Long Read: This Doctor Might Have the Answer to the Fentanyl Crisis

Long Read: This Doctor Might Have the Answer to the Fentanyl Crisis

Essays Featured Science

From VANCOUVER MAGAZINE, November 14, 2017

Pooya Nabei photo

“I’m going to be the least compelling speaker you’ll hear tonight,” Dr. Evan Wood tells me as we pull up in front of the Anvil Centre auditorium in New Westminster. People are already trickling in for tonight’s event, Recovery Speaks, featuring inspiring personal tales of sobriety on the other side of hellish addiction.

Wood holds a fistful of titles—including professor of medicine at UBC, Canada Research Chair in Inner-City Medicine and head of the province’s newly established response to the opioid crisis, the British Columbia Centre for Substance Use (BCCSU). He’s giving the keynote address tonight—and he’s going to have to thread the needle.

Many of the attendees here are part of the “recovery community”—their journeys involve getting clean largely via the 12 steps. The path involves fierce personal reckoning and surrender to a higher power until the demon slowly loosens its grip and you get your life back, though with eternal vigilance and abstinence as part of the deal.

“Twelve-step facilitation therapy,” hatched some 80 years ago by the American Bill Wilson (or simply Bill W., as he’s known in AA circles) and Dr. Robert Smith, is still the prevailing model for treating addiction, both in the U.S. and in Canada. It’s traditionally a cold-turkey approach: just you and your god and the dark night (with your support group on call). Wood’s own view is that there’s a less torturous and more effective strategy. Reduced to a bumper sticker, it might read: Get off drugs with drugs.

It sounds like pretzel logic: drink your way to sobriety. Use to get clean. Yet this is the chatter on the frontier of addiction medicine—an emerging field promoting evidence-based strategies to treat addiction instead of the entrenched old ways, no matter how beloved they might be.

Abstinence, the evidence increasingly suggests, doesn’t work for many people. More than 80 percent of those who try it will relapse, some studies show.

The rising death toll in the fentanyl epidemic means it’s never been more urgent to come up with something that works more reliably—and to quickly clear a legislative path for it.

The new thinking, Wood’s thinking, is that, far from being a kind of defect of the psyche, addiction may in fact be an evolutionary inheritance—a deeply human trait that turns out to be ill fitted in some ways to the modern era. Wood is exploring pharmaceutical treatments for addiction, pioneering an approach where abstinence isn’t necessarily the end goal, and even using common street drugs to temper its expression.

All of this would seem to cast him as a fox in the henhouse here. And yet Wood is given a warm setup by the man who invited him here tonight, Marshall Smith, a former top B.C. government bureaucrat whose own lost-now-found story is as dramatic as they come.

Ten years clean after a brutal cocaine addiction that left him unemployed and living in a shipping container, Smith is now in full reboot. He runs a non-profit recovery centre on Vancouver Island, coordinates these speaking events and serves as a senior advisor at the BCCSU, a $10-million provincially funded network aimed at developing an evidence-based framework for addiction treatment. Part of the mandate is to tap the “lived experience” of users to develop effective new strategies, which is where Smith comes in. Wood hired him after he realized Smith’s credibility and charisma could help shape the evolving narrative of addiction treatment in B.C.

It was nuts, both men realized, to present themselves as adversaries—penning opposing op-eds in newspapers, pitting harm reduction against abstinence-based recovery—when all that did was make the entire addiction-medicine space radioactive to politicians and potential funders. “We clearly came from different perspectives, we clearly came from different personal experiences and we clearly represented different constituencies of substance-using people,” Smith says. “But…we were in absolute agreement that the system we have now is failing people at best and killing people at worst.”

Wood steps up to the lectern without notes. Bespectacled and self-contained, he has the air of an uncle about to give a toast at Thanksgiving dinner. He tiptoes through a decent joke before quickly establishing a sensitive, commiserating tone that finds common ground with Smith. “The system of addiction treatment in British Columbia isn’t broken,” he says. “There. Is. No. System.” Sufferers are left alone to figure out their options amid a Wild West climate of murky regulations and an absurd circumstance where opioids are prescribed to people who don’t need them and withheld from those who do, one in which rehabbing users are discharged from detox with a handshake and directions to the bus stop, and where wait-lists for rehab facilities can be months long. Every story he’s hearing, in this room and out there in the world, Wood says, every scrap of data he’s gathering, will go into the batter of this new thing they’re cooking at the BCCSU.

