12 Questions That Will Change Your Life


42andpointless

The instinct is to look for answers, but the truth is that questions that teach us most. It can also be that the rhetorical questions—the ones that don’t even seem to have answers—that push and push the hardest. Who do you think you are? What does all this mean? Why? Why? Why?

The right question at the right time can change the course of a life, can still a turbulent mind, or heal an angry heart. While every situation can generate its own, there are twelve questions, I think, that deserve to be asked not just once but many times over the course of a lifetime, some even many times over the course of the day. I have gathered them from some of the wisest philosophers, most incisive thinkers, greatest leaders and most awesome badasses that ever lived. I’m not saying I know the answer to any of them, but I can say there is value in letting them challenge you. If you let them. If you let them do their work on you—and let them change you.

Start now by asking:

Who Do You Spend Time With? Goethe would say “Tell me who you spend time with and I will tell you who you are.” Who we know and what we do that influences more than any other factor, who we will become. Because what you do puts you around people, and the people you’re around affects what you do. Think about your friends and colleagues: do they inspire you, validate you, or drag you down? We seem to understand that a young kid who spends time with kids who don’t want to go anywhere in life, probably isn’t going to go anywhere in life. What we understand less is that an adult who spends time with other adults who tolerate crappy jobs, or unhappy lifestyles is going to find themselves making similar choices. Same goes for what you read, what you watch, what you think about. Your life comes to resemble its environment (Ben Hardy calls this the proximity effect). So choose your surroundings wisely.

Is This In My Control? Epictetus says that the chief task of the philosopher is to make the distinction between what is in their control and what is not—what is up to us and what is not up to us? We waste incredible amounts of time on the latter and leave so many opportunities on the table by mislabeling the former. Our actions, our thoughts, our feelings, these are up to us. Other people, the weather, external events, these are not. But here’s where it comes full circle: our responses to other people, the weather, external events are in our control. Making this distinction will make you happier, make you stronger and make you more successful if only because it concentrates your resources in the places where they matter.

What Does Your Ideal Day Look Like? If you don’t know what your ideal day looks like, how are you ever going to make decisions or plans for ensuring that you actually get to experience them on a regular basis? It’s important to take an inventory of the most enjoyable and satisfying days of your life. What did you do? Why did you like them? Now be sure that your job, personal life, even the place you’ve chosen to live takes you towards these, not away from them. If you don’t want an office, don’t set up an office. I run my company remotely. If you enjoy being in harness and that’s what makes you feel good, then you’ll probably need something that has a lot of responsibilities and set requirements. If you enjoy influence more than material success, then make sure you pick something that allows for that. If you’re a quiet person, then you need a lifestyle that will let you be quiet—not one that forces you to be constantly not yourself. If you thrive on attention and collaboration, then pick accordingly. If you want to live in the same place for a long time, maybe buy a house. If you don’t—God, please don’t. And on and on and on.

To Be Or To Do? One of the best strategists of the last century, John Boyd, would ask the promising young acolytes under him: “To be or to do? Which way will you go?” That is, will you choose to fall in love with the image of how success looks like or you focus on a higher purpose? Will you pick obsessing over your title, number of fans, size of paycheck or on real, tangible accomplishment? He said that in life there is a roll call and it sorts people by their answer to this question, the doers and those who simply pretend. Which will you be? Which have you been?

If I Am Not For Me, Who Is? If I Am Only For Me, Who Am I? The alternative translation of that last part is “If I am only only for me, what am I?” The answer is “the worst.” The question comes from Hillel the Elder (also happens to be a favorite quote of Reid Hoffman, the venture capitalist). It doesn’t make you a bad person to want to be remembered. To want to make it to the top. To provide for yourself and your family. But if this is all you want it is a problem. There is a balance. Think of someone like General George Marshall, winner of the Nobel Peace Prize for the Marshall Plan, who had the same traits that everyone has— ego, self-​interest, pride, dignity, ambition—but they were “tempered by a sense of humility and selflessness.” When he was practically offered the command of the troops on D-Day he told President Roosevelt: “The decision is yours, Mr. President; my wishes have nothing to do with the matter.” It came to be that Eisenhower led the invasion and performed with excellence, Marshall’s opportunity to change history came soon after—winning the peace prize and saving Europe as Secretary of State.

What Am I Missing By Choosing To Worry or Be Afraid? As Gavin de Becker writes in The Gift of Fear, “When you worry, ask yourself, ‘What am I choosing to not see right now?’ What important things are you missing because you chose worry over introspection, alertness or wisdom?” Another way of putting it: Does getting upset provide you with more options? Obstacles in life make us emotional, but the only way we’ll survive or overcome them is by keeping those distracting emotions in check—if we can keep steady no matter what happens, no matter how much external events may fluctuate. The Greeks had a word for this: apatheia. It’s the kind of calm equanimity that comes with the absence of irrational or extreme emotions. And so when you find yourself indulging in those emotions, one way to get yourself back on track is simply by reminding yourself of the cost they incur: That you’re missing something by being nervous, scared, or anxious. That you’re taking your eye off the ball to do it. Can you afford that? Probably not.

Am I Doing My Job? The three-word command from Bill Belichick, Nick Saban, Sean Payton, Jason Garrett: Do Your Job. The last thing the great John Wooden would say to his players in the locker room before a game was, “Well, I’ve done my job.” So the question is: Are you doing yours? Do you even know what that job is? It’s important to remember that we can be very busy—exhaustingly busy—and still not be doing our job. We can be caught up in the things that don’t matter, we can be interfering and encroaching on someone else’s job, we can be just plain procrastinating. All these things keep us working—but not on the job that actually matters.

What Is The Most Important Thing? If you don’t know what the most important thing is to you, how do you know if you’re putting it first? How do you know if you’re taking the right steps to get it. Maybe the most important thing to you is family. Awesome, so that’s your priority. What it means is that not only do you have to start measuring yourself by family-related metrics, but you have to stop comparing yourself to people with different priorities. Maybe money is the most important thing to you. That’s perfectly fine. Know that and own it—as Michael Lewis writes, the problem is the lying to yourself. You have to know and own whatever it is. Only then can you understand what matters and what doesn’t. Only then can you say no—can you opt out of stupid races that don’t matter, or exist. Only then is it easy to ignore “successful” people, because most of the time they aren’t—at least relative to you, and often even to themselves. Only then you can develop the quiet confidence that Seneca called euthymia—“the belief that you’re on the right path and not led astray by the many tracks which cross yours of people who are hopelessly lost.”

Who Is This For? If you’re making something, selling something, trying to reach people you have to be able to answer this question. It is shocking how many entrepreneurs, writers, salesman, even politicians never bother to stop and go: Who the hell is my audience here? The result is that the message is out of tune or the wrong group is targeted (and failure usually follows). Every creative must stop and really think about who their audience is. What do these people want? What do they need? What value am I offering them? Don’t try to get lucky. Don’t follow your hunch. Get it right. Ask the question, make sure the answer is clear.

Does This Actually Matter? The reason that wise people never let the very real fact of their mortality slip too far from their mind (memento mori) is because it helps them ask this question: Given the shortness of life, does this thing I’m thinking about, worrying about, fighting about, throwing myself into even fucking matter? Sadly, the answer is usually no. We want to ask ourselves this question before we throw good time after bad, before we waste more life than we have to. “You could leave life right now,” Marcus Aurelius reminded himself, “Let that determine what you do and say and think.” In light of that, does this thing you’re so worked up about actually matter? As Stephen Colbert, a man who has experienced unimaginable tragedy has recounted, “Momentary disappointments can be seen,’ as my mother used to say when we had a heart-breaker, ‘in the light of eternity. This moment is nothing in the light of eternity,’ and that opens you up to the next moment if you don’t put too much weight on the moment where you are failing right now.”

Will This Be Alive Time or Dead Time? Early on in my career I had a pivotal conversation with author Robert Greene. I was working full-time at a really good job but planning my next move, saving my money and thinking about what I might do next. I told him I wanted to write a book one day, but I wasn’t sure what, how or when or what about. He told me, Ryan, there are two types of time: Dead time—where we are just waiting and Alive time—where we are learning and active and leveraging. And then he left it there with me to decide which I would choose. Alive time or Dead Time? So let that question catch you the next time you find yourself sitting on your hands or goofing off as you wait. Let it jolt you back into line. Pick up a book, pick up a pen and get back to work. Resist the temptation to get distracted with silly politics or wanderlust. Make the most of every moment as you prepare for the next move or the next event. If you want to be productive, be fully alive.

