#so get into the habit of that when you're doing tracing studies. “it's not accurate!” yeah but 9.99/10 times it looks so much better | Explore Tumblr posts and blogs

terubakudan · 3 years ago

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This may be an old article from 3 years ago, but these cultural aspects/observations still apply even today. And though this is strictly a Chinese perspective, a lot of these everyday life bits are observed in Overseas Chinese communities in countries such as The Philippines, Malaysia, Indonesia, etc. as well as countries heavily influenced by Chinese culture like Taiwan, Japan, and Korea.

I've always liked learning about other cultures and making comparisons between how things are done East vs West. Which probably stems from growing up with two cultures and Mom raising me on American movies xD

So the irony is if you asked me how many Chinese, Taiwanese, or Hong Kong actors I know, chances are I know as much as you do xD Like Jackie Chan, Andy Lau, and that's about it. But if you asked me about Western (specifically American and British) actors, then I have a useless brain dump of movie trivia and who was with who in what movie xD

Hmmm, both Taiwan and the Philippines are two distinct cultures but both look up to a certain country and are fascinated by that. In Taiwan's case, Japan and the US for the Philippines. In both cases, this is due to being under the rule of those countries in their history. Taiwan being under Japan for 50 years, and the Philippines being under Spain for 300+ years, followed by periods of American and Japanese rule. To put it simply though:

Taiwan is "mini-Japan with a very Chinese culture".

The Philippines is "former colony of Spain with lots of American influences".

But unlike the author, I've never set foot in any Western country, so my understandings are strictly what I've observed in media, which while it can be accurate, doesn't compare to actually experiencing the culture.

Some further elaboration on most points:

#1 We quite literally use chopsticks for everything. We use it to pick rice, viands, vegetables, fruit, smaller desserts, almost all the food you can think of.

But where do you put your chopsticks when you're not using them? Just put them on top of your bowl or flat on your plate. But do not ever stick them vertically. It's taboo, since it looks like incense sticks, which we use to pray for those who have passed, like our ancestors or during funerary services.

#3 The majority of Asia is obsessed with fair/white skin. In my time at the Philippines, I grew up watching all these Dove Whitening commercials and my classmates often commented on how fair my skin was, how they envied it etc. In Taiwan, girls often say they don't want to 變黑 (biàn hēi) 'become dark'. Japan and Korea too are not innocent of this either (if their beauty/skin products weren't a dead giveaway).

People here at Taiwan often mistake me for being from Hong Kong or Japan (as long as I don't speak Mandarin with my heavy accent xD). A Taiwanese classmate of mine joked that she often gets mistaken for being from Southeast Asia due to having a darker complexion. And while I laughed it off with her at that time, looking back, I now realize she was lowkey being racist. xD

And believe me Filipinas have mentioned literally being told 'your skin is so dark' here in Taiwan, or being given backhanded compliments like 'you're pretty despite having dark skin' and...*facepalms*

My point is, beauty is not exclusive to skin color. People who still think that are assholes.

#5 Not to say we don't have salt and pepper, but yes soy sauce and vinegar are the classic condiments you see on the table, be it at home or at a restaurant.

And if I may add, Taiwanese love their pepper. xD If you ever get to eat at a night market or a smaller "Mom n' Pop-style" restaurant here, some dishes/soups tend to add quite an excessive amount of pepper. Not like anthills, but quite liberally and way more than average. Enough that you see traces of pepper at the bottom of the food paper bag or swirling in your soup. xD

#6 I know this all too well from personal experience. In my years of studying at Taiwan, I always had roommates. 3 in my first school (I graduated high school in the Philippines pre K-12 so I had to make up 2 years of Senior High), followed by 2 in college, with the exception of 1 in freshman year.

My college did offer single person dorms but at around 9000 NTD ($324) per month compared to around 6000 NTD ($216) per semester. Because I wanted to save, the choice was obvious for me xD. But ah, this doesn't mean I don't value personal space, in fact I love having the room to myself, and since both my roomies would go home to their families every weekend, weekends were bliss for me xD

And you don't have to be friends with your roommates (that's an added bonus however), you just have to get along with them. I was quite lucky to have really great roommates all throughout my schooling years.

#9 In the Philippines, we do. Owing mostly to American influences and maybe being predominantly Catholic? xD

#10 *sigh* Chinese parents and parents from similar Asian cultures tend to put too much emphasis on grades, so much that kids could get sent to cram school as early as elementary. This is because what school you get into could literally affect your future job opportunities, and while that's not exclusive to any particular country/culture, I feel it's especially pronounced here in Asia. I'm really lucky my own parents weren't that strict about it. However, if your parents don't point the mistakes out to you, chances are you'll do it yourself, if you're an Asian kid like me anyway. xD It just becomes a habit.