He gets a standing O.

In the Giant’s Shadow

I first met Wood, 43, in his upstairs office at St. Paul’s Hospital, tucked away from the emergency room, where fatal opioid overdoses have become an almost daily occurrence.

His eyes were red behind his spectacles: too many short nights in a row. He was wearing a crisply cut suit in banker’s blue—the better to convene high-level meetings with senior staff of health agencies, convey gravitas in media interviews and beat the bushes for funding. That suit, and his quiet, squeaky-clean intensity, evokes Eliot Ness, the famous Prohibition-era Chicago crime fighter. Only their missions are exactly backwards. Wood is at war against the War on Drugs and all it has wrought—from rampant gang violence to a lethally toxic drug supply. He’s less interested in bringing drug criminals to justice than he is in restoring justice by decriminalizing drugs.

But politics are not his official brief. As head of the BCCSU, Wood’s loftiest goal is to change the way we think about addiction. To make us understand it as a kind of contagion—albeit a social rather than viral one. The best strategy to suppress an outbreak? Deploy massive resources at multiple levels all at once. Toss a blanket over the fire so that it sends out no sparks.

Wood’s job one is to wrangle those resources and channel them toward an effective treatment model. That means training doctors and nurses who work with addiction sufferers on which drugs work best to curb cravings and ease withdrawal, when to use them, and how to wean folks off them where appropriate. It means laying out clear options for users who want to get clean and making sure they have access to them. Right now, it means hosting lots and lots of meetings with addicts and their families, the people whose voices most need to be heard.

Wood’s current position is an evolution of his career at the forefront of public health and epidemiology, but he began by tackling a different scourge.

He grew up in West Vancouver, raised by his social-worker mother. His father was an inventor who designed marine navigation systems and who separated from his mother when Wood was two.

Wood approached the medical-health field in a gradually tightening circle. In an undergrad geography degree at UBC, he did a term project that involved mapping the spread of HIV, which nudged him to pursue medical geography—a subfield that looks at airborne and vector-borne illness. He applied for a summer job at the BC Centre for Excellence in HIV/AIDS, where he quickly distinguished himself as a protégé of Dr. Julio Montaner. Hired as a junior research assistant, the young Wood churned out a provocative paper so quickly that Montaner read about it in the newspaper he opened on a flight later that same summer. After Wood knocked off a PhD in epidemiology in 2003, he began publishing at a furious rate. He and Montaner would go on to co-author dozens of influential papers, including two humdingers—one published in The Lancet that helped shape the conversation around AIDS treatment in Africa and another on anti-viral drug strategy, published in The British Medical Journal, that was dubbed Science magazine’s 2011 scientific breakthrough of the year.

In 2005, Wood and his colleague Thomas Kerr—an epidemiologist and now co-director of the BCCSU—found themselves almost single-handedly trying to save InSite, Canada’s first supervised drug-injection site, from a court challenge by the Harper government, which vehemently viewed drug use as a criminal matter. The battle went all the way to the Supreme Court, with Wood and Kerr arguing evidence should trump morality when it came to reducing the risk of disease transmission and overdose.

In the end, their efforts ensured one of the world’s most high-profile experiments in harm reduction, one that has since become a global model in public health, was spared the knife.

In the mid-aughts, Wood interrupted his progress in HIV/AIDS research to go to med school, thinking he would have more impact as a physician. He blitzed through the University of Calgary’s compressed curriculum, putting himself in the comically intense position of being a professor at UBC while a med student in Calgary. He completed his MD in two years and nine months.

Upon returning to Vancouver, however, Wood discovered the fire he was now doubly armed to fight was nearly contained. The death rate from AIDS was down 80 percent, as was the number of new HIV cases. Wood pivoted to apply his harm-reduction strategies to another issue affecting the same at-risk communities he’d come to know through his work with Montaner. He emerged as a leader in addiction medicine around 2010, just as a drug called fentanyl began to show up on city streets, igniting yet another public health crisis and thrusting the issue of addiction into the spotlight. 

What Humans Do

In the lobby of the Anvil Centre, during intermission at the Recovery Speaks event, a woman named Lynn buttonholes Wood. Her 23-year-old son is in treatment, battling a heroin addiction. He’s been in an abstinence-based treatment facility for several months and is due home soon.