Is This Who I Want To Be? Our mind has the cunning ability to make the distinction between what we do and who we are. The problem is that this is complete nonsense. You can’t be a good person if your actions are consistently bad. You can’t be a hardworking person if you take every shortcut you can. It doesn’t matter that you say you love someone, it only matters if you show that you love them. Remember Cheryl Strayed’s line: “In your twenties you’re in the process of becoming who you are, so you might as well not be an asshole.” This is true for life itself. You are what you do—so ask yourself whenever you’re doing something: Is this reflective of the person I want to be? That I see myself to be? How we do anything is how we do everything. It is who we are. So ask this question about every action, thought and word. Because it adds up in a way that no amount of self-image or belief ever will.  

**

Last question. Sort of. It comes from the great Viktor Frankl, the psychotherapist who survived the Auschwitz and wrote many beautiful books. He tried, as best he could, to try to address that perennial question that every philosopher and hungry young person has struggled with: What is the meaning of life? Frankl struggled with this question too, surely the horrors of a concentration camp and the loss of one’s entire existence will do that to you. But he found that the answer was simple, though there was a problem how the question was posed. You see, he said, it is not us who get to demand of the world, “What is the meaning of life?” Rather, he said, life is demanding that we answer the question with the actions and decisions we make. That we create meaning in our choices and our beliefs. I think we create it in doing our best to challenge ourselves with the questions above:

What am I for?

What is my job?

Who do I want to be?

What’s up to me?

What does a good day look like?

Some are simpler than others, sure, but the answers rarely are—and the act of asking is the most important thing.

Read more: https://thoughtcatalog.com/ryan-holiday/2017/09/12-questions-that-will-change-your-life/

How one actor turned her brush with street harassment into a raucous, emotional concert.

Three years ago, Diana Oh was followed down the street and viciously catcalled by a group of men in an SUV.

In the wake of that incident, the New York City-based actor and musician sat down in Times Square in her lingerie in front of a stack of paper bags arranged on a soapbox.

One bag read, “The world bends over backward to make excuses for male violence.” She stood there, silent, for hours, as passersby stared, applauded, jeered, and, occasionally, joined in.

Photo by Jeremy Daniel.

That installation, titled {my lingerie play}, garnered a raft of national media attention (in Upworthy and elsewhere) and spawned nine further installments, which eventually came together in a raucous storytelling concert that follows Oh’s struggle to assert her voice and exist without fear of abuse as a queer woman of color in America.

Now remounted at Rattlestick Playwrights Theater in New York after two years of development, the concert seesaws between tales from Oh’s childhood and life in New York City and its anthemic songs, laid down by a hugely talented, synced-up band (full disclosure: Oh and I once collaborated together on a theatrical project). Where the piece truly transcends are in its audacious — and plentiful — moments of audience participation, including an on-stage haircut and an electric make-out session (more on that later). Audience members are encouraged to write their own messages on paper bags before the show and take one home at the end, either their own or someone else’s.  

Oh, who grew up the child of working-class immigrant parents in Southern California, is a magnetic, open-hearted, and funny performer. She transforms the show’s wrenching subject matter into a celebration of life, difference, and voice. She considers the stage show, with its message of joyful resistance and predominately performer-of-color cast, a radical statement.

“We do what we want,” Oh says. “I do what I want on that stage. And that is a revolutionary act, to see a queer woman of color who is Korean-American get to be … doing what I want on that stage.”

As the Harvey Weinstein scandal sinks toward an unknown bottom, and #MeToo stories continue to spread, I sat down with Oh to discuss the performance, its call to arms, her belief that white critics frequently get art made by people of color wrong, how much work putting together a diverse team required, and why that work feels worth it.

(This interview has been edited and condensed for clarity.)

Photo by Jeremy Daniel.

There’s a moment, late in the concert, where you talk about the frightening experience you had on the street and how it led to the genesis of {my lingerie play}. What was the moment like when you decided, “I’m going to stand on a soapbox in my underwear in Times Square”?

My roommate was like, “Do you want this thing someone is throwing away outside? It’s a soapbox.” I remember I saw it, and it was turned over, so it looked like an open box, and then I turned it upside down, and it was like, “Oh my God. A soapbox. I know what soapboxes are. People used to use them. They used to stand up on them and talk about their feelings.” And I was like, “OK, I think this is something. And then that was it. Before I even knew, like knew, what a soapbox was, I primally knew what a soapbox was. My memory, my previous life or something like that. It was like a spiritual something, where it was just like, my spirit knows that I have to be with this thing.

I knew that I wanted it to be silent. I knew that I just wanted to stand there and make a point, and I wasn’t going to yell, and I wasn’t going to be frantic.

How did you choose the location?

It was the most public location I could think of, and it was like the center of the universe, and anywhere else would have been too subtle. I was done being subtle. I don’t want to be subtle anymore.

Diana Oh. Photo by Jeremy Daniel.

I was already writing this piece [for the stage]. And then eventually, I was like, “This is crap.” Because all the people who know not to treat people like shit are going to come to the theater and be like, “I’m doing so great.” It came out of being frustrated that I was choosing a bubble — that my art form was actually a bubble. Knowing the things I had to say, I wanted it blasted to the universe. So that’s where the street installations came in.

It’s very bold, obviously. You’re standing there and you know that the people walking by you — it’s not necessarily safe. What was the experience you expected to have?

I don’t even know. It was like I blacked out. It was like something came over me. I didn’t even have an expectation. I just knew that I had to. I had zero expectations.

“Every step of the way, I feel like, I always have agency. Always. And that is the power behind this piece.” — Diana Oh

Being out there, it was a mix. A lot of people were like, “Thank you,” and a lot of other people were like, “I don’t understand? Why are we seeing more women in their underwear. I just don’t get it.”  

In thinking about the stage show, and selling it, was there something you came up with that was like, “This is how we’re going to get people in who wouldn’t ordinarily come?”

I’m a theater nerd at heart. And I believe in collecting people in a room together and having a powerful, spiritual experience. And that’s a gift that only theater can give. So that’s what I knew. In terms of marketing or selling it in any way, it was less about that than about “join in.” The revolution can’t be bought. I cannot sell the revolution. I don’t own the revolution, so it’s not mine to sell. But I can join the revolution, and you can join with me. And you can give your time and your support, and that’s it.

In terms of this year, 2017, with this concert, the thing I keep rubbing up against right now is this concert is for the people and by the people. I can sense that there’s a great chasm in between the people and theater culture and the theater critic world.

What sort of divide?

The divide I sense is in what we’re doing. And I believe the people who come to it believe in it. And I believe the people of color who are in the audience are a direct result of us making sure that people of color are making the work. The culture of the room needs to be right for the culture of the room. And I wish you could write down this dance move.

I’ll write down what you’re doing.

[Oh does a breaststroke in the air, as if releasing, then corralling, a litter of puppies.]

The chasm I find is — I call it the “theater helmet.” When people put on their theater helmet, that’s like, “Ah-ha. I know how to take this work in because I am incredibly educated. I come from a lot of privilege. I studied many many things. And I come from a very certain socioeconomic background. And now I am deemed as a professional thinker in the arts. I know what good art is.” But when it gets to be the same people with the same backgrounds commenting on what good art is, you can feel that commentary. You can feel the difference in experience an audience member is having versus a theater critic who has had a lot of schooling.

Guitarist Matt Park. Photo by Jeremy Daniel.

One of the things that I connect with is that many people of color have grown up in messy households. And I find that to be very true. Even if we’re wealthy, even if we’re becoming doctors or whatnot, there’s a certain mess to our households by virtue of us straddling this dual citizenship in the world. And I think it’s this messiness that our educated theater critic cohort don’t quite know and understand. Understandably — because why would they? They didn’t grow up in these messy households. So there’s a certain hunger that I feel from them to have neatness.

Do you think there’s a solution? Do you think there’s something these critics and theater professionals can do to put in the work to come to a better understanding, or do you think it really has to be a change in personnel?

Does it have to be a change of personnel? Sure. Absolutely. Do I want to see more of my artist-of-color friends being reviewed by writers of color? Absolutely. Because I feel like we would feel more seen. It wouldn’t feel so dimming. It would just feel like, “Oh my gosh, you see me. Thank you.”

I think part of the nature of the game is, “I dispense my wisdom from up on this perch,” and that in itself creates a resistance to listening. Because you get so many people telling you, from angles, who are mad at you for giving their shows a bad review, so I wonder if part of it is, you create this wall.

