuana distributor. Two senior employees were fired as a result.
But the remnants of Old Vice linger, and many employees I spoke to found themselves asking: Where’s Shane? Smith has been largely quiet since handing over the reins to Dubuc last spring and elevating himself to executive chairman, although in May, at the prompting of the Vice News team, he held several off-the-record dinners with congressmen and staffers in D.C., hoping the same charm that wooed countless media executives and chief marketing officers would work on a political world the Vice News staff has had difficulty reaching.
One thing that’s certain is that Smith never planned to still be looking for someone to cash him out of his company. In 2015, he told one of his employees that the company would be sold before VNT ever aired on HBO in the fall of 2016 — three years ago. A once-floated IPO now seems out of the question, leaving Dubuc, whose contract reportedly rewards her in the event of a sale, to try to find a buyer. In February, Tyrangiel told his staff that Vice’s investors were demanding that it become profitable this year, and a person with knowledge of the company’s business strategy said Dubuc hopes to find a buyer by the end of next year. In August, Vanity Fair reported that Dubuc had been trying to woo CBS-Viacom, deploying the same logic that had led so many investors, media companies, and brands to Vice: You know old people, we know the youth. (Among the problems with the idea is that Bob Bakish, Viacom’s CEO, said in 2016, “Unequivocally, I have no interest in buying a stake in Vice, and we are not going to do it.”) Some employees have noted the fact that Jesse Angelo is childhood friends with James Murdoch, Rupert’s progressive-ish son,who has been on Vice’s board since News Corp’s 2013 investment in the company. Murdoch received $2 billion last year from News Corp’s sale of 21st Century Fox, and is said to be interested in making his own mark. In April, the Financial Times reported that Murdoch planned to use his spoils “to assemble a new portfolio of media companies that could include a liberal-leaning news outlet.”
Vice does have assets to offer a potential buyer. Despite Viceland’s poor ratings it remains a nicely profitable business thanks to the carriage fees from cable providers. (In his Q&A with the Vice News staff, Angelo avoided saying the name Viceland, and several employees told me they expected the channel’s name to be rebranded.) Spotify is paying Vice to make podcasts, and a documentary series with Hulu has been in the works for months without being officially announced. Vice Studios produced the Netflix Fyre Festival documentary and has a movie out this fall with Adam Driver. Employees on the digital side say traffic has stabilized, and the company is hiring. Vice has a popular astrology app. And the world’s largest companies and organizations, from Marriott and Sephora to Philip Morris and the Saudi Arabian government, still see Vice as a way to reach young people. The Journal has reported — in a story about the Viceland layoffs — that the company exceeded its decreased revenue goals in the first half of this year.
But it’s unclear how much all that is actually worth. In 2017, Vice was valued at $5.7 billion, an implausible number then that seems laughable now. Citing a company insider, Vanity Fair reported that the valuation is now closer to $1.5 billion. (In 2016, Smith told the Journal that by 2020, Vice could be worth $50 billion.) Whatever the price, the clock is ticking. Vice’s deal with TPG, the private-equity firm that poured $450 million into the company in 2017, includes a clause that allows TPG’s stake to grow until the company is sold. In 2016, Smith declared that by distributing stock to employees, Vice saw itself “as a tech company,” boasting that, on paper, Vice had minted 250 millionaires, with 2,000 more on the way. While some early employees have been able to cash out some of their options, the vast majority — who arrived more recently and purchased their options at an inflated valuation —are likely to see almost no return at anything close to a $1.5 billion valuation. “I’m pretty sure that my shares are worthless,” one employee told me.
For now, the company is “doubling down” on news, as Angelo put it to the staff. The new slate of programming is expected to launch later this year, and after two days off following Friday’s HBO finale, the Vice News team is returning to the working groups established to brainstorm what exactly they should do with three hours of nightly news. The Vice News employees I spoke to were largely apprehensive about what it would take to build three hours of nightly TV. Some were intrigued by the possibilities — including the idea of getting their own shows and becoming the Rachel Maddow, Sean Hannity, or Anderson Cooper of Vice. All of them described VNT as the most diverse, creative newsroom they had ever been a part of, with award-winning journalists covering stories that didn’t get much play on the cable-news networks they were now going directly up against, and none of them wanted to see it go away. But pretty much all of them were entertaining other job opportunities.