Wood listens silently, rabbinically. (Privately, he is a little worried about this young man, who is about to be sprung loose, his tolerance low, onto a landscape mined with fentanyl and carfentanil. “Anyone in that position is just a sitting duck for a fatal overdose,” he tells me later.)

Wood allows that some people do manage to get clean all at once just because they decided to, overriding primitive instructions from a brain that has actually been rewired, by trauma or stress or crushing circumstances, to crave solace. But it’s clear which side he believes the science tips toward. The data doesn’t support abstinence as Plan A.

Lynn tells Wood she has discovered a book touting a pharmaceutical “cure” for alcoholism. You simply take a drug—an alcohol antagonist—an hour before you plan to imbibe, and it whisks the reward off the table. So a drink is just a drink, not a ticket anywhere, and you stop at one or two. Eventually the thrill is gone. You can drink socially without fear of drinking to excess—then taper down to complete sobriety, or not. There’s evidence the drug works for opioids too.

This approach would clearly not be embraced by most of the people in this auditorium. But Wood believes the data shows that you can manage addiction without trying to hold it at bay through brute abstinence. It may even be the more humane tack.

“The vast majority of people who have what we would now call substance-use disorder are working, they have families, they’re going about their life, but they have this compulsion to use,” Wood elaborates later. “They may wish to cut down but have difficulty doing so. They might get withdrawal if they stop. But they’re getting along with their lives pretty well.” In the new landscape of addiction treatment that he envisions, “if people come to a health-care provider, we could offer things to help them cut down, or quit, or reduce their cravings.

“This is really part of the human condition. The oldest written records show people using things like alcohol. We could have coffees in front of us. We could be having a glass of wine tonight. I mean, this is what humans do.”

And here is where Wood and Smith—not to mention the people who have shared their heartbreaking but hopeful personal stories tonight—really do have a common cause. They deeply believe that people with substance-abuse issues ought not to be vilified for being a little more demonstrably human than everybody else.

In a sense, people prone to addiction—and “about 50 percent of the burden of substance use is genetic,” Wood says—are simply exquisitely attuned to the promise of rewards. For most of human history that was a good thing. “Being a good reward appreciator,” as the addiction psychologist Anna Rose Childress put it, would have made an individual more, not less, evolutionarily fit.

Only in the last 75 years, when consumer culture began producing a glut of irresistible temptations, did that trait stop delivering benefits and start creating problems. Now that same quester who was once first to try a new food, a new route, a new mate, is now first to fall hard for the shiny poisoned bauble.

Not long ago, certain variants of a gene called OPRM1 were found to be linked to impulsivity and risk-taking behaviour—and a predisposition for drug addiction.

But, Wood explains, OPRM1 is really an attachment gene. “In rhesus macaque monkeys, having the gene correlates to how upset the babies get when they’re separated from their mother.” The gene is thought to work in a similar way in humans.

“So here you have this attachment gene that makes great sense for survival, so you don’t go wandering off a cliff,” Wood says. “But that same gene, if you get prescribed Oxycontin by your doctor—and Oxycontin is extremely rewarding—it can just grab hold of you.”

Wood works the room. He is adept at saying the right things and leaving out the right things. He chats with the private donor who quietly gave $1 million to his centre and with mothers who have watched their children slip through their fingers—grieving moms have become the face of the fentanyl crisis. Wood’s own kids, aged 4 and 9, are still too little to worry about in this respect.

There’s something almost epidemiological about the way he circulates, each point of contact meaningful in some hard-to-measure way. If the root of all addiction is dislocation, as a recovery-community adage has it, then an antidote for addiction is connection. This is a second belief that both camps share. Indeed, you could say that the secret sauce of supervised injection sites like InSite is not that they prevent substance users from overdosing to death right now (though they indeed do that) but that they bring users into contact with potential social lifelines—health professionals whom they can trust to help them get their lives back on track.

Wood has been welcomed here. The kumbaya factor is high. But there remains one major, lingering disconnect: the God thing.

Another Path to Transcendence

The psychoanalyst Carl Jung advised Bill W. that without a spiritual dimension to AA, it would never work—the roots of addiction run too deep. Many in the recovery movement hold fast to that theory, but the required belief in a higher power also prevents many seeking recovery from buying into the program.