That sounds like a terrible life. I don’t know why anyone would choose it.

The night I was there, at least, you had a very young audience, very diverse, all genders and ethnicities and ages. Not the typical profile of a theater audience. What does that feel like, that you made that happen?

That feels like we did the work. That feels like, I fucking fought for that. I’m done with subtlety, and I’m done with being silent. And if I’m feeling an instinct, I’m feeling an instinct. If these young people need to be reached out to, they need to be reached out to. And our collaborators need to represent the houses that we want. We have a big problem if the majority of our group is white or cisgender or straight. We’ve got a really big, big problem. And so we have to queer our room so that we can queer our room.

You spent five months looking for a female bassist of color. Was it important to you to have a woman of color in that specific role, or was it because you didn’t have that represented already in the band?

Oh (L) with bassist Rocky Vega (R). Photo by Jeremy Daniel.

It just was really important that it extended beyond parity, that it extended beyond equality, that it was more about just representing my upbringing. I wanted more than one Asian person because I was tired of being the token Asian. I wanted that there, and I knew the bassist had to be a person of color, and I didn’t want to be the only woman or non-binary or queer person in the band.

People often talk about, “If you’re really committed to find full representation, you just have to look harder.” What was that process like for you?

It was exactly that. So much digging, so many emails, so much asking friends of friends. And even with bass player Rocky Vega, we found her, we found this spirit, we found a voice, we found her politics, everything. And we still had to be like, “Let’s teach you the instrument.” Because we could find all these capable bassists, but also the ability to sing and do harmony and stand up on stage with us in their underwear and be liberated.

Where did you find her?

Guitarist Matt Park had done “Peer Gynt” with her, and he was like, “Rocky is so awesome.” And for a long time, we were like, “Oh my gosh, but she doesn’t play bass, so we can’t.” And then eventually it got down to the end of five months, and it was like, if we don’t find someone, I’ll be so sad, and we can’t do it. So we just asked her, and Ryan got in a room with her alone to play bass, and he was like, “She can do this. She can learn this.” And she’s incredible.

There are two big moments in the show where you engage in fairly intimate audience interaction. There’s one where you shave someone’s head and one where you make out with an audience member as part of a consent workshop. And I’m wondering how you went about creating those moments — and the guardrails around them.

There was a lot of work that went into it, into framing it, into how to word it perfectly so that we are naming enthusiastic consent. So that we know that we are making sure it feels like an invitation and not like hazing. So that it feels like a gift for an audience member and not like they’re a prop. And every night, it changes. I usually share my head-shaving story. And some nights, I don’t want to share it when I’m shaving a person’s head. I just want to honor it and be with them. And then I’ll share my stuff later. And it’s just about being really present.

The make-out workshop came out of so many rewrites and so many things being thrown away, being like, “We can’t do this. We can’t do this. It’s not working.” There was a point where there was a version of this concert where there was so much trauma in it that it was like, we’re not here to exploit trauma. And the make-out session was born out of a conversation that our dramaturg Mei Ann Teo [note: a dramaturg is essentially a theatrical editor, though the scope of the role varies from production to production.] and the director Orion Johnstone had. I think they were having a conversation about the text, and they came to me the next day and were like, “We have a proposal for you. What if you make out with an audience member on stage.” And I was like, done. Yes.

You were super enthusiastic about that from the beginning?

Yes. Huge. I was just like, life of my dreams. Let’s freaking do it. We’re done with subtlety. Orion, Mei Ann, and me were all aligned in the belief that our sexual liberation is so intertwined with social justice. Oftentimes, the shame or the hiding or the silence or the questions or the anxiety that surrounds my sexual expression, it wasn’t born out of nowhere. And I wasn’t born with all of that. And it’s something that I feel like was piled on me as I have lived my life through this world, identifying the way I do sexually.

I don’t want to feel shame in the streets. I don’t want to feel shame in the bed. And I find that to be true of so many people. To think of how much hiding we do, of the kind of intimacy that we want and who we want to have it with and all this stuff, and all the hiding that we do, and all the breath-holding that we do, and how that’s actually intertwined with, “Well, if you would just let us be who we are, maybe we wouldn’t close in so much.”

The night I was there, two people volunteered really quickly to make out with you. Do you ever have a moment where you felt uncomfortable during that part of the show? Where you had to be, like, this is not working for me at this moment?

This is why working with a sex and relationships coach on your art is amazing because they literally had to tell me, “Take your time to choose.” I have been conditioned to be like, “Make a choice. You have to love it. I’m so into it. Yeah. Do whatever you want.” Where it’s like, “No no no, we’re going to disrupt that and be like, ‘let me take this in and see who it is that I actually want to share this moment with.'”

From there, I have that time to sit with them in the Super Sexy Hot Enthusiastic Consent workshop to be like, “How is it that I want to kiss you as I’m looking at you?” And some nights I want to, like, make out with the person. And some night it’s like, I want to give them a really soft, welcoming kiss. And some nights, it’s like, I want to kiss you everywhere but the mouth. But every step of the way, I feel like, I always have agency. Always. And that is the power behind this piece. And that’s something the dramaturg has given voice to. That the night is actually about watching you, about agency in the room.

You’re performing this at a moment where these issues are exploding into public life in an unfortunate way — with previous accusations against the president of the United States and, of course, more recently in your industry, with Harvey Weinstein. What sort of tools do you hope people walk away from the show with?

My hope is that people walk away feeling like they have complete and total agency to act and speak out and honor themselves and honor their truth and honor their power. That any time they feel that urge to be like, “I feel like I can do something but I don’t know if it’s like this, and I don’t know,” that it’s like, “You can. You can and you will. And you must.” You just have to put one foot in front of the other to do it.

You said you’re preparing one more installation?

Drummer Ryan McCurdy (L), Oh (C) and Vega (R). Photo by Jeremy Daniel.

On Oct. 28, at a to-be-disclosed location, at 4 p.m., we are going to be inviting all the past audience members of the show to stand outside together with the paper bag they left with. And if you don’t have a brown paper bag, we’ll give you one of the leftover ones that we have with the hopes that between now and then you will have given some thought to how we can make this thing possible in whatever small and big way. And it’s just a chance for us to stand outside together, be together, meet each other.

I think that community is built by shared experience, and we will have shared this experience. And every night is so different.

In the meantime, we want everyone to see the show because we believe in it so much. We believe in the spell of it , that it’s really using our civic duty.

{my lingerie play} 2017: THE CONCERT AND CALL TO ARMS. The Final Installation runs through Oct. 28 at Rattlestick Playwrights Theatre in New York City. Tickets can be found here.

Read more: http://www.upworthy.com/how-one-actor-turned-her-brush-with-street-harassment-into-a-raucous-emotional-concert

The little red pill being pushed on the elderly

The maker of a little red pill intended to treat a rare condition is raking in hundreds of millions of dollars a year as it aggressively targets frail and elderly nursing home residents for whom the drug may be unnecessary or even unsafe,a CNN investigation has found.

And much of the money is coming straight from the federal government.
The pill, called Nuedexta, is approved to treat a disorder marked by sudden and uncontrollable laughing or crying — known as pseudobulbar affect, or PBA.This condition afflicts less than 1% of all Americans, based on a calculation using the drugmaker’s own figures,and it is most commonly associated with people who have multiple sclerosis (MS) or ALS, also known as Lou Gehrig’s disease.
Nuedexta’s financial success, however, is being propelled by a sales force focused on expanding the drug’s use among elderly patients suffering from dementia and Alzheimer’s disease, and high-volume prescribing and advocacy efforts by doctors receiving payments from the company, CNN found.
Since 2012, more than half of all Nuedexta pills have gone to long-term care facilities. The number of pills rose to roughly 14 million in 2016, a jump of nearly 400% in just four years, according to data obtained from QuintilesIMS, which tracks pharmaceutical sales. Total sales of Nuedexta reached almost $300 million that year.
Nuedexta is being increasingly prescribed in nursing homes even though drugmaker Avanir Pharmaceuticals acknowledges in prescribing information that the drug has not been extensively studied in elderly patients — prompting critics to liken its use to an uncontrolled experiment. The one study the company conducted solely on patients with Alzheimer’s (a type of dementia) had 194 subjects and found that those on Nuedexta experienced falls at more than twice the rate as those on a placebo.