#11 My family is an exception to this. xD We do say 'I love you' directly, but complete with the 'ah eat well ok?', 'don't scrimp on food', 'sleep well' and similar indirect words/actions of affection. We were doing 'Conceal, Don't Feel' before it became popular. xD

#13 I'm kind of confused about this but this has sort have changed over the years in which eye-contact is now more encouraged. But don't stare, especially at elders and authority figures. Sometimes it's just shyness though. xD And I've observed this with my own Taiwanese friend, especially when I'm complaining or ranting to her about something. xD I'm a person who likes to express my opinions strongly, which tends to scare/alienate some of the locals here, as doing so is kind of frowned upon. Thankfully, she does listen and offers her take on things.

#14 Ah this. xD In the Philippines, this is a common greeting known as beso-beso, and I freaked out too when an auntie did that to me. xD Needless to say, Mom lectured me later on what that was. ^^"

#16 Along with #3 another crazy beauty standard. In my view, people always look better with a little meat on them and when they're not horribly thin. Asia still has a loonng way to go with accepting different types of bodies if you ask me. This combined with modern beauty standards has made the pressure for women especially to 'look beautiful' higher than ever.

I know many people love them but please, starving yourself or glorifying eating disorders is never OK just to get this kind of 'ideal' body. I'm not part of the Kpop fandom, but even I think when idols get bullied just for gaining the least bit of weight among other insensitive comments, that's really going too far.

#17 'If you want to make friends, go eat.' <- I couldn't agree more. In the Philippines we have a greeting: 'Kumain ka na ba?' (Have you eaten?) . Similarly in Taiwan, we have 吃飯了沒? (chī fàn le méi), both of these can mean that in the literal sense but are often used as greetings instead. By then which invitation to having lunch/dinner together may or may not follow. Food really is a way for us to socialize and to catch up with what's going on in each other's lives. Not to say we don't have regular outings like going out to the mall, going shopping, etc. but eating together is a huge part of our culture, be it with family or friends.

And while I'm at it, some memes that are way too accurate good to pass up xD

Parents, uncles, aunties alike will fight over the bill xD

Alternatively:

You just space out until your name is called xD

My parents are guilty of the last one. Logic how? xD

#18 True. xD I like giving compliments out to people but I have a hard time accepting them myself, though I've learnt how to accept them much more now than before. We're kind of raised to constantly downplay ourselves so we often say things like 'ah no no' or 'I'm really not that good'. The downside of this of course is that it can come off as somewhat fake. xD

Again from personal experience, that same classmate who made the lowkey racist remark, she was good, she was on the debate team, was a honor student, knew how to mingle with people, but she downplayed herself way too much, while praising me but I honestly thought that she never really meant it from how she treated me. She wanted to keep me around her yet make backhanded compliments at me and she didn't want me socializing with my other classmate who is now my friend. *sigh* It was only after discussing this with one of my roomies did I realize how this 'excessive downplaying' might come off to people like me who more or less grew up with a more 'Westernized' mindset. I'm not saying brag about your achievements but don't be overly humble about them either, which can also be a turn off.

#20 We do tend to be a lot more realistic on how we view things, neither entirely optimistic nor pessimistic. We try to think of things practically and often analyze things on pure logic. A downside of this however, is that Chinese people can be overly practical. Taiwanese for instance don't like to 'find inconveniences' and generally keep to themselves, meaning, they won't help you in your hour of need even when they do have the capabilities. Sounds really harsh I know, but in my 6 years of living in Taiwan, while this doesn't apply to all the people, a lot of them really do only find/talk to you when they need something.

So for some people saying Taiwanese are 'friendly', that's BS xD If you ask me, Filipinos are infinitely more friendly, and again while not all, generally make more of an effort to help you when you need it. I really felt more of a real sense of community during my years growing up in the Philippines compared to Taiwan.

#21 Children do tend to stay with their parents well into college and adulthood, since Chinese families are indeed very family-oriented, in a lot of cases, grandparents often live under the same roof as us as well! And it really does save a lot of money. I see there's a real stigma in the US when it comes to "living with your parents", but that's starting to change especially because of Covid and having more and more people move back in with their parents.

Housing unfortunately is pretty much hella expensive no matter where you go, and Taiwan is no exception. Steep housing prices and the very high cost of raising a child (schooling + buxiban fees, etc.) contribute to a very low birth rate and thus an aging population like Japan. It's not uncommon to see both parents working in Taiwan.

#23 I'm an overthinker myself, but I totally agree with the author that the best is to strike a good balance between these two. Which I guess is why I love drawing or any other related creative attempts, it helps me be more spontaneous or well, creative! I like to remain intellectually or artistically inspired.