Wood believes there may be a way to square the circle here—to bring God into the picture without losing one’s evidence-based bona fides.

The last five or so years have seen a resurgence of clinical interest in psychedelics—the old hippie drugs that can open what Johns Hopkins psychologist Roland Griffiths calls a “spiritual window” through which deep insight might flow.

“The neuroimaging work that’s being done around this, particularly in the U.K., is really fascinating,” Wood says. One way to look at addiction is as a communication failure on a neural level. The most primitive part of the brain—the instinctive, reptilian part that drives compulsive behaviour—“doesn’t typically talk to the frontal lobe that’s really wanting to make changes,” Wood says. “But on psilocybin, those two brain regions are talking like crazy.” In preliminary experimental trials, the deep emotions that hallucinogenic trips unlock seem to help users reach a profound level of insight into their self and their predicament—which can prove a powerful weapon against hard-to-resist cravings.

Indeed, Bill W. himself experimented with LSD after he became sober, and found it to be such an effective spiritual assist he considered making it a standard part of AA meetings. “So the science is showing that we can probably bring about a spiritual awakening for people at a much higher rate this way than our traditional motivational techniques can,” Wood says.

This spring, the BCCSU announced plans to fast-track hallucinogenic experiments. Drugs such as psilocybin, the active ingredient in “magic mushrooms,” LSD and/or MDMA (ecstasy) will be administered in a controlled setting—a dedicated, soundproof room in the BCCSU’s headquarters on Powell Street. (Right now the room is bare and clinical; it’s definitely going to need some groovy-ing up—and a bathroom.)

“It’s just a question now of the clinical protocols and then getting them through ethics,” Wood says. “And then getting these medications made by pharmaceutical labs, storing them and then doing the trials” with trained psychotherapists. “But we hope to be doing them in the next year.”

This isn’t something the BCCSU is trying to sneak past the public. The initiative is openly displayed on the website, along with other research such as “Intentional cannabis use to reduce crack cocaine use in a Canadian setting: a longitudinal analysis.”

The message? The road from “sick” to “well” is not a straight shot. For many, the endgame is total sobriety, but for some it will never be. While working at the heroin prescription clinic on the Downtown Eastside, Wood always asked his clients about their long-term goals. In some cases it was as straightforward as “Hey, if you want to see your kids again, this cocaine thing is going to be an issue.” But for others, say, an alcoholic who just wants to be able to drink socially, “recovery” has a different meaning and requires another protocol altogether. A system that can handle both has yet to be developed.

The endgame, which Wood sees as inevitable, is the decriminalization of all drugs along the lines of what Portugal has undertaken. The fentanyl crisis may eventually seal the fate of the disastrous, larcenously expensive century-old War on Drugs, Wood believes, but we’re not there yet.

“If you look at the situation in the States, the opioid crisis is the biggest issue that’s being debated around health-care reform. The Republican base of middle-class white conservative Americans, they’re being hit hard. And this thing hasn’t peaked yet.

“I think fentanyl is going to lead to pretty dramatic changes in Canada, for sure. I think we’re going to see prescription heroin. Investments in things like therapeutic communities”—long-term, professionally staffed rehab facilities—“on the other end.

“Unfortunately, before that happens, there are going to be thousands more dead people than there should be.”

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What does the future hold for the Twins Who Share a Brain?

What does the future hold for the Twins Who Share a Brain?

Featured Kids Psychology Science

from VANCOUVER MAGAZINE, Sept. 1, 2011

The moment they were born, on October 25, 2006, in Vancouver, this much was known about Krista and Tatiana Hogan. The girls were conjoined—what used to be called “Siamese”—twins. Their skulls were fused such that their tiny bodies together made the shape of an open hinge, the girls facing the same direction but essentially away from each other. Each had her own organs and limbs, but they shared plenty of blood vessels in the netlike sheath beneath their scalp. And they shared something else, too, something believed to be unprecedented among living twins: a “bridge” of tissue connected their otherwise-separate brains amidships, at a crucial relay station called the thalamus.

Eight hours after the twins’ birth, a remarkable thing happened, and it immediately transformed the story of two little girls from Vernon, B.C., into something almost mythic. Tatiana got a shot and Krista flinched. Clearly, the girls were not just attached but connected. Sensory information passed between them.