Sign Up for the Intelligencer Newsletter
Daily news about the politics, business, and technology shaping our world.
By submitting your email, you agree to our Terms and Privacy Notice and to receive email correspondence from us.
via Intelligencer
0 notes
Tennessee Titans, including Marcus Mariota, unveil team's new uniforms down Broadway in Nashville
Click here for More Olympics Updates https://www.winterolympian.com/tennessee-titans-including-marcus-mariota-unveil-teams-new-uniforms-down-broadway-in-nashville/
Tennessee Titans, including Marcus Mariota, unveil team's new uniforms down Broadway in Nashville
NASHVILLE, Tenn. — It felt like much of Nashville was behind the Tennessee Titans Wednesday night as several players — past and present — led by quarterback Marcus Mariota unveiled the team’s new uniforms. Mariota rocked the all-navy blue jersey.
Several thousand fans were shoulder-to-shoulder down Broadway, a long street of honky-tonks. Butch Spyridon, CEO of the Nashville Convention & Visitors Corp., estimated that the crowd numbered somewhere between 15,000 and 20,000.
Music blasted from an on-stage DJ, a live Titans band and a performance by Florida Georgia Line to close out the festivities. It was about as Nashville as you can get.
“Nashville knows how to throw a party,” Titans head coach Mike Vrabel yelled before the unveiling.
The Titans’ new uniforms, which they’ve branded as “tradition evolved,” come as the team celebrates its 20th season in Tennessee. It signals the Titans taking another step toward making themselves a brand separate from their predecessors, the Houston Oilers.
The Titans’ uniforms consist of three primary color combinations: navy blue (home), white (away) and a light blue called Titans blue (color rush).
Titan Up, Tennessee! @KB31_Era pic.twitter.com/860tAqvmnK
— Tennessee Titans (@Titans) April 5, 2018
Let’s see those new helmets! 🔥🔥🔥 pic.twitter.com/LWfaZ881hL
— Tennessee Titans (@Titans) April 5, 2018
The most drastic shift comes in the look of the helmet, which is now navy blue with one two-toned silver stripe, a feature that resembles a Titan sword. The uniform pants have this same feature. The Titans’ previous helmet was white with two navy blue stripes.
The new uniforms have multiple instances of Tennessee state pride and Titans pride, such as the three red stars from the state flag featured on the inside neckline of the jersey.
The number on each jersey is shaped similarly to the northeast corner of the state of Tennessee and is inspired by Greek lettering, playing off the team’s name.
Titans controlling owner Amy Adams Strunk figured the numbers would get the most widespread reaction from the fan base because the edges were pointed and far different than numbers on other NFL uniforms. But the Titans wanted Tennessee state pride to be a big part of the uniform design, and they were open to a modern look.
“This team is not rebuilding. It’s just reloading. And this uniforms symbolize that,” said Titans linebacker Brian Orakpo, who rocked the white road jerseys. “Look good, play good.”
Titans general manager Jon Robinson, a Tennessee native, teared up when he talked about what this team meant to him. He called the new uniforms “fierce.”
Nike said the new uniform is 29 percent lighter in weight than the previous uniform, with a focus on it being more comfortable and cooler for the players.
“When I first saw them, I really liked them,” Titans all-time leading rusher Eddie George said. “I was really jealous. They have so many options.”
The team has noticeably embraced change in the months leading up to this, such as when Robinson in January introduced Vrabel as the fifth head coach in Titans history, instead of the 18th coach in franchise history.
Dozens of Titans players were attendance in the crowd.