Avanir declined repeated requests to be interviewed for this article. In an emailed statement, the company said PBA is often “misunderstood” and that the condition can affect people with dementia and other neurological disorders, which are common among residents in long-term care facilities. A company website states PBA can afflict up to roughly 40% of dementia patients — a figure that is based on an Avanir-funded survey and was repeatedly disputed by medical experts interviewed by CNN, including some of those paid by Avanir.
Nuedexta is approved by the Food and Drug Administration (FDA) to treat anyone with PBA, including those with a variety of neurological conditions such as dementia. But geriatric physicians, dementia researchers and other medical experts told CNN that PBA is extremely rare in dementia patients; several said it affects 5% or less. And state regulators have found doctors inappropriately diagnosing nursing home residents with PBA to justify using Nuedexta to treat patients whose confusion, agitation and unruly behavior make them difficult to manage.
“There has to be a diagnosis for every drug prescribed, and that diagnosis has to be real … it cannot be simply made up by a doctor,” said Kathryn Locatell, a geriatric physician who helps the California Department of Justice investigate cases of elder abuse in nursing homes. “There is little to no medical literature to support the drug’s use in nursing home residents (with dementia) — the population apparently being targeted.”
CNN identified dozens of cases across the country since 2013 in which state nursing home inspectors questioned the use of Nuedexta.
In a Los Angeles nursing home last year, regulators found that more than a quarter of its residents — 46 of 162 — had been placed on Nuedexta, noting that a facility psychiatrist had given a talk about the drug to employees. This psychiatrist was a paid speaker for Avanir.
At another facility in 2015, also in Southern California, an employee admitted to inspectors that a resident had been given a diagnosis of PBA to “somehow justify the use” of Nuedexta, even though its intended purpose was to control the resident’s “mood disturbances” and yelling out.
And an Ohio doctor paid by Avanir has come under government investigation for allegedly receiving kickbacks for prescribing the drug and fraudulently diagnosing patients with PBA in order to secure Medicare coverage — though the doctor has denied any wrongdoing.
The federal government foots the bill for a big portion of the money being spent on Nuedexta in the form of Medicare Part D prescription drug funding, for people 65 and over and the disabled. In 2015, the most recent year for which data is available, this Medicare program spent $138 million on Nuedexta — up more than 400% from just three years earlier.
Medicare is supposed to pay for drug uses that have been proven safe and effective for the population they are intended to treat or that have been otherwise supported by a specific collection of medical research. Nuedexta is currently only approved by the FDA for patients who have PBA. So experts say that Medicare coverage of the drug, which has been crucial to its financial success, relies on the diagnosis of this single condition. So-called “off-label” prescribing, in which doctors use the drug to treat patients who have not been diagnosed with PBA, would typically not be covered.

The Centers for Medicare & Medicaid Services (CMS) declined to comment on the growing use of Nuedexta in nursing homes.
Thousands of the doctors prescribing Nuedexta have received money, or at least a meal, from its maker — a legal but controversial practice in the industry. Between 2013 and 2016, Avanir and its parent company, Otsuka, paid doctors nearly $14 million for Nuedexta-related consulting, promotional speaking and other services, according to government data. The companies also spent $4.6 million on travel and dining costs, both for speakers and for doctors being targeted by salespeople.
A CNN analysis also found that nearly half the Nuedexta claims filed with Medicare in 2015 came from doctors who had received money or other perks from the company (ranging from a few dollars’ worth of food or drink to hundreds of thousands of dollars in direct payments).
Pharmaceutical companies are allowed to pay a doctor to promote a drug to colleagues and other medical professionals. It is illegal, however, for doctors to prescribe the drug in exchange for kickback payments from a manufacturer.
Several of these paid advocates of Nuedexta argue that PBA manifests differently depending on the person. With dementia patients, they say, the typical crying or laughing outbursts seen in multiple sclerosis patients may be absent. Instead, symptoms may include moaning, wailing, hitting a wheelchair over and over again or repeating the same phrase. And they are adamant that the medication can be life-changing for patients, touting how safe and benign it is.
“I never hear, ‘hey doc, we put a patient on this and had really bad side effects,'” said Jason Kellogg, a geriatric psychiatrist who sees patients at nursing homes across California. Kellogg has received $612,000 in payments, meals and travel from Avanir and its parent company between 2013 and 2016, according to government data. He was a top Medicare prescriber for the drug in 2015, the most recent year for which data is available.
Kellogg, who said he was involved in early company testing of the drug for PBA, said Nuedexta is “such a blessing in psychiatry.”
“In our treatments, we don’t have many meds that are well tolerated, and I would hate if someone took that away from me,” he said.
During the FDA approval process, two key doctors on the committee raised concerns about Nuedexta being used for PBA in Alzheimer’s patients. They both strongly recommended that Nuedexta only be approved for PBA in patients with MSorALS. They argued that evidence it would be effective in other conditions was “weak,” that not enough was known about the safety of the drug in the elderly, and that it was unclear that PBA even existed in Alzheimer’s patients. Despite these concerns, the agency approved Nuedexta in 2010 for treating PBA in patients who have neurological conditions such as dementia.

Soon after Nuedexta hit the market in 2011, doctors, nurses and family members began filing reports of potential harm — ranging from rashes, dizziness and falls to comas and death. Nuedexta was listed as a “suspect” medication in nearly 1,000 so-called adverse event reports received by the FDA detailing side effects, drug interactions and other issues, CNN found. While the FDA uses these voluntary reports to monitor potential issues with a drug, a report does not mean that a suspected medication has been ruled the cause of the harm.
The FDA declined to comment on these adverse events or the concerns raised about Nuedexta during the approval process. But it did say that after any drug is approved, the agency continues to review safety information from a variety of sources (including adverse event data) and will take action as needed — such as updating a medication’s label, restricting its use or even taking it off the market entirely.
Lon Schneider, director of the University of Southern California’s California Alzheimer’s Disease Center, reviewed information from roughly 500 of the reports which CNN obtained through a Freedom of Information Act request. Schneider, a physician specializing in geriatric and dementia care, said he was concerned about the problems stemming from potential interactions between Nuedexta and other powerful medications intended to treat problematic behaviors.
He warned that given how medicated the elderly typically are, adding just one more pill — especially one that hasn’t been extensively tested — could be dangerous.
One report filed by a nurse practitioner in 2015 detailed the rapid decline of an 86-year-old Alzheimer’s patient after Nuedexta was added to the psychotropic medications she took including Zoloft (an antidepressant), Xanax (an antianxiety drug) and Risperidone (an antipsychotic). Nuedexta had been prescribed to treat PBA and “weeping with underlying Alzheimer’s dementia.”
Almost immediately, the woman experienced weakness and fatigue to the point that she was barely able to talk and was described as being “almost unresponsive.” The dose of Nuedexta was increased, and her symptoms worsened. The drug was discontinued about a week later, but she failed to recover. She remained unable to eat or drink and her kidneys failed — ultimately leading to her death.
“The patient seemed to be doing fine,” the nurse practitioner reported, “until she was placed on Nuedexta.”

Aggressive sales force

The combination of two generic drugs that makes up Nuedexta — a cough suppressant and heart medication — was once available from specialty pharmacists willing to combine the ingredients for less than $1 a pill, according to a US Senate report on rising prescription drug prices.
Now the FDA-approved medication costs as much as $12.60 a pill, wholesale pricing data from First Databank shows. That can add up to more than $9,000 a year, though the amount a patient actually pays depends on factors including individual insurance coverage. Medicare Part D spending on the drug averaged $3,400 per patient in 2015.