“This is not telepathy. This is not ‘sixth sense,” says Douglas Cochrane, a veteran pediatric neurosurgeon at BC Children’s Hospital who has been the twins’ wingman—their doctor, advocate, and, in a sense, protector—since they were in utero. “The girls send chemical messengers in the bloodstream between each other. They send electrical impulses and information between each other along this bridge”—on the CT-scan image he’s pointing to, it looks like a long kidney bean—“and I’m sure along the coverings that they share.”

The bridge has been likened to a FireWire connection between their brains, and its bandwidth appears broad. Months after their birth, tests confirmed that images falling on the retina of Tatiana were processed in the visual cortex of Krista. What one girl looks at, the other girl sees.

This development, bordering on miraculous, had a flipside: separating them would be a bear. The risks were extraordinary. At best it would likely mean, at the end of many complicated operations teasing apart bone, skin, and vessels, some vision and speech impairment for both girls. Plus: “Given the way the brains are packed together—they’re physically separate but they sort of interdigitate like the teeth of a zipper—it was clear to me that we’d end up with weakness on one side for one twin and on the opposite side for the other,” Cochrane explains. “What else would happen no one knows.”

A semi-crazy-sounding philosophical question presented itself: Is it better to be healthy and fused to someone at the head, or to be impaired and partially paralyzed but on your own? To answer means having to assign a value to independence. Do we perhaps overvalue it? And undervalue—because no singleton can appreciate it—the presence of someone who gets you because they are in you, of you?

Cochrane viewed his job, in those early days, as articulating what splitting the girls up would mean (in terms of gains and losses), and then stepping back and letting mother Felicia Simms—then just 21—and the rest of the family make the call. The family chose not to separate. The twins would move into the future as one.

Brain surgeons have a reputation for an appalling bedside manner—almost as if they’re unwilling to devote even a bit of RAM to niceties that could go instead to saving lives. But David Douglas Cochrane has somehow found space inside himself for both. He is a big man with softly recessed eyes and a cultivated patience. On the consumer website RateMDs.com, where patients can describe their experiences with physicians, a father weighed in. Cochrane had successfully excised a bone cyst from his son’s skull. “Dr. Cochrane is the most professional, talented, kind, humble man I have ever met,” he wrote. Other comments strike a similarly devotional tone. (Alerted to the praise, Cochrane laughingly dismissed it because the sample size isn’t statistically significant.)

Cochrane became a doctor for some of the usual reasons: he wanted to help people, a family friend whom he idolized practised family medicine in hometown Cambridge, Ontario, and he (Douglas) had the brains and the stamina to get through med school. His ambitions drew him into the wider world. At the University of Toronto, he won the Faculty of Medicine’s Cody gold medal, then struck out for Angola and worked under the medical missionary Robert Foster at the tail end of a brutal civil war. Foster’s resourcefulness under fire (literally) provided a new benchmark. Cochrane decided there to specialize in neurosurgery. Neurosurgeons are medicine’s bomb squad—brain disorders are among the most threatening to patients, and treatments carry the most risk. Family medicine it isn’t, but for Cochrane that combination of complexity and high stakes was exactly the appeal. “I found I enjoyed trying to solve tough problems,” he says. Pediatric neurosurgery is the no-limit table: the highest stakes of all. If your itch is to help, life offers few more useful places to scratch. He has been at Childrens’, where he specializes in fetuses with congenital neurological malformations, for 25 years.

But nothing in his background, he says, prepared him for a case like the Hogan twins. Cochrane is watching and listening like everyone else to see what the girls reveal about who they are.

The twins, chestnut-haired and blue-eyed, are nearly five years old. Developmentally they’re closer to four, Cochrane says, but that may just be the Ginger Rogers syndrome: they do what other kids do, but backwards and in heels, so to speak. “They have had to learn motor movements differently,” Cochrane says. “They had to work on how to sit and stand and cruise and walk.” (Even bum-scooting required heroic teamwork.)

Their language has come slowly. Cochrane admits he doesn’t quite know why but reckons the answer might be social rather than physiological. The twins are the not-so-still centre of an extended family of 14 people, all mustered under the roof of a 10-room rented house, all more or less devoted to the insatiable needs of the world’s rarest craniopagus twins. “You could say that there’s a household there that’s so full of adults and kids communicating that they’re kind of communicating for them,” Cochrane says. “It’s like the third child: he’s not going to talk until he’s three because the other two are doing all the talking for him.”