Source link
0 notes
perfectzablog · 6 years
Text
How Trauma, Abuse and Neglect in Childhood Connects to Serious Diseases in Adults
Excerpted from THE DEEPEST WELL: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris. Copyright © 2018 by Nadine Burke Harris. Reprinted by permission of Houghton Mifflin Harcourt Publishing Company. All rights reserved.
[Dr. Vincent] Felitti suspected that he might have glimpsed a hidden relationship between histories of abuse and obesity. To get a clearer picture of that potential relationship, when he conducted his normal checkups and patient interviews for the obesity program, he now began asking people if they had a history of childhood sexual abuse. To his shock, it seemed as if every other patient acknowledged such a history. At first he thought there was no way this could be true. Wouldn’t he have learned about this correlation in medical school? However, after 186 patients, he was becoming convinced. But in order to make sure there wasn’t something idiosyncratic about his group of patients or about the way he asked the questions, he enlisted five colleagues to screen their next hundred weight patients for a history of abuse. When they turned up the same results, Felitti knew they had uncovered something big.
Dr. Felitti’s initial insight about the link between childhood adversity and health outcomes led to the landmark ACE Study. This was a prime example of doctors thinking like detectives, following a hunch and
then putting it through its scientific paces. Beginning with just two patients, this research would eventually become both the foundation and the inspiration for ongoing work giving medical professionals critical insight into the lives of so many others.
After the initial detective work within his own department, Felitti started trying to spread the word. In 1990 he presented his findings at a national obesity meeting in Atlanta and was roundly criticized by his peers. One physician in the audience insisted that patients’ stories of abuse were fabrications meant to provide cover for their failed lives. Felitti reported that the man got a round of applause.
There was at least one person at the conference who didn’t think Dr. Felitti had been hoodwinked by his patients. An epidemiologist from the Centers for Disease Control and Prevention (CDC), David Williamson was seated next to Felitti at a dinner for the speakers later that night. The senior scientist told Felitti that if what he was claiming — that there was a connection between childhood abuse and obesity — was true, it could be enormously important. But he pointed out that no one was going to believe evidence based on a mere 286 cases. What Felitti needed was a large-scale, epidemiologically sound study with thousands of people who came from a wide cross-section of the population, not just a subgroup in an obesity program.
In the weeks following their meeting, Williamson introduced Felitti to a physician epidemiologist at the CDC, Robert Anda. Anda had spent years at the CDC researching the link between behavioral health and cardiovascular disease. For the next two years Anda and Felitti would review the existing literature on the connection between abuse and obesity and figure out the best way to create a meaningful study. Their aim was to identify two things: (1) the relationship between exposure to abuse and/or household dysfunction in childhood and adult health-risk behavior (alcoholism, smoking, severe obesity), and (2) the relationship between exposure to abuse and/or household dysfunction in childhood and disease. To do that, they needed comprehensive medical evaluations and health data from a large number of adults.
Fortunately, part of the data they needed was already being collected every day at Kaiser Permanente in San Diego, where over 45,000 adults a year were getting comprehensive medical evaluations in the health appraisal center. The medical evaluations amassed by Kaiser would be a treasure trove of important data for Felitti and Anda because they contained demographic information, previous diagnoses, family history, and current conditions or diseases each patient was dealing with. After nine months of battling and finally gaining approval from the oversight committees for their ACE Study protocol, Felitti and Anda were ready to go. Between 1995 and 1997, they asked 26,000 Kaiser members if they would help improve understanding of how childhood experiences affected health, and 17,421 of those Kaiser health-plan members agreed to participate. A week after the first two visits for this process, Felitti and Anda sent each patient a questionnaire asking about childhood abuse and exposure to household dysfunction as well as about current health-risk factors, like smoking, drug abuse, and exposure to sexually transmitted diseases.
The questionnaire collected crucial information about what Felitti and Anda termed “adverse childhood experiences,” or ACEs. Based on the prevalence of adversities they had seen in the obesity program, Felitti and Anda sorted their definitions of abuse, neglect, and household dysfunction into ten specific categories of ACEs. Their goal was to determine each patient’s level of exposure by asking if he or she had experienced any of the ten categories before the age of eighteen.