It is Avanir’s main product and biggest moneymaker. It has gained attention with the public through its television commercial featuring actor Danny Glover seesawing between laughter and tears. And it was this drug’s financial potential that attracted Japanese pharmaceutical giant Otsuka to the boutique California firm, purchasing Avanir for $3.5 billion several years ago. Otsuka declined to comment for this story.
Avanir investor documents have stated that only a small fraction — 100,000 of the 1.8 million patients suffering from moderate to severe PBA — live in long-term care facilities. Yet the company has described nursing homes as key to its growth.
On a 2013 earnings call, Rohan Palekar, a top executive who eventually became CEO but is no longer with the company, said Avanir had “just scratched the surface of its full potential” in nursing homes, according to an online transcript. He said the company aimed to get Nuedexta prescribed in far more facilities. Palekar did not respond to requests for comment.
To rack up these prescriptions, salespeople identified doctors, nurses and pharmacists who could serve as advocates for the drug, according to interviews with former Avanir employees and internal documents and emails reviewed by CNN. Salespeople then worked closely with these advocates to identify potential patients. In one case, a salesperson worked with a doctor’s office manager to pull patients’ charts, identify those who should be screened for PBA and make sure that Nuedexta brochures were inserted in their files. The sales force also coached doctors and facility employees on how to fight for Medicare coverage of the drug if it was initially refused.
Federal laws restrict the tactics pharmaceutical sales representatives can use to sell a medication. They can’t give favor or payments in exchange for a doctor prescribing the drug. They can’t have any contact with private patient records, without the patient’s consent. And they can’t promote use of a drug off-label, in a way that hasn’t been approved by the FDA.
Internal company emails obtained by CNN show a culture filled with intense pressure to get the drug sold and how Avanir sales representatives were encouraged to directly target dementia and Alzheimer’s patients — a practice which is legal as long as these patients also had PBA.
In an email from several years ago, one of the company’s regional managers, Kevin Tiffany, bluntly urged his salespeople to spend “99.9 percent” of their time focused on such patients.

What should we investigate next?

Email Blake Ellis and Melanie Hicken

Devoting time to other conditions more commonly associated with PBA amounted to “diluting your chances,” wrote Tiffany, a senior sales manager in California.
“Give yourself the best chance to win,” Tiffany added.
Tiffany, who no longer works for Avanir, declined to comment through an attorney.
Other emails from managers show how the government’s crackdown on dangerous antipsychotic drugs — which were once widely used to control unruly and erratic behavior in nursing home patients — created an opportunity for Avanir.
After receiving the FDA’s most severe “black box” warning for an increased risk of death in elderly dementia patients, antipsychotics are now closely monitored by government regulators, who penalize and lower the ratings of facilities that overuse them. Internal company communications show Avanir salespeople were directed to specifically target facilities that historically used high levels of antipsychotic medications — facilities that would see Nuedexta as an attractive alternative.
Some of these tactics employed by Avanir salespeople cross into ethical gray areas, said medical ethicists and other experts who were read the emails and sales training documents or provided with details from them.
“It definitely feels like it is too much in the business of prescribing and not in the business of conveying information,” said Michael Santoro, a Santa Clara University professor and an expert in pharmaceutical industry ethics.”It feels like (the salespeople) are actually participating in the prescribing decision.”
In its statement, Avanir said that the company was committed to “an ethical culture,” uses methods “that are consistent with the law” and that its goal is “to give doctors truthful, accurate and balanced information so they can decide on the proper treatment for their patients.”
Avanir executives have long touted plans for securing FDA approval for Nuedexta’s use to treat dementia patients who don’t have PBA — setting their sights on the more widespread condition of agitation in dementia and Alzheimer’s patients, characterized by emotional and physical outbursts and restless behaviors. The company announced clinical trials for testing a version of the medication for this use in 2015, but those have not yet been completed. Without additional FDA approval for the drug’s use in those conditions, salespeople cannot promote Nuedexta for that purpose. They can only market its use for dementia patients who also have PBA.
There are currently no FDA-approved drugs for treating dementia-related agitation, and other drug makers have been penalized for marketing drugs for this use. Abbott Laboratories Inc., for instance, pleaded guilty in 2012 to illegally marketing an anticonvulsant called Depakote in nursing homes as a way to control agitated and aggressive dementia patients. But the drug had only been approved for treating seizures, bipolar disorder and migraines. The company ultimately paid a total of $1.6 billion in civil and criminal penalties.
Those who care for the elderly remain eager for tools to manage these behaviors, however. Some caregivers say investments in increased staffing can reduce the need for medications. But such measures are expensive and don’t always work, so some facilities opt for pharmaceutical solutions that can help make their many patients easier to treat.”Rather than taking someone off an antipsychotic” and opting to treat the patient in ways that don’t require medication, “providers search for a different ‘magic bullet,'” said Helen Kales, a geriatric psychiatrist and University of Michigan professor.
In one case, the executive director of a California assisted living facility tried to push Nuedexta on a dementia patient to address her “aggressive” behavior, according to emails reviewed by CNN. The director at the facility, Oakmont of Mariner Point in Alameda, California, told the patient’s son, Jason Laveglia, that the medication wasn’t an antipsychotic and threatened to evict his mother if she wasn’t put on the medication.
“(I)f her behavior cannot be muted through prescription means, I would have no choice but to pursue delivering a 30-day eviction notice,” Joan Riordan wrote to Laveglia last year.
Laveglia turned to the state for help, and by the time officials investigated weeks later, Riordan no longer worked at the facility. Social service officials ultimately found that her eviction attempt had violated state law. A spokesperson for the facility would not comment on the state’s findings, but said it “does not endorse or recommend Nuedexta nor any other medication” and that staff should not be involved in medical decisions.
In an interview with CNN, Riordan disputed the idea that her emails served as an official eviction notice. Riordan, who is not a doctor, said that she had recommended Nuedexta after learning about the medication from a local psychiatrist and had seen it help a number of other aggressive dementia patients without the dangers and sedative effects of an antipsychotic.
“I’ve seen it just work wonders with people,” she said. “It was the only intervention I could come up with. We needed to do something not only for her own benefit, but also for the people around her.”
When asked whether her residents had PBA, Riordan told CNN she had never heard of the condition and had no knowledge of whether they had received such a diagnosis.

Red flags and questionable use

Across the country, the use of Nuedexta in nursing homes has prompted concerns among state regulators whose job is to ensure adherence to federal guidelines and protect residents from being given unnecessary drugs — especially those used as chemical restraints. But to date, the red flags raised by these regulators have been largely left buried in nursing home inspection reports and have drawn little public attention.
CNN identified more than 80 cases in 19 states since 2013 where inspectors cited nursing homes for inappropriate monitoring and use of Nuedexta — often because residents hadn’t exhibited any symptoms of PBA. Many of the cases — about 40% — were clustered in Southern California, where Avanir is based and where former employees said there has been aggressive marketing.
At the Montrose Healthcare Center near Los Angeles, three nursing home residents were given Nuedextawithout a doctor’s prescription or approval, according to one inspection report. All were cognitively impaired. One was known to call out for help, while another would cry when their family left the facility. But employees acknowledged that they had never seen the residents laugh or cry involuntarily — the hallmark indicators of PBA.

    Is your doctor being paid by a drug company?

Regulators learned of these prescriptions in 2015, after a family member discovered that her relative was receiving Nuedexta without her consent. While researching the medication, she learned it could be dangerous for her family member because of other medications she took for a serious heart condition.
The doctors for all three residents denied ever prescribing Nuedexta. State investigators later discovered nursing staff had obtained the prescriptions without a doctor’s approval, which they are not authorized to do. They also found that at least two nurses at the facility had attended a sales seminar about Nuedexta, where they were given a doctor’s sample prescription for the medication. The facility said in a statement that it had addressed the concerns raised by the state inspection report and suggested that outside pressure had been at play.
“Our Center does not condone the pressuring of nurses by pharmaceutical reps and physicians to favor certain medications,” the facility said. “Should they feel pressured to administer medications they do not feel are appropriate, our nurses can and should bring it to our immediate attention so we may assist them in advocating for their patients.”
In New Jersey, St. Vincent’s Healthcare and Rehab Center was cited by regulators last year because six residents were prescribed Nuedexta even though no symptoms of PBA had been documented. A representative of the facility told CNN it takes a “close look at all medications prescribed to ensure appropriate use.”
One resident in the report told the facility’s psychiatrist there was a legitimate reason for their sadness: “All I really want is a companion. I am lonely.” In the case of another resident given the medication, a nurse said the resident’s crying was an expression of frustration, and that this had improved with a change in routine.
Two other residents at the facility were originally prescribed Nuedexta for “Dementia with Behaviors.”
Those diagnoses were then crossed out or rewritten — replaced with “PBA.”