Exactly what the girls’ internal landscape is like we can’t yet know. The best tool for getting a real-time snapshot of what’s happening in the brain is an fMRI scan, which measures changes in blood flow (which correlate to changes in neural activity). For those pictures the girls will need to go into the scanner without anesthetic, which means getting their cooperation. It’ll likely be at least a year before Cochrane lets that happen. For now everybody is guessing.

Some things are established. It seems clear that Tatiana will “see” the sickle moon that Krista is looking at (and vice-versa). Very likely, in some fashion, she will hear the Bruno Mars song piping into Krista’s ear bud, and taste the Tin Roof ice cream Krista just licked, and feel the give of the soft-shelled crab Krista just picked up. (One exception: she may not smell the chrysanthemum Krista has leaned down to sniff; olfaction appears to be the one sense that routes around the thalamus.) The fear Krista experiences in her nightmare will agitate sleeping Tatiana, too. And when Krista jars awake, so will Tatiana. (The thalamus governs wakefulness.) So they will save money on alarm clocks.

It’s not clear how their brains will sort out the interference from the two-way traffic on the bridge. If they are both reading a book, will each see both sets of words? (Some neurologists wonder if the twins will have an increased chance of synesthesia—a blending of senses disproportionately common in visual artists.) The communication between them will likely prove to be a uniquely intimate call-and-response. But can we say what they are sharing are actual thoughts?

The thalamus relays not only sensory information but also some memory information to a part of the midbrain called the cingulate cortex, which is involved in, among other things, processing emotion. So the exchange is bound to have at least a dimension of what we think of as “thoughts.”

Felicia Simms is convinced her girls are playing a sort of private game of tennis, mentally. Kelowna filmmaker Alison Love, who spent a year with the twins while helping create the documentary Twins Who Share a Brain, believes it, too. “In the beginning we weren’t sure ourselves,” she says. “Is it just Mom hoping that the kids are really more special than they are?” But then both she and filmmaking partner David McIlvride began to see the same thing: a tight, coded link between the girls’ behaviour without a sound passing between them.

Cochrane, for his part, is somewhat a kindred spirit to Atul Gawande, a Boston-based endocrine surgeon and popular writer. Both men crusade for patient safety, ensured by systems of checklists and protocols for doctors to work more efficiently and limit catastrophic errors. Gawande wrote a book called Better, which promotes these issues; Cochrane co-directs the Canadian Patient Safety Institute and was recently appointed to chair the inquiry into thousands of medical scans performed and interpreted by a couple of B.C. doctors unlicensed to do so.

But Cochrane is like Gawande in another way, too. Gawande has an oft-quoted line that could easily be Cochrane’s mantra: “The social dimension turns out to be as essential as the scientific.” Cochrane is a listener above all else. Patients know better than doctors do whether their treatment has been “successful,” but that’s not the way the equation works now. Correcting that thinking, Cochrane says, “becomes more important to me the older I get.”

A powerful social lens may prove one of Cochrane’s best assets as far as the girls are concerned. (For theirs is going to be as much a social story as a medical one, a story of standing out and fitting in.) Cochrane is a curator of the twins’ uniqueness who emphasizes their ordinariness. “My sort of mental model of these kids is that they’re two kids who come to visit me,” he says. “I’m involved in the care of many kids with deformities and malformations, kids who don’t look normal and their arms and legs don’t work normally.” In this sense, the twins are like any other of his patients. “I see them as children.” If this case were special, the other ones wouldn’t be.

Cochrane doesn’t burn much daylight thinking about the philosophical and poetic implications of the girls who share a brain. Even the twists and turns of the neuroscience don’t preoccupy him. “I am interested,” he says, “and when the time is right we’ll try and put some sense to this. But I’m not prepared to put the girls out as medical curiosities. I mean, where historically did these people end up? In circuses.”