Emotional abuse (recurrent) Physical abuse (recurrent) Sexual abuse (contact) Physical neglect Emotional neglect Substance abuse in the household (e.g., living with an alcoholic or a person with a substance-abuse problem) Mental illness in the household (e.g., living with someone who suffered from depression or mental illness or who had attempted suicide) Mother treated violently Divorce or parental separation Criminal behavior in household (e.g., a household member going to prison)
Each category of abuse, neglect, or dysfunction experienced counted as one point. Because there were ten categories, the highest possible ACE score was ten.
Using the data from the medical evaluations and the questionnaires, Felitti and Anda correlated the ACE scores with health-risk behaviors and health outcomes.
First, they discovered that ACEs were astonishingly common — 67 percent of the population had at least one category of ACE and 12.6 percent had four or more categories of ACEs.
Second, they found a dose-response relationship between ACEs and poor health outcomes, meaning that the higher a person’s ACE score, the greater the risk to his or her health. For instance, a person with four or more ACEs was twice as likely to develop heart disease and cancer and three and a half times as likely to develop chronic obstructive pulmonary disease (COPD) as a person with zero ACEs.
Given what I’d seen in my patients and in the community, I knew in my bones that this study was dead-on.
Dr. Nadine Burke Harris (Michael Winokur)
It was powerful evidence of the connection that I had seen clinically but had never seen substantiated in the literature. After reading the ACE Study, I was able to answer the question of whether there was a medical connection between the stress of childhood abuse and neglect and the bodily changes and damage that could last a lifetime. It seemed clear now that there was a dangerous exposure in the well at Bayview Hunters Point. It wasn’t lead. It wasn’t toxic waste. It wasn’t even poverty, per se. It was childhood adversity. And it was making people sick.
One of the most revealing parts of the ACE Study was not what it investigated but who it investigated.
Many people might look at Bayview Hunters Point and see the rates of poverty and violence and the lack of health care and say, “Of course those people are sicker; that makes sense.” After all, that’s what I learned in public-health school. Poverty and lack of adequate health care are what really drives poor health outcomes, right?
This is where the ACE Study comes in and shakes things up, showing us that the dominant view is missing something big. Because where was the ACE Study conducted?
Bayview? Harlem? South-Central Los Angeles?
Nope.
Solidly middle-class San Diego.
The original ACE Study was done in a population that was 70 percent Caucasian and 70 percent college-educated.
The study’s participants, as patients of Kaiser, also had great health care. Over and over again, further studies about ACEs have validated the original findings. The body of research sparked by the ACE Study makes it clear that adverse childhood experiences in and of themselves are a risk factor for many of the most common and serious diseases in the United States (and worldwide), regardless of income or race or access to care.
The ACE Study is powerful for a lot of reasons, but a big one is that its focus goes beyond behavioral or mental-health outcomes. The research wasn’t conducted by a psychologist; it was conducted by two internal medicine doctors. Most people intuitively understand that there’s a connection between trauma in childhood and risky behavior, like drinking too much, eating poorly, and smoking, in adulthood (more on that later).
But what most people don’t recognize is that there is a connection between early life adversity and well-known killers like heart disease and cancer. Every day in the clinic I saw the way my patients’ exposure to ACEs was taking a toll on their bodies. They may have been too young for heart disease, but I could certainly see the early signs in their high rates of obesity and asthma.
Dr. Nadine Burke Harris is the founder of CEO of the Center for Youth Wellness in San Francisco’s Bayview Hunters Point. She is the subject of a New Yorker profile and the recipient of a Heinz Award, among many other honors. Her TED talk “How Childhood Trauma Affects Health Across the Lifetime” has been viewed over three million times. She lives in San Francisco with her husband and four sons. THE DEEPEST WELL is her first book.