#24 Is French high school really like that? xD My friend did watch SKAM France and more or less got a culture shock from what was depicted on the show. I can confirm however that most high schools both in the Philippines and Taiwan require students to wear a uniform, only in college is everybody free to wear casual/civilian clothes.

#26 Ah this is part of our Asian gift-giving etiquette xD We always open gifts later after the event/meeting and in private. Never open them in front of the person who gave it to you or in front of others. This is to prevent any 'shame/embarrassment' that may result both to yourself and to the gift giver. I know this may come off as something weird since some people may want a more honest response or immediate feedback when it comes to gift-giving, but that's just how it is in our culture. You're always free to ask us though (in private) if we liked the gift or not ^^"

#28 I want to say the same goes to drinking, partying, and drugs however xD Those are things which are still frowned upon in our culture. And to be honest, whenever I see those in movies, it does kind of turn me off xD It doesn't mean that we're "uncool" or "boring", we just think that there are much better or healthier ways of "having fun".

#31 Is this true in France?! Man I would kind of prefer that instead of people being on their phones all the time xD This kind of goes with #20 in that Chinese are overly practical or logical, and don't read fiction as much as nonfiction. My Taiwanese friend is an exception though, she's a bibliophile who loves the feel of paper books compared to e-books, and it's a trait of her that I like a lot. Both the Philippines and Taiwan however have a huge fanbase when it comes to manga and anime though.

I'm all for reading outside of "designated reading" at schools especially. Reading fiction improves your vocabulary too, and can be quite fun! It helps you imagine and really invest in a world/story, and if you ask me something that I feel Westerners are better at, they're more in touch with their emotions and creativity, and are thus much more able to write compelling or original stories. Believe me, I've seen a fair amount of Chinese movies that rip off Western movie plotlines xD

#33 Nothing much to add on here..except that since I'm a "weird" person, Mom often jokes that she got the wrong baby from the hospital. xD

#35 True. While I agree with the care and concern that your fellow community can give you, the downside of this is we tend to only hang out with our own people, e.g Chinese with Chinese, Taiwanese with Taiwanese, etc. I've seen too that it's especially hard to make friends in Japan and Korea as a foreigner. Not only is there the language barrier, but the differences in culture too. In a way, Asians can be pretty close-minded on getting to know other cultures or actually making friends with people from other countries. I know this all too well being half-Taiwanese/half-Filipino, being neither "Filipino" enough nor "Taiwanese" enough. xD It's more of people here being too used to what they're comfortable with.

#36 Oh this is something I feel that Chinese students and other students from similar cultures should really improve on. xD How will people respect you if you don't speak your mind?

I felt bad especially for my Spanish teacher in college, granted it was an introductory course (Spanish I and II) but the amount of times that our teacher had to prompt a student to recite/speak even with clear hints already made her (and me too) extremely frustrated. The thing is, these are college students, I personally feel they don't have any reason to be so shy of speaking and technically by not doing so they're slowing the pace of the class too much and a lot of time is wasted.

Unfortunately you can't always be very vocal with your thoughts and opinions in most Asian cultures. I would say strive for that, but at the same time, play your cards well, especially if you're in a workplace setting.

If you made it to the end, thank you for reading and here's a cookie! 🍪 I'm not perfect and there's bound to be something I missed so please let me know if you spotted anything wrong. Feedback/questions are very much welcome and please feel free to share about your country/culture's differences or similarities!

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sarcasticgaypotato · 8 years ago

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Oh my *god* I didn't know people were still active in this fandom/ship and I'M SO HAPPY!! If you're still doing requests would you mind doing something small where Chell takes off her shirt to shower or something and GLaDOS realizes how alarmingly thin she is from all that time asleep, and does her best to casually apologize for the comments about Chell's weight.

(( Indeed there are! Unfortunately it’s a precious few who still make chelldos content, but I try to be somewhat regular! Please enjoy! ))Let it be said that, for all the things GLaDOS had done, she hadn’t ever watched the cameras in the test subject showers while humans were in there. Not out of any concern for their privacy; she spied on them in practically every other way. She supposed she just had no real interest in watching naked humans cover themselves in soap to make their disgusting bodies slightly less disgusting. And besides, every human was dead anyway, so the cameras were nothing more than a formality. Well, every human except for one. Chell, her former test subject. She had let the girl go, but Chell had found herself back here regardless. In a world where everything was dead, it only made sense to return to live with a robot.

So with a human finally living in its halls again, not being confined to test chambers, Aperture’s shower room finally got some usage.