The pill pushers

At first, Alex Carington couldn’t figure out why her 85-year-old mother, Lenore Greenfield, was on Nuedexta, a pill Carington had never heard of. A psychiatrist had prescribed the medication after visiting the elderly woman in her Los Angeles nursing home while she was sleeping, Carington said. Even when the drug appeared to do nothing to ease her mother’s sadness, confusion or emotional outbursts as she battled dementia, she said the doctor kept her on it.
“Something about this whole thing made me think money was behind it,” Carington, who lived near her mother’s facility and visited her often, wrote at the time in an online comment on the blog of a psychiatrist who had questioned Nuedexta’s aggressive advertising.
As she began to look into her mother’s doctor, she discovered he had received more than $100,000 from Avanir in just over a year.
Outraged, she finally got her mother taken off Nuedexta for good. Now, around two years later, she is in a new nursing home and Carington believes she is doing much better.
Her mother’s doctor was Romeo Isidro, a speaker for Avanir and one of the physicians paid the most by the drugmaker. Between 2013 and 2016, Isidro received more than $500,000 in payments, travel and meals from Avanir and its parent company. According to internal company documents, he was an advocate for Nuedexta as early as 2012, the year after it hit the market.
He had more than 100 patients in 11 facilities on the drug that year.
In Avanir training documents, a California salesperson explained how he worked to get Isidro to prescribe Nuedexta. Now a senior sales manager at the company, Chris Burch wrote in 2012 that he and his colleague saw or spoke to Isidro about twice a week — regularly calling and texting him, and visiting him at both his office and nursing homes. Burch wrote that Isidro was at first skeptical about the condition of PBA, but after he successfully used Nuedexta to treat possible symptoms of it in one patient, he became more comfortable prescribing the medication. Burch then explained how he had directly targeted facilities where Isidro worked, finding employees who could serve as “advocate(s)” to help identify potential Nuedexta candidates for Isidro.
“He is now a speaker and I ask him to advocate in his facilities, corporate facilities, and (to) other psychiatrists, internists and pharmacies,” Burch, who did not respond to requests for comment, wrote in a form used by the company to track certain prescribers.
CNN attempted to contact Isidro by phone and by visiting his office, where two stacks of PBA and Nuedexta pamphlets sat on a table in the waiting room. He declined to be interviewed but ultimately provided a written statement saying that he had “never prescribed medication for financial incentives” and that he prescribes Nuedexta to patients who he has properly diagnosed with PBA.
He also wrote about the first success he had seen with the drug, and how it helped him wean an elderly patient off of dangerous psychotropic medications — noting that her inappropriate crying and screaming symptoms reminded him of a visit from a Nuedexta representative who had told him about PBA. He said Avanir approached him about becoming a speaker, and that he agreed in order to share his first-hand experience with the medication — not to promote it.
“Since learning about PBA, I have become more skilled at recognizing it in my patients, which would in turn produce increased numbers of patients on Nuedexta,” he wrote. “I am not an advocate for a particular drug or pharmaceutical companies. I am an advocate for my patients and their families.”
In response to questions about Carington’s mother, he said he couldn’t comment on specific patients but that memories are not “infallible.” He urged CNN to substantiate any claims with medical records about her case. Carington provided her mother’s records to CNN, which confirmed that Isidro had diagnosed her with PBA and prescribed her Nuedexta, which she remained on for months.
A different speaker paid by Avanir, a pharmacist in northern California, appeared to suggest during a 2012 presentation that doctors could broaden the use of Nuedexta when prescribing, according to an audio recording obtained by CNN. A person in attendance, who recorded the event, identified the pharmacist as Flora Brahmbhatt.
“I’m definitely pushing this a little bit, perhaps considered off label … but maybe it’s effective on some of the other behaviors too that we find challenging,” the pharmacist said in her presentation, which was sponsored by Avanir. “There are certain nursing home chains, specifically in Southern California, that are saying, ‘Hey, if you have somebody with dementia that has a behavior issue, try them on Nuedexta before you put them on a psychotropic (medication.)’ It’s a little aggressive, I’ll say that. But CMS isn’t making it easy for us to use antipsychotics anymore.”
She went on to discuss how a PBA diagnosis was essential for the medication to be “covered by insurance and not be off-label,” as well as how PBA’s definition of inappropriate laughing and crying could be interpreted by physicians. At one point, she told an Avanir employee in the room that they could cover their ears.
“We don’t have anybody from the FDA in here. I’m telling you … you can extrapolate that to mean any kind of socially inappropriate behavior when you’ve ruled out other causes,” she said. “If they have an episodic behavior and they have an underlying neurological condition, you can pretty much come up with a diagnosis.”
When contacted by CNN about the event and asked about the recorded statements, Brahmbhatt said she hadn’t given presentations about Nuedexta for many years. She said she didn’t give permission to be recorded and didn’t recall making those statements. “I don’t know if I said this stuff,” she said. “It was five years ago, at best.” She was read several of the quotes from the recording but declined to listen to it. An attorney representing Brahmbhatt contacted CNN after publication and said that Brahmbhatt denies making the statements in the audio recording.
Former FDA investigator Larry Stevens, who now works for the consulting firm The FDA Group, said it is a violation of federal law for a paid speaker to promote a drug for anything other than its FDA-approved use.
Yet another paid speaker, the Ohio physician accused of accepting kickbacks in exchange for prescribing Nuedexta, has been under government investigation. Internal Avanir documents show Cleveland neurologist Deepak Raheja was a top prescriber of the drug from the beginning, in 2011. Between 2013 and 2016, he received $289,000 in payments, meals and travel.
In addition to allegedly accepting kickbacks, Raheja is accused of fraudulently diagnosing patients with PBA in order to secure Medicare coverage for off-label use and increasing dosages of Nuedexta beyond what is recommended, according to a letter obtained by CNN. The letter, circulated by the Centers for Medicare & Medicaid Services (CMS) in January, alerted insurance providers that work with Medicare about the fraud allegations so that they could take “appropriate measures.”
Medicare officials said the agency could not comment on pending or active investigations. When contacted by CNN, Raheja denied that he had received kickbacks or been involved in any kind of Medicare fraud in his 25 years of practice.
He also said he no longer prescribes Nuedexta.
Email Blake Ellis and Melanie Hicken at watchdog@cnn.com.
This story was updated to reflect a statement from Flora Brahmbhatt’s attorney made after publication.

Read more: http://www.cnn.com/2017/10/12/health/nuedexta-nursing-homes-invs/index.html

Dove under fire for racist Facebook adand weak apology

Dove’s latest Facebook ad is leaving many women of color scratching their heads over its blatant racism.

Last week, Dove published a three-second GIF depicting three women stripping off their shirts to show another woman underneath. But in one case, a Black woman in a brown shirt takes off her shirt to reveal a white woman in a lighter shirt. Many claim Dove’s ad draws on age-old racist depictions in beauty commercials, where Black people are considered dirty and white people are shown as good or pure.

It didn’t take long for stills from the ad to circulate across the internet, breaking down just how racist it is toward Black women. Dove has since apologized for the ad and pulled it from Facebook.

“An image we recently posted on Facebook missed the mark in representing women of color thoughtfully,” Dove wrote in a tweet. “We deeply regret the offense it caused.”

But many think the apology isn’t enough. In fact, some are still surprised that an entire marketing division approved the idea.

Others argued that this is an ongoing issue with Dove ads, as the company tends to showcase Black people as lesser than white people.

Selma and 13TH director Ava DuVernay even called out Dove, saying that the company owes a better apology than “missed the mark.”

Dove occasionally creates thoughtful beauty and body care promos, doing everything from depicting a transgender mother in its ads to representing blind peoples’ experiences. But the company has a much longer legacy of struggling with intersectional feminism, especially when it comes to bigger bodies or racist beauty standards—and this one is no exception.

H/T New York Times

Read more: https://www.dailydot.com/irl/dove-facebook-ad-racist/

How to stop ads from following you online

Is this just a coincidence? You recently looked at cameras online, and now you’re seeing ads for cameras. You were browsing new outfits, and now your browser is showing ads for shirts and trousers.

Not long ago, “interest-based advertising” creeped out a lot of people who couldn’t understand why Facebook, for example, knew what they had just shopped for on Amazon. The truth is that personalized ads are the result of a very impersonal process.

Interest-based advertising crunches bits of data gathered from your browser to make marketing more efficient. Special algorithms analyze your visits over time and across different websites, making it possible to predict your preferences and show ads that are likely to interest you.

But sometimes, all this tracking can be overwhelming. While the process is basically automatic and unmanned, interest-based ads can feel like an invasion of privacy. That’s why many people look for ways to throw the trackers off their scent.

Here are three simple ways to do just that.

More on this…

Read more: http://www.foxnews.com/tech/2017/10/07/how-to-stop-ads-from-following-online.html

Fans call for McDonald’s ‘boycott’ following Szechuan sauce snafu

McDonald’s is receiving major backlash after a failed attempt at bringing back a cult-favorite sauce.