How Trauma, Abuse and Neglect in Childhood Connects to Serious Diseases in Adults published first on https://greatpricecourse.tumblr.com/
0 notes
bisoroblog · 6 years
Text
How Trauma, Abuse and Neglect in Childhood Connects to Serious Diseases in Adults
Excerpted from THE DEEPEST WELL: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris. Copyright © 2018 by Nadine Burke Harris. Reprinted by permission of Houghton Mifflin Harcourt Publishing Company. All rights reserved.
[Dr. Vincent] Felitti suspected that he might have glimpsed a hidden relationship between histories of abuse and obesity. To get a clearer picture of that potential relationship, when he conducted his normal checkups and patient interviews for the obesity program, he now began asking people if they had a history of childhood sexual abuse. To his shock, it seemed as if every other patient acknowledged such a history. At first he thought there was no way this could be true. Wouldn’t he have learned about this correlation in medical school? However, after 186 patients, he was becoming convinced. But in order to make sure there wasn’t something idiosyncratic about his group of patients or about the way he asked the questions, he enlisted five colleagues to screen their next hundred weight patients for a history of abuse. When they turned up the same results, Felitti knew they had uncovered something big.
Dr. Felitti’s initial insight about the link between childhood adversity and health outcomes led to the landmark ACE Study. This was a prime example of doctors thinking like detectives, following a hunch and
then putting it through its scientific paces. Beginning with just two patients, this research would eventually become both the foundation and the inspiration for ongoing work giving medical professionals critical insight into the lives of so many others.
After the initial detective work within his own department, Felitti started trying to spread the word. In 1990 he presented his findings at a national obesity meeting in Atlanta and was roundly criticized by his peers. One physician in the audience insisted that patients’ stories of abuse were fabrications meant to provide cover for their failed lives. Felitti reported that the man got a round of applause.
There was at least one person at the conference who didn’t think Dr. Felitti had been hoodwinked by his patients. An epidemiologist from the Centers for Disease Control and Prevention (CDC), David Williamson was seated next to Felitti at a dinner for the speakers later that night. The senior scientist told Felitti that if what he was claiming — that there was a connection between childhood abuse and obesity — was true, it could be enormously important. But he pointed out that no one was going to believe evidence based on a mere 286 cases. What Felitti needed was a large-scale, epidemiologically sound study with thousands of people who came from a wide cross-section of the population, not just a subgroup in an obesity program.
In the weeks following their meeting, Williamson introduced Felitti to a physician epidemiologist at the CDC, Robert Anda. Anda had spent years at the CDC researching the link between behavioral health and cardiovascular disease. For the next two years Anda and Felitti would review the existing literature on the connection between abuse and obesity and figure out the best way to create a meaningful study. Their aim was to identify two things: (1) the relationship between exposure to abuse and/or household dysfunction in childhood and adult health-risk behavior (alcoholism, smoking, severe obesity), and (2) the relationship between exposure to abuse and/or household dysfunction in childhood and disease. To do that, they needed comprehensive medical evaluations and health data from a large number of adults.
Fortunately, part of the data they needed was already being collected every day at Kaiser Permanente in San Diego, where over 45,000 adults a year were getting comprehensive medical evaluations in the health appraisal center. The medical evaluations amassed by Kaiser would be a treasure trove of important data for Felitti and Anda because they contained demographic information, previous diagnoses, family history, and current conditions or diseases each patient was dealing with. After nine months of battling and finally gaining approval from the oversight committees for their ACE Study protocol, Felitti and Anda were ready to go. Between 1995 and 1997, they asked 26,000 Kaiser members if they would help improve understanding of how childhood experiences affected health, and 17,421 of those Kaiser health-plan members agreed to participate. A week after the first two visits for this process, Felitti and Anda sent each patient a questionnaire asking about childhood abuse and exposure to household dysfunction as well as about current health-risk factors, like smoking, drug abuse, and exposure to sexually transmitted diseases.
The questionnaire collected crucial information about what Felitti and Anda termed “adverse childhood experiences,” or ACEs. Based on the prevalence of adversities they had seen in the obesity program, Felitti and Anda sorted their definitions of abuse, neglect, and household dysfunction into ten specific categories of ACEs. Their goal was to determine each patient’s level of exposure by asking if he or she had experienced any of the ten categories before the age of eighteen.