GLaDOS had no real reason to check the camera when she noticed Chell walking in there, but a spark of curiosity tempted her to just… look. To see this whirlwind of a woman, powerful, stoic and unshakable, finally let her hair down. Quite literally- GLaDOS didn’t think she had ever seen the human with her hair out of its ponytail. Chell walked to the very end of the room, picking the shower stall farthest from the door. It wasn’t as if there was any other humans in there for her to be avoiding, but perhaps it was just habit. GLaDOS watched with interest, the cameras whirring to life for the first time in years.She could not tell if Chell had noticed them, but the AI assumed she had. There were several very obvious cameras lining the walls, though they didn’t look inside the stalls. Made the humans notice them, and assume there weren’t any more. That wasn’t true. Slightly more hidden ones were in each stall, providing a view of anything the test subjects did.GLaDOS hadn’t designed this area, but she could only assume the scientist who did was incredibly desperate.So, both the outer and inner camera tracked Chell’s movements, watching as she grabbed soap and shampoo, disrobed, tested the heat of the stream of water, then got in.There must’ve been at least a hundred things GLaDOS could have been looking at or studying. She could’ve thought about how Chell relaxed under the hot water- how foolish, to let her guard down- or perhaps she could’ve noted how the human had accidentally gotten soap in her eyes when trying to wash her hair for the first time in many years.But she didn’t. All GLaDOS could seem to notice about Chell in this moment, was her body. And, not in the way that the scientists who installed these cameras might have.She did not stare at the girl’s long legs, or gawk at the way her silky, dark brown hair clung to her back when wet. Instead, there was a distinct twist of uneasiness in her non-existent stomach how just how… skeletal Chell seemed. Years of being asleep, time spent on the surface with likely little to no food source, and constant exercise resulted in a very clear outline of the former test subject’s ribs starkly showing against her skin.GLaDOS supposed she ought not to care, it wasn’t her problem. Yet, guilt coiled inside her, and she found herself nervously tapping the armrest of her chair as she watched, wanting to look away but unable to tear her gaze from the screen.

Do you pity her?

Echos of a woman long dead rung in GLaDOS’s ears, causing her hand to twitch and her expression to shift, repressing the urge to verbally respond to a voice in her head.Did she pity Chell? Was that the sole reason for her uneasiness? No.She knew full well why she felt guilty. It was the comments, coming from herself, and at times, a certain, space bound moron. Teasing the girl for her weight, only in the opposite direction. Not once had GLaDOS ever made mention, or hell, even look all that closely at the girl’s form, especially not when it was hidden by baggy clothing. She had teased and poked at something so nonexistent, it was frankly ridiculous. She pondered over this for a few moments, her mind swimming with thoughts, and her feelings uneasy.Part of her wondered if Chell was aware of all this. If she knew what a bad state of health she appeared in be in. If so, why wouldn’t she say something? Well, maybe not SAY anything, but GLaDOS knew the girl was stubborn and seemingly quite fixed on keeping herself alive, so why not make some kind of indication that she needed something?Was she simply not aware of the poor condition of her own body? Did she actually believe GLaDOS’s sarcastic comments? Surely not. Even GLaDOS herself had always known the insults were a stretch, but they were cheap, easy, low blows. They could dig deep and cause insecurity, and at the time, that had been her goal.Now though, she found herself… regretting her words.That thought alone caused her to recoil, her artificially constructed face to scrunch up with a mixture of confusion and surprise. That never happened. She didn’t take things back. She was always right; she was the smartest being alive. This was her facility. She could do and say whatever she wanted, and she was justified.To regret her comments over a pathetic feeling of guilt wasn’t right. The queen of Aperture had no reason to feel guilt. She would simply ignore it. Any problem will go away with enough time if you don’t think about it.The android huffed, forcing her gaze to a different screen, staring at Orange and Blue testing with as much intensity and focus as she could muster.However, the shower room camera screen remained in the corner of her eye, never leaving her peripheral.Minutes passed like hours, and GLaDOS was not thinking about Chell. She was thinking about science, and she was not distracted. Any traces of guilt were gone, replaced by the cool, calm indifference of a true scientist. No, she was not digging her fingers into the armrests of her chair. She was perfectly content.…Chell had finished her shower, GLaDOS noted. The water had been turned off, which prompted the core to glance at the screen just to… make sure there weren’t any problems with the plumbing.The android couldn’t tear her eyes away this time, the feeling of unease that had lingered in her stomach only getting worse the more she stared.Chell grabbed a towel and started drying her hair, slowly stepping out of the shower stall and into the open area where a clean set of clothes awaited her. She faltered as she moved, GLaDOS caught it. A small, barely noticeable movement, but seen by the core’s keen eye. For a second, the human’s legs shook, and she seemed unsteady. Tired. Exhausted even. Had she been like this the whole time?GLaDOS did a quick scan of any footage of the test subject over the past hour or two, and found her answer. Chell was stubborn and determined, but not immortal, and most definitely human. Her breathing had been shallow all day, and she took frequent, very short breaks. No longer than a minute, but it seemed the girl was stopping far more often than GLaDOS remembered.She wasn’t lazy, she was genuinely unable to keep going like this. And yet, she did nothing to change it. She went about her day with her head held high, as prideful as a lioness, strutting around Aperture like she owned it.At first, it didn’t make any sense to the robot. Chell was so hyperfocused on her own survival, facing anything the world threw at her just to keep her own life. She’d take down a god for her life and freedom, only to waltz right back on her own terms when she needed it. So why not seek help? Why not request assistance from GLaDOS?Then, it dawned on her.The AI’s comments actually got to the girl. Whether she believed them or not, they had an effect. Maybe she believed the core completely, or maybe knew she needed help but expected more cruel comments from the core if she asked for help.It seemed impossible, that petty, little insults were enough to get under Chell’s skin when she appeared so unshakable and collected in the face of said comments when they were thrown at her, but the evidence lined up.Before the core even realized what she was doing, she had turned her mic on, and started to speak.“Of course. You always manage to cause problems, don’t you?”GLaDOS hardly knew what she was saying before it came out of her mouth, the words tumbling out with little grace.Chell looked up at the camera, a shirt halfway over her head and a confused expression on her face. She hadn’t done anything.“I really do hate being wrong, and it isn’t my fault you humans are so fickle.”The android felt a rush of heat surge to her face as she scrambled to explain herself without actually apologizing. She felt this overwhelming urge to relieve herself of this guilt, but she couldn’t apologize. She couldn’t. She didn’t know how. It made her feel weak, human.Quickly and vainly trying to compose herself, she spoke again, trying to sound as professional as possible.“For the sake of being an accurate source of knowledge at all times, we at Aperture Science… temporarily take back any comments on excessive body mass on your part. Aperture Science will aid you in fixing this inaccuracy, after which you will be required to properly maintain your mind and body in order to qualify as a viable test subject. You are dismissed.”Slowly, the feeling of uneasiness lessened. GLaDOS let her shoulders relax, and found herself checking to see if there was any cake mix laying around.