This is Cochrane as protector—trying to create normalcy around a family circumstance that would quicken the pulse of a reality-show producer. That 14-member extended family—including mom Felicia and father Brendan, five kids (the twins have an older brother and a sister, plus a baby sister called Shaggy), grandmother Louise, and various aunts and uncles and cousins—are stretched impossibly thin. The monthly budget doesn’t cover the frequent car trips to Vancouver for medical tests, which are only partly subsidized by the provincial health ministry. Some of the adults, at least three of whom have health issues of their own, report that they sometimes go hungry so that the twins can eat. To manage the twins’ exposure and drum up income (through things like speaking gigs for Felicia), the family has retained Los Angeles agent Chuck Harris. The self-described “Wizard of Odd,” Harris counts among his other clients “Lizard Boy,” “Wolf Boy,” and a guy who balances a car on his head. (Not to mention 49-year-old Lori and George Schappell of Reading, Pennsylvania, the world’s oldest set of craniopagus twins.)

The frenzy of academic interest in the twins is its own kind of P.T. Barnum scrum, in Cochrane’s view. “It’s ‘Who’s published about it? Show me the article!’” he says. And here the face of this perfectly controlled man clouds with frustration. (Cochrane has published no papers on the girls himself.) “The kids need to develop in order for us to understand some of the things that they’re asking. And the case study of these two twins will in fact be important when we can do it.”

The Hogan twins—the fact of them—is a little like the fact of life on Earth: a series of odds-defying events compounded to a level of staggering improbability. They weren’t supposed to make it this far. Early fears were that Tatiana’s heart, which was doing almost the work of two hearts, might fail. But now that the twins have grown, and grown stronger, that fear has faded and they are thriving beyond all expectation. Cochrane heaps credit on the family. “The support I remain in awe of,” he says. “That family has remained absolutely committed and absolutely strong. Without them the girls probably would have ended up in foster care.”

Out in public the girls still generate strong reactions. That’s not likely to change. “People’s immediate response is, ‘The twins should be separated—let’s make them like us,’ ” Cochrane says. Whatever the motives for that reflex—to spare the girls an impossibly complicated life or just to spare ourselves the uncomfortable feelings they might arouse in us—it’s not likely to happen now. “The only two other twins I know of who had this form of joining, though not the bridge, were two Iranian sisters,” Cochrane says. “They chose to do it in adulthood. And they did not survive.”

So, barring some game-changing microsurgical advance 30 years down the road, these two British Columbian sisters, bred in the bone, will move through life together, communicating in ways they’ll probably never be able fully to articulate. No one else will understand. But one man will understand better than most.

www.vanmag.com/News_and_Features/The_Worlds_Rarest_Twins?page=0%2C0

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The Western/Eastern Mind Divide

The Western/Eastern Mind Divide

Featured Psychology

UBC cultural psychologist Steven Heine discovered profound differences between Western and Eastern minds. A recipe for prejudice, or just the opposite?

from VANCOUVER MAGAZINE, April, 2010

It would be overstating things to claim it made Steven Heine famous—because nobody in his emerging field of cultural psychology is famous—but a study led by the young UBC professor did generate chatter in all kinds of quarters, from academic journals to the back page of Time. It got people thinking about the Western mind and the Eastern mind and the differences between them. Now that the East has just overtaken the West in economic strength (the tipping point, after a couple of centuries of Western dominance, came in 2006), Heine’s experiment seems positively pregnant with meaning.

Here’s the scoop. Heine and three colleagues recruited two groups of students—one Euro-Canadian and the second Japanese—and he gave them a bogus “creativity” task. The test was graded, and the students were told they had done well on some parts and poorly on others. Heine was interested in what would come next. The students were given a second, similar test, and the psychologist and his colleagues secretly watched how the subjects tackled it. Turned out there was a glaring difference. The Westerners worked longer on the stuff they were told they had aced the first time. The Easterners concentrated on the areas they thought they had botched. Students from the West—where the cult of self-esteem reigns supreme—wanted a tummy rub. Students from the East were more concerned with fixing their blind spots, becoming well-rounded. The Westerners polished up their strengths while the Easterners addressed their weaknesses. You could hardly fail to take away a moral: what gains might be made if Westerners could just check their egos and learn to see opportunity in failure! (Largely on the strength of the study, Heine received in 2003 the American Psychological Association’s Award for Distinguished Scientific Early Career Contributions to Psychology.)

But Heine wasn’t trying to sermonize or shill for the Ministry of Education. By exposing this deep cultural rift, Heine punctured a long-held myth. You’d think positive self-regard gets everyone through their day, but it doesn’t. If such a seemingly basic human motivation is culturally determined, what else is? Turns out, lots. Western and Eastern minds fare dissimilar in ways that we’re only now able to measure.