As previously reported, McDonald’s had agreed to bring back the discontinued Szechuan sauce following pleas from Cartoon Network’s adult cartoon, “Rick and Morty.”

McDonald’s announced last week that for one-day only, the fast food restaurant would carry the Szechuan sauce for customers at participating locations.

BURGER KING ITEM HITS GROCERY STORES

That one day – Saturday, October 7 – “Rick and Morty” and Szechuan sauce fans gathered outside McDonald’s restaurants nationwide. Thousands lined up hours before the packets were allowed to be sold, all clamoring for the sweet plum sauce.  

However, McDonald’s failed to mention in any of their widespread promos that only 20 packets of the highly anticipated sauce would be available at the stores. The Huffington Post reported that some locations listed online as participating stores didn’t actually have the sauce packets at all or some had sold out before the authorized selling time.

Once the fans realized that the sauce had been sold out after waiting in line for hours, they were outraged. So much so that the police had to be called to disband an angry crowd surrounding a Wellington, FL McDonald’s.

At another McDonald’s, a mob chanting “we want sauce” formed and the police had to push them back.

Other locations, adults left angry and kids left crying.

The disgruntled customers took to Twitter to vent their frustrations at the chain, claiming false advertising and calling for both a “class action lawsuit” and a “boycott.” The latter became a trending hashtag for the day, #boycottMcDonalds.

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McDonald’s responded to the outrage, issuing a public apology on their Twitter account.

“The best fans in the multiverse showed us what they got today,” McDonald’s tweeted. “We hear you & we’re sorry not everyone could get some super-limited Szechuan.”

Fans weren’t buying it and accused the hamburger joint of just wanting the publicity.

A McDonald’s representative was not immediately available for comment. 

Read more: http://www.foxnews.com/food-drink/2017/10/08/fans-call-for-mcdonalds-boycott-following-szechuan-sauce-snafu.html

If there Was a Crappy Design Hall of Fame these Would be the First Inductees

At the reddit community of /r/CrappyDesign you will find all text in Comic Sans, heavy hits of turquoise, and gradients galore.

Boasting 720,000 members, the community provides a daily reminder that crappy design is everywhere, from products to advertising. Below you will find 15 designs so crappy, well just see for yourself.

[via /r/CrappyDesign]

15. This Rotating Billboard

Video via throatfrog

14. The Audio Clip in this Textbook

Photograph via j0m1n1n

13. The Maze on this Kids Menu

Photograph via MyBoener

12. Hard Hats, Because Safety Comes First

Photograph via CanadianUkr

11. You Are Not Our Trollies

Photograph via TheBombayMixer

10. Do Not Season the Birds

Photograph via Steven_NotMyRealName

9. Over There

Video via joeri_poeri

8. Handed Out as Part of
Safe Sex Campaign on Campus (Donut = Do Not…)

Photograph via wrags23

7. Cookie Comes with Free Gluten?

Photograph via Vexced

6. Oh No Baby! What Is You Doin???

Photograph via yoziphek

5. This Got Me Down Dog

Photograph via skankyfish

4. Schadenfreude?

Photograph via HomemadeGrapplePie

3. This Important Safety Message

Photograph via J4CKR4BB1TSL1MS

2. The Buttons on this Elevator

Photograph via Xadacka

1. This Bathroom Door Lock

Read more: http://twistedsifter.com/2017/10/crappy-design-hall-of-fame-inductees/

Heres What Really Goes Into Those Flat Tummy Tea Instagram Posts

It’s no secret that some people can make big bucks on Instagram just by building a following, but it’s easy to forget the reality when we’re looking at perfectly curated images of someone else’s life. It’s not even just celebs who make money by trying to sell their followers on a glamorized version of their life, everyday people who happen to be beautiful and have an eye for aesthetics can build a brand as an “influencer” and command tens of thousands of dollars for a single post.

Here’s an email one influencer tweeted in which she was offered $11,850 (along with a commission) by one brand for a single post:

The whole thing seems even slimier when influencers simply copy and paste the instructions they get from the product’s marketing team, accidentally making it transparent that the whole things is very, very staged. Here’s a D list celebrity from MTV’s who left the staging instructions on her Instagram post:


Mackenzie McKee’s Instagram

The instructions read:

“Style: Be wearing active wear, have your tummy out and be facing square onto the camera. Now bend your knees a little babe (kind of like your mid shakin it!), shove the shakes box out front and be beaming at the camera with an expression that screams “OMG It’s finally here!!!)! We want the pic to look and feel like you’ve just been snapped in the middle of your shake it baby tummy wiggle!

Caption: #ad Girls! It’s actually here! @flattummyco JUST launched their Shake it Baby program, and I can’t wait to start shaking my booty off (and tummy!) this month! This stuff is going to be a lifesaver, it’s clinically proven to be 3 x more effective than diet and exercise alone, so I know I’m going to actually see some REAL results! Want to shake these extra few pounds with me? You’re in luck girls, it just dropped so you get it too 🙌 Check it out at flattummyco.com”

For comparison, here’s another post by Mackenzie in which she didn’t forget to delete the instructions from the company:


McKenzie McKee’s Instagram

The caption is written in the same voice, only this time we aren’t made aware that this isn’t McKenzie’s effervescent love for the product bubbling through, the whole thing is written by the product’s marketing team and copy/pasted by McKenzie into her Instagram. Considering the entire idea of a ‘detox’ has been throughly debunked, it’s insane to think how these people are making a living off of something so fake.

It’s also worth noting that Mackenzie bills herself as a personal trainer, something her followers might mistake for expertise when it comes to whether “flat tummy” teas and detoxes are effective.

The next time you look at a perfectly sculpted human being smiling at you over a vat of flat tummy tea or a weight loss smoothie remember how much money goes into marketing this image to you, and whether a product that really worked would need so many theatrics.

Read more: https://thoughtcatalog.com/emily-madriga/2017/09/heres-what-really-goes-into-those-flat-tummy-instagram-posts/

There’s a cool new way to help kids with cancer keep calm during treatment.

Pretty much nobody likes getting their blood drawn.

Some of us are better about it than others, but when it comes to needles, it’s safe to say very few people jump at the opportunity to get stuck with one — aside from the good-hearted folks who donate.

Unfortunately, part of what cancer patients have to go through for treatment includes tons of needle-y, pokey, proddy procedures that can give even the most stoic patients pain and anxiety. And for pediatric cancer patients, it’s even worse.

Image via iStock.

Jenny Hoag, a pediatric psychologist at the Children’s Hospital of Wisconsin, tells the story of one patient, Jamie*, whose experience demonstrates just how distressing regular procedures can be for kids with cancer and other chronic diseases:

“I had worked with him since the beginning of his treatment, and he really, really struggled,” she says. “He would get here and immediately feel nauseous and anxious and would almost always vomit, sometimes more than once, before we even did anything.”

Hoag’s job is to come up with ways to help kids conquer that discomfort and anxiety. But in Jamie’s case, he wasn’t interested.

Jamie rejected Hoag’s coping mechanisms, but once she suggested virtual reality, his curiosity won out.

Hoag brought in a virtual reality program that makes the wearer feel as though they’re underwater, being pushed along calmly while viewing colorful fish, ships, and other distracting scenes.

“Once the headset was on, he was already smiling, which I almost never saw,” Hoag says. Jamie sat through the whole 20-minute program, enjoying every moment. “He took it off and said, ‘I really want to do that again.'”

Image via Northwestern Mutual.

Using the immersive program, Hoag was able to help Jamie endure his procedures with a lot less stress, anxiety, and pain. But it didn’t stop there. Once Jamie saw that Hoag was right about the benefits of VR, he was suddenly much more willing to try her other coping suggestions.

While once he had been anxious and withdrawn, now his virtual reality experience was encouraging Jamie to branch out into actual reality too.

Now, Hoag is working with Northwestern Mutual and KindVR to study just how much virtual reality could benefit kids at Children’s Hospital of Wisconsin and beyond.

In her work thus far, Hoag has mainly looked to solve individual cases of anxiety instead of searching for options that could be applied to help kids all over the country. “But obviously,” she says, “having an empirically supported treatment is the best way to treat kids.”

Dr. Hoag has been letting her patients try VR informally, and is getting ready to conduct a clinical study on its benefits. Image via Northwestern Mutual.

That’s why she’s preparing to apply the solution she saw work so well with Jamie to a clinical study that could result in VR programs being implemented in children’s hospitals nationwide.