#under a read more #chelldos #chell #glados #portal #portal 2 #kinda angsty #little bit

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sherristockman · 7 years ago

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Doctors Get Paid to Prescribe More Opioids Dr. Mercola By Dr. Mercola Opioid addiction is at an all-time high in the U.S. — so much so, it's been identified as a significant factor in unemployment among men,1 and opioid overdoses are now the leading cause of death among Americans under the age of 50.2 According to the Centers for Disease Control and Prevention (CDC), of the more than 63,600 Americans who died from drug overdoses in 2016,3,4 more than 42,000 were related specifically to opioids5 — a 28 percent jump in opioid deaths from the year before. As if that's not disturbing enough, recent research6 suggests opioid overdose deaths are being undercounted by 20 to 35 percent, due to drug omissions on death certificates.7 In many cases, the specific drug that contributed to the death isn't listed on the death certificate, and it's quite likely that many of the general "drug deaths" are actually due to opioids specifically. According to this paper, a more accurate count would probably put the opioid-related death toll at nearly 40,000 for 2015 and closer to 50,000 for 2016. The most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone (such as OxyContin®) and hydrocodone (such as Vicodin®),8 and evidence suggests opioid makers such as Purdue Pharma, owned by the Sackler family, knew exactly what they were doing when they claimed opioids — which are chemically very similar to heroin — have an exceptionally low addiction rate when taken by people with pain. In fact, the massive increase in opioid sales has been traced back to an orchestrated marketing plan aimed at misinforming doctors about the drug's addictive potential. Remarkably, despite widespread discussion about the dangers of opioids and the high risk of addiction, and despite updated treatment guidelines for back pain that stress nondrug interventions over pain killers, doctors are still overprescribing these drugs. Paying Doctors Who Prescribe Opioids May Be a Significant Part of the Problem One of the reasons for this appears to be financial. As reported by CNN, "The more opioids doctors prescribe, the more money they make."9 According to an analysis by CNN and Harvard researchers, in 2014 and 2015, hundreds of doctors received in excess of $25,000 each from opioid manufacturers, and those who prescribed the most opioids received the largest payments. Dr. Andrew Kolodny, senior scientist at the Institute for Behavioral Health, co-director of the Opioid Policy Research Collaborative and executive director of Physicians for Responsible Opioid Prescribing told CNN, "This is the first time we've seen this, and it's really important. It smells like doctors being bribed to sell narcotics, and that's very disturbing." At least one doctor received more than $1 million over those two years. One of his patients, who is struggling with opioid addiction, was shocked when she discovered her doctor had received such large payments from the drugmaker. "Once I found out he was being paid, I thought, 'Was it really in my best interest, or was it in his best interest?'" she told CNN. Dr. Michael Barnett, assistant professor of health policy and management at Harvard T.H. Chan School of Public Health added, "I don't know if the money is causing the prescribing or the prescribing led to the money, but in either case, it's potentially a vicious cycle. It's cementing the idea for these physicians that prescribing this many opioids is creating value." Source: CNN March 12, 2018 One-Quarter of All Doctors Prescribe Opioids to Medicare Patients and Receive Payments From Opioid Makers To assess the link between drug company payments and prescription habits, the team reviewed data from two federal government sources — one that tracks drug company payments to doctors and another that tracks prescriptions made to Medicare patients. Of the 811,000 doctors who wrote prescriptions for Medicare recipients during 2014 and 2015, more than 200,000 prescribed opioids and received payments from the drug makers. While a majority of them received only minor payments, ranging from $100 to $1,000, more than 31,400 of them received as much as $15,000, and nearly 4,000 of them received more than $15,000. As you'd expect with a kickback scheme, those who prescribed the most opioids received the most money. According to CNN:10 "On average, doctors whose opioid prescription volume ranked among the top 5 percent nationally received twice as much money from the opioid manufacturers, compared with doctors whose prescription volume was in the median. Doctors in the top 1 percent of opioid prescribers received on average four times as much money as the typical doctor. Doctors in the top 10th of 1 percent, on average, received nine times more money than the typical doctor." Does Your Doctor Have a Financial Incentive to Prescribe Opioids? While it's legal for drug companies to pay doctors for a variety of services, including speaking and consulting fees — and nearly half of all doctors get paid by drug companies each year — it's illegal for doctors to prescribe drugs in exchange for kickback payments from the manufacturer. This investigation reveals the line is thin indeed between what's legal and what's illegal. Are doctors prescribing opioids with the expectation or promise of payment? At bare minimum, the data provides additional proof that payments influence a doctor's prescribing habits, even if it's not wholly intentional. A number of previous studies have confirmed this trend, showing that regardless of what the payments are for, when a doctor receives money from a drug company, he or she is far more likely to prescribe that company's drugs. As noted by Dr. Daniel Carlat, a psychiatrist and former director of the Prescription Project at the Pew Charitable Trusts who writes about conflicts of interest in medicine:11 "It's not proof positive, but it's another very significant data point in the growing evidence base that marketing payments from drug companies are not good for medicine and not good for patient care. It makes me extremely concerned." Did Fentanyl Maker Bribe Doctors to Overprescribe? In one particularly disturbing case highlighted by CNN, a woman with Crohn's disease was prescribed Subsys, an "ultrapowerful form of fentanyl" for her abdominal pain by a pain specialist in Greenville, South Carolina. Subsys is up to 100 times more potent than morphine, and while it eliminated her pain, the drug also put her in a "zombie-like state," making her unable to care for her children. What's worse, she couldn't quit. Skipping a day led to "uncontrollable diarrhea and vomiting," and when she asked her doctor for another option, "he became belligerent," saying "it was Subsys or nothing." As it turns out, this doctor received more than $190,000 from the maker of Subsys between 2014 and 2015. A lawsuit is now pending in which she's accusing her doctor of "setting out to 'defraud and deceive' her for 'the sole purpose of increasing prescriptions, sales and consumption of Subsys to increase ... profits.'" Incidentally, in October 2017, John Kapoor, the founder of Insys, which makes Subsys, was arrested and charged with bribing doctors to overprescribe the drug. Other Insys executives have also been arrested on racketeering charges.12 Other Research Shows Payments to Doctors Could be Fueling Opioid Epidemic The investigation by Harvard and CNN is not the first to suggest drug company payments may be a driving factor in the opioid epidemic. According to a study13 published in August 2017, between August 2013 and December 2015, more than 375,000 non-research opioid-related payments were made to more than 68,000 physicians, totaling more than $46 million. This means 1 in 12 U.S. physicians collected payments from drug companies producing prescription opioids during those 29 months. Here, fentanyl prescriptions, specifically, were associated with the highest payments, and many of the states struggling with the highest rates of overdose deaths, such as Indiana, Ohio and New Jersey, also had the most opioid-related payments to physicians. In other words, this study showed there's a direct link between doctors' payments and patient addiction rates and deaths. Conflicts of Interest Abound Between Drug Makers and Government Conflicts of interest that hurt the public also exist between drug companies and the U.S. government. As reported by STAT News,14 the National Institutes of Health (NIH) had originally planned on sharing the cost of a $400 million opioid addiction research project with a dozen different drug companies. The goal of the project would be to develop new drug addiction medicines and alternative pain killers. However, after ethics flags were raised by an advisory panel, the agency made a sudden turnabout, announcing it will not accept drug industry contributions after all. Instead, the project will be exclusively funded by taxpayers. STAT News writes: "The agency has long pursued such partnerships on disease-specific research … Last year, the NIH announced a separate partnership on cancer immunotherapy, which relies on $55 million in funding from drug companies. On the issue of opioids, however, attitudes appear to be dramatically different — largely due to the role many pharma companies are seen to have played in the opioid crisis. In its recommendations, the NIH advisory committee specifically cited Purdue Pharma and Mallinckrodt, two opioid manufacturers currently being sued for their opioid marketing tactics. 