Read the whole article here:

www.vanmag.com/News_and_Features/The_EastWest_Mind_Divide

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Made you look!

Made you look!

Featured Psychology

The familiar becomes invisible. And that’s a problem.

from VANCOUVER MAGAZINE, July 2009

“Choice architecture” is suddenly a sexy idea, thanks largely to a recent book called Nudge. A nudge, as authors Richard Thaler (an economist) and Cass Sunstein (a legal scholar) explain, is a little intervention in our daily lives from the unseen hand of an engineer or a designer that subtly encourages a behaviour, presenting options in such a way that we’re inclined to do the socially beneficial thing. It tricks us into eating our spinach. Some of the most ingenious examples come from traffic-engineering departments. On a dangerously winding stretch of Lake Shore Drive in Chicago, the city dealt with speed-caused fatalities by painting lines on the road. The lines become more tightly spaced on the curves, giving drivers the illusion that they’re speeding up-and so those drivers slow down. (In 1996 here in B.C., on a soporific stretch of Highway 5 between Little Fort and Blackpool, engineers first installed those now-familiar “rumble strips” on the shoulder hem of the lane, which function as alarm clocks if you drift onto them, producing “Holy crap, I’ll never do that again!” moments that may change driving habits permanently.) Other intriguing examples abound. It turns out people can be nudged to save more money (by manipulating the psychology of pension plans) or to use energy more efficiently (if a hydro meter is installed in a place where they can actually see their energy consumption as it happens). Should we be worried about the coercion implicit in such tactics? Well, there is coercion in any tactic, as Thaler points out: “There’s no such thing as a neutral environment.” The salad bar is either in the front or the back; the hydro meter is either in view or not. It’s better to choose the better thing, and the experts make no apologies for stacking the deck that way.

Nudges matter because if you take action early in a behaviour chain you’re attacking problems at the level of prevention, not repair-and preventing problems is a lot cheaper and less trouble. That’s one of the reasons Barack Obama is such a huge fan of the concept. He thinks this sort of “libertarian paternalism” might help show America the way out of its economic woes, by getting a lot of people doing small responsible things from the get-go. (He appointed Sunstein, his former law-school pal at the University of Chicago, to his administration, as his “regulatory czar.”) Choice architecture has made designers the new “unacknowledged legislators of the world,” and from Mumbai to Vancouver, their modest acts reverberate and produce big, if sometimes hard to quantify, changes in the behaviour of the masses.

Read the whole article here:

www.vanmag.com/News_and_Features/Environment/Made_You_Look

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The Time Machine

The Time Machine

Featured Science

It’s been called the biggest scientific project ever. And Vancouver scientists are poised to help understand the origins of the universe

from VANCOUVER MAGAZINE, December 2008

Given Canada’s key role in the experiment, it would have been a little embarrassing if this business at the Large Hadron Collider near Geneva had destroyed the universe. In theory, it still could produce microscopic black holes that will suck us into oblivion and pull our screams in behind us. But frankly, scientists at TRIUMF-Canada’s national laboratory for particle and nuclear physics-aren’t too concerned. “These collisions are going on all the time with cosmic rays,” says Nigel Lockyer, TRIUMF’s director. “I wish we could make collisions of higher energy than what nature does routinely.”

No, any nail-biting at TRIUMF concerned whether the hardware would work on game day. TRIUMF built a part of the accelerator-a system of “kicker magnets” that spank the already fast-moving protons into the main ring of the collider where they really start to motor. There was a tense moment when word came from CERN (Compact Muon Solenoid Experiment) that some magnets had failed, followed by relief when they weren’t crucial and, as one TRIUMFer puts it, “they weren’t ours.” In fact, the “Canadian Insertion” worked perfectly and the Great Discovery Machine was up and humming, conducting the groundbreaking ATLAS Experiment, stalking the so-called God particle and probing the mysteries of the origins of everything.

Read the whole article here:

www.vanmag.com/News_and_Features/The_Time_Machine

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Father Abraham

Father Abraham

Essays Featured Profiles

From VANCOUVER MAGAZINE, July 1, 2008

At the tiny hole-in-the-wall Chinese restaurant around the corner from his Point Grey