Not only could VR provide a more effective way to treat patient discomfort, it could also increase the number of children that could benefit from the hospital’s psychological intervention program. With VR, many hospital staff — not just psychologists — can help patients use the equipment.

Right now, only cases that are extreme enough merit a visit from a psychologist. But if Hoag’s research proves that VR treatment is effective, hospitals could drastically increase the amount of kids receiving anxiety treatment without having to hire more staff.

Image via iStock.

For kids enduring a chronic illness, the calming effects of VR could be life-changing.

Drawing blood might not seem traumatic, but after months of frequent treatments, it can be.

“The average adolescent is having an IV maybe never, or if anything, maybe once or twice through the course of their childhood,” Hoag says. “These patients are coming in sometimes multiple times a week and having this done. So the anticipation of knowing you have to have a needle is really stressful for kids, and by the time they even get to the hospital, they’re pretty worked up about it.”

Image via iStock.

For many, the excitement of getting to use a piece of virtual reality software can help temper those feelings of nervousness or nausea, which can improve a child’s life overall by a lot.

In the end, that’s what Hoag is hoping to do: make the lives of kids with cancer just a little bit easier.

Image via iStock.

“Going through cancer treatment is probably the hardest thing that these kids will ever do — not just as children, in adolescence, but in their entire lives,” Hoag says. That’s the motivation behind her research and the efforts that Northwestern Mutual has made to sponsor similar quality of life projects to help kids with cancer.

“If there are things that we can offer that improve their quality of life or improve their experience while undergoing cancer treatment, that’s absolutely something that we want to do.”

Image to via Northwestern Mutual.

Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company, Milwaukee, Wisconsin, and its subsidiaries. Learn more at northwesternmutual.com.

Read more: http://www.upworthy.com/theres-a-cool-new-way-to-help-kids-with-cancer-keep-calm-during-treatment

iPhone X: new Apple smartphone dumps home button for all-screen design

New model with 3 November release date promises better cameras, facial recognition, animated emojis, longer battery life and wireless charging

Apple has unveiled the iPhone X, its new radically redesigned smartphone that drops the traditional home button for an all-screen design, as well as new iPhone 8 and iPhone 8 Plus models.

Apples senior vice president of worldwide marketing, Phil Schiller, took to the stage of the companys new Steve Jobs Theater situated within the brand new Apple Park spaceship headquarters to unveil the new iPhones.

The new $999 (999 there is dollar-to-pound parity on the new range of Apple products) iPhone X will come with the companys new iOS 11 software featuring new on-screen buttons and gestures to replace the standard physical home button, which has been a mainstay of iPhones since the lines launch in 2007, plus new animated emoji called Animoji.

The iPhone X, pronounced 10, will come in two colours, space grey and silver, and is available for pre-order on 27 October, and shipping by 3 November. A 256GB storage option will also be available for 1,149.

Apple chief executive Tim Cook said: This is the iPhone X. Its the biggest leap forward since the original iPhone.

Instead of pressing a button, users swipe up from the bottom to get to the home screen and swipe and hold to go into multitasking. To wake the device users just tap the screen or lift the iPhone, while the control centre is now accessed by swiping down from top right corner of the phone.

The
The iPhone X has a new OLED screen. Photograph: Justin Sullivan/Getty Images

The front of the device features a cutout at the top of the new OLED Super Retina display housing a new True Depth camera system for the Face ID facial recognition system and for taking selfies with Apples Portrait Mode. Apple says Face ID is capable of identifying the phones owner from a 3D scan of the face in order to unlock the device, authenticate payments and input saved passwords into login screens as well as integrate into third-party apps.

Similar systems have been used by Microsoft for its Windows Hello-capable Surface computer line, but no one has yet cracked the technology on a smartphone. Apple said the system was capable of operating even when the user was wearing glasses, and only unlocks the phone when the user is actively looking at it.

The iPhone X does not include Apples Touch ID fingerprint scanner, which was introduced in 2013 under the home button with the iPhone 5S.

But Apple said that its Face ID was more secure than Touch ID by a factor of 20, capable of discerning between the users real face and photographs and even Hollywood-level replica masks using the True Depth camera system, which projects an IR dot map on to the face to map it. It even works in the dark.

The
The back of the iPhone X is glass. Photograph: Justin Sullivan/Getty Images

The rest of the device is made from stainless steel and glass, harking back to the design of the iPhone 4, and mirroring that of rival Samsungs Galaxy S8 but without a curved screen. It marks a striking contrast to recent all-metal iPhone models, and remains to be seen whether it suffers from a similar level of fragility as rival glass-and-metal sandwich smartphones. Apple said the glass was the most durable ever fitted to a smartphone with metal reinforcement. The headphone jack is still gone too.

The iPhone X will have Apples latest processor, the A11 Bionic that comes with an integrated Neural Engine for face recognition and now has six cores, up from last years A10 with four cores. Apple said that the A11 had 30% faster graphics and was an up to 70% faster processor than the A10, while extending battery life by two hours over the iPhone 7 a pain point for the majority of current iPhone users.

Apple also introduced Qi wireless charging to the iPhone line for the first time, which uses a a plate within the back of the phone to accept an inductive charge from a pad or a piece of furniture with wireless charging built in. Its a feature thats been standard in Samsungs Galaxy S line of smartphones for the last three years and available with several other rivals, and removes the need to fiddle with a power cable to charge your smartphone.

The back of the iPhone X has Apples now familiar dual camera system, which debuted on 2016s iPhone 7 Plus with one wide-angle camera and one telephoto camera capable of giving the phone a two-times optical zoom, but oriented vertically rather than horizontally. Both cameras have new 12-megapixel sensors, optical image stabilisation and Apple said that it had improved its computational photography system to produce better, more detailed images.

Part of the improved system is a new version of the companys Portrait Mode, which allows users to artificially blur the background to create a shallow depth of field, similar to that created by dSLR cameras, and change the lighting effects across the subjects face. Rivals Samsung and others have also shipped similar features, with inherent flaws around fine detail such as hair. It remains to be seen whether Apples system can fix those problems.

Apple also unveiled new animated emoji characters it calls animoji, which allow users to map facial expressions on to little characters, such as a robot, fox, unicorn, or anthropomorphised poo using the iPhone Xs facial recognition system. The animoji can only be sent to other Apple users through the companys Messages app.

Ben Wood, chief of research for CCS Insight said: The iPhone X is the blueprint for the iPhones new hardware direction. An OLED display and the new design is likely to [be] standard on future iPhone models, but Apple must first tackle the challenge of obtaining sufficient supply.

A staggered introduction of OLED technology and the new design enables Apple to steadily ramp up scale in its supply chain and maximise profits. The relatively high prices of the iPhone X are a necessary and important mechanism to control demand in the near term.

iPhone 8

The
The iPhone 8, which will start at $699/699. Photograph: Stephen Lam/Reuters

Alongside the iPhone X, Apple also unveiled two other new smartphones, the iPhone 8 and 8 Plus, which are essentially updated versions of 2016s iPhone 7 and 7 Plus, which were themselves updates of the iPhone 6 and iPhone 6S lines from 2014 and 2015 respectively.

On the outside the iPhone 8 and 8 Plus has glass on the front and back, with a colour-matched aluminium band around the outside. Apple said that the glass on the back was the most durable glass on any smartphone, attempting to assuage fears that the new iPhone would be less durable than the iPhone 7.

The iPhone 8 and 8 Plus both have Apples new A11 Bionic chip, but without the Neural Engine of that fitted to the iPhone X, and come with improved screens with the companys True Tone feature and improved speakers while keeping its current form with a home button with Touch ID 2 fingerprint scanner. But they lack facial recognition and an all-screen design of the iPhone X.

Schiller said: This is the first iPhone created for AR. The cameras are individually calibrated in the factory which makes a huge difference for AR, plus AR benefits from the new A11 Bionic chip.

Apple also added wireless Qi charging like the iPhone X and the latest Bluetooth 5.0 standard, which is expected to become widely used in the next year for headphones and other peripherals.

The iPhone 8 and 8 Plus will come in three colours and start at $699/699 and $799/799 respectively with 64GB of storage, available for pre-order from 15 September and shipping by 22 September. A 256GB storage option will also available.

Wood said: The iPhone X and iPhone 8 models are very strong additions to Apples portfolio that address increasing competition from Samsung and others. Rivals will be watching how quickly Apple can meet demand for the iPhone X and begin to build margins on a new design with new components.

Read more: https://www.theguardian.com/technology/2017/sep/12/iphone-x-release-date-apple-home-button-screen