'There's so much controversy swirling around pharmaceuticals on the opioid issue,' said Rep. Tom Cole (R-Okla.), who chairs the House appropriations subcommittee on health … Cole and others … also cited the ongoing controversy involving Dr. George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism, a unit within the NIH. STAT reported this month that Koob had discouraged research on the impact of alcohol marketing after working with beverage industry lobbyists to fund research promoting the benefits of moderate alcohol consumption." Could Cannabis Curb the Opioid Epidemic? In related news, CNN chief medical correspondent Dr. Sanjay Gupta recently published an open letter to U.S. attorney general Jeff Sessions, in which he urges Sessions to change his stance on cannabis, saying "Not only can cannabis work for a variety of conditions such as epilepsy, multiple sclerosis and pain, sometimes, it is the only thing that works … It is time for safe and regulated medical marijuana to be made available nationally." Gupta cites research from the Rand Corporation, which found a 20 percent decline in opioid overdose deaths in states that had legalized medical marijuana. "[T]hese data suggest that medicinal marijuana could save up to 10,000 lives every year," he writes. Not only could cannabis treat the pain itself, lowering or eliminating the need for narcotics, but it can also ease symptoms associated with opioid withdrawal. There's also no risk of overdose or death using cannabis. "[P]erhaps most important, the compounds found in cannabis can heal the diseased addict's brain, helping them break the cycle of addiction," Gupta notes, adding, "there is no other known substance that can accomplish all this. If we had to … design a medicine to help lead us out of the opioid epidemic, it would likely look very much like cannabis." Gupta also provides an example of an individual who received virtually no pain relief from opioids, taking an estimated 40,000 pills over the course of a decade, who suddenly was nearly pain-free after a single dose of cannabis. Indeed, in addition to underestimating opioid's addictive potential, the drug's effectiveness against chronic pain has also been vastly exaggerated, further heightening the potential for addiction. As noted in a 2016 paper by the CDC:15 "Most placebo-controlled, randomized trials of opioids have lasted six weeks or less, and we are aware of no study that has compared opioid therapy with other treatments in terms of long-term (more than 1 year) outcomes related to pain, function, or quality of life. The few randomized trials to evaluate opioid efficacy for longer than six weeks had consistently poor results. In fact, several studies have showed that use of opioids for chronic pain may actually worsen pain and functioning, possibly by potentiating pain perception …" Treating Your Pain Without Drugs With all the health risks associated with opioid painkillers, I strongly urge you to exhaust other options before resorting to these drugs. Following is information about nondrug remedies, dietary changes and bodywork interventions that can help you safely manage your pain. Medical cannabis Medical marijuana has a long history as a natural analgesic and is now legal in 29 states. You can learn more about the laws in your state on medicalmarijuana.procon.org.16 Kratom Kratom (Mitragyna speciose) is a plant remedy that has become a popular opioid substitute.17 In August 2016, the DEA issued a notice saying it was planning to ban kratom, listing it as Schedule 1 controlled substance. However, following massive outrage from kratom users who say opioids are their only alternative, the agency reversed its decision.18 Unfortunately, its legal status is still unstable, as the U.S. Food and Drug Administration is on a crusade to eliminate kratom. Kratom is safer than an opioid for someone in serious and chronic pain. However, it's important to recognize that it is a psychoactive substance and should be used with great care. There's very little research showing how to use it safely and effectively, and it may have a very different effect from one person to the next. The other issue to address is that there are a number of different strains available with different effects. Also, while it may be useful for weaning people off opioids, kratom is in itself addictive. So, while it appears to be a far safer alternative to opioids, it's still a powerful and potentially addictive substance. So please, do your own research before trying it. Low-Dose Naltrexone (LDN) Naltrexone is an opiate antagonist, originally developed in the early 1960s for the treatment of opioid addiction. When taken at very low doses (LDN, available only by prescription), it triggers endorphin production, which can boost your immune function and ease pain. Curcumin A primary therapeutic compound identified in the spice turmeric, curcumin has been shown in more than 50 clinical studies to have potent anti-inflammatory activity. Curcumin is hard to absorb, so best results are achieved with preparations designed to improve absorption. It is very safe and you can take two to three every hour if you need to. Astaxanthin One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required for pain relief, and you may need 8 milligrams or more per day to achieve results. Boswellia Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites, as it worked well for many of my former rheumatoid arthritis patients. Bromelain This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind most of the bromelain is found within the core of the pineapple, so consider eating some of the pulpy core when you consume the fruit. Cayenne cream Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting your body's supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain. Cetyl myristoleate (CMO) This oil, found in dairy butter and fish, acts as a joint lubricant and anti-inflammatory. I have used a topical preparation of CMO to relieve ganglion