Emotional abuse (recurrent) Physical abuse (recurrent) Sexual abuse (contact) Physical neglect Emotional neglect Substance abuse in the household (e.g., living with an alcoholic or a person with a substance-abuse problem) Mental illness in the household (e.g., living with someone who suffered from depression or mental illness or who had attempted suicide) Mother treated violently Divorce or parental separation Criminal behavior in household (e.g., a household member going to prison)
Each category of abuse, neglect, or dysfunction experienced counted as one point. Because there were ten categories, the highest possible ACE score was ten.
Using the data from the medical evaluations and the questionnaires, Felitti and Anda correlated the ACE scores with health-risk behaviors and health outcomes.
First, they discovered that ACEs were astonishingly common — 67 percent of the population had at least one category of ACE and 12.6 percent had four or more categories of ACEs.
Second, they found a dose-response relationship between ACEs and poor health outcomes, meaning that the higher a person’s ACE score, the greater the risk to his or her health. For instance, a person with four or more ACEs was twice as likely to develop heart disease and cancer and three and a half times as likely to develop chronic obstructive pulmonary disease (COPD) as a person with zero ACEs.
Given what I’d seen in my patients and in the community, I knew in my bones that this study was dead-on.
Dr. Nadine Burke Harris (Michael Winokur)
It was powerful evidence of the connection that I had seen clinically but had never seen substantiated in the literature. After reading the ACE Study, I was able to answer the question of whether there was a medical connection between the stress of childhood abuse and neglect and the bodily changes and damage that could last a lifetime. It seemed clear now that there was a dangerous exposure in the well at Bayview Hunters Point. It wasn’t lead. It wasn’t toxic waste. It wasn’t even poverty, per se. It was childhood adversity. And it was making people sick.
One of the most revealing parts of the ACE Study was not what it investigated but who it investigated.
Many people might look at Bayview Hunters Point and see the rates of poverty and violence and the lack of health care and say, “Of course those people are sicker; that makes sense.” After all, that’s what I learned in public-health school. Poverty and lack of adequate health care are what really drives poor health outcomes, right?
This is where the ACE Study comes in and shakes things up, showing us that the dominant view is missing something big. Because where was the ACE Study conducted?
Bayview? Harlem? South-Central Los Angeles?
Nope.
Solidly middle-class San Diego.
The original ACE Study was done in a population that was 70 percent Caucasian and 70 percent college-educated.
The study’s participants, as patients of Kaiser, also had great health care. Over and over again, further studies about ACEs have validated the original findings. The body of research sparked by the ACE Study makes it clear that adverse childhood experiences in and of themselves are a risk factor for many of the most common and serious diseases in the United States (and worldwide), regardless of income or race or access to care.
The ACE Study is powerful for a lot of reasons, but a big one is that its focus goes beyond behavioral or mental-health outcomes. The research wasn’t conducted by a psychologist; it was conducted by two internal medicine doctors. Most people intuitively understand that there’s a connection between trauma in childhood and risky behavior, like drinking too much, eating poorly, and smoking, in adulthood (more on that later).
But what most people don’t recognize is that there is a connection between early life adversity and well-known killers like heart disease and cancer. Every day in the clinic I saw the way my patients’ exposure to ACEs was taking a toll on their bodies. They may have been too young for heart disease, but I could certainly see the early signs in their high rates of obesity and asthma.
Dr. Nadine Burke Harris is the founder of CEO of the Center for Youth Wellness in San Francisco’s Bayview Hunters Point. She is the subject of a New Yorker profile and the recipient of a Heinz Award, among many other honors. Her TED talk “How Childhood Trauma Affects Health Across the Lifetime” has been viewed over three million times. She lives in San Francisco with her husband and four sons. THE DEEPEST WELL is her first book.
How Trauma, Abuse and Neglect in Childhood Connects to Serious Diseases in Adults published first on https://dlbusinessnow.tumblr.com/
0 notes