cysts and a mild case of carpal tunnel syndrome. Evening primrose, black currant and borage oils These oils contain the fatty acid gamma-linolenic acid, which is useful for treating arthritic pain. Ginger This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea, or incorporated into fresh vegetable juice. Dietary Changes to Fight Inflammation and Manage Your Pain Unfortunately, physicians often fall short when attempting to effectively treat chronic pain, resorting to the only treatment they know: prescription drugs. While these drugs may bring some temporary relief, they will do nothing to resolve the underlying causes of your pain. If you suffer from chronic pain, making the following changes to your diet may bring you some relief. Consume more animal-based omega-3 fats. Similar to the effects of anti-inflammatory pharmaceutical drugs, omega-3 fats from fish and fish oils work to directly or indirectly modulate a number of cellular activities associated with inflammation. While drugs have a powerful ability to inhibit your body's pain signals, omega-3s cause a gentle shift in cell signaling to bring about a lessened reactivity to pain. Eating healthy seafood like anchovies or sardines, which are low in environmental toxins, or taking a high-quality supplement such as krill oil are your best options for obtaining omega-3s. DHA and EPA, the omega-3 oils contained in krill oil, have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief. Radically reduce your intake of processed foods. Processed foods not only contain chemical additives and excessive amounts of sugar, but also are loaded with damaging omega-6 fats. By eating these foods, especially fried foods, you upset your body's ratio of omega-3 to omega-6 fatty-acids, which triggers inflammation. Inflammation is a key factor in most pain. Eliminate or radically reduce your consumption of grains and sugars. Avoiding grains and sugars, especially fructose, will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production, which contributes to pain. While healthy individuals are advised to keep their daily fructose consumption below 25 grams from all sources, you'll want to limit your intake to 15 grams per day until your pain is reduced. Eating sugar increases your uric acid levels, which leads to chronic, low-level inflammation. Optimize your production of vitamin D. As much as possible, regulate your vitamin D levels by regularly exposing large amounts of your skin to sunshine. If you cannot get sufficient sun exposure, taking an oral vitamin D3 supplement, along with vitamin K2 and magnesium, is highly advisable. Get your blood level tested to be sure you're within the therapeutic range of 60 to 80 ng/mL year-round. Bodywork Methods That Reduce Pain The following bodywork methods have also demonstrated effectiveness for pain relief and pain management. • Acupuncture: According to The New York Times,19 an estimated 3 million American adults receive acupuncture annually, most often for the treatment of chronic pain. A study20 published in the Archives of Internal Medicine concluded acupuncture has a definite effect in reducing back and neck pain, chronic headache, osteoarthritis and shoulder pain — more so than standard pain treatment. • Chiropractic adjustments: While previously used most often to treat back pain, chiropractic treatment addresses many other problems — including asthma, carpal tunnel syndrome, fibromyalgia, headaches, migraines, musculoskeletal pain, neck pain and whiplash. According to a study21 published in the Annals of Internal Medicine, patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain-free in 12 weeks compared to those who took medication. • Massage therapy: Massage releases endorphins, which help induce relaxation, relieve pain and reduce levels of stress chemicals such as cortisol and noradrenaline. A systematic review and meta-analysis22 published in the journal Pain Medicine, included 60 high-quality and seven low-quality studies that looked into the use of massage for various types of pain, including bone and muscle, fibromyalgia, headache and spinal-cord pain. The study revealed massage therapy relieves pain better than getting no treatment at all. When compared to other pain treatments like acupuncture and physical therapy, massage therapy still proved beneficial and had few side effects. In addition to relieving pain, massage therapy also improved anxiety and health-related quality of life. • Emotional Freedom Techniques (EFT): EFT continues to be one of the easiest and most effective ways to deal with acute and chronic pain. The technique is simple and can be applied in mere minutes. A study23 published in Energy Psychology examined the levels of pain in a group of 50 people attending a three-day EFT workshop, and found their pain dropped by 43 percent during the workshop. Six weeks later, their pain levels were reported to be 42 percent lower than before the workshop. As a result of applying EFT, participants felt they had an improved sense of control and ability to cope with their chronic pain. In the video below, EFT expert Julie Schiffman, teaches you how to use EFT to address chronic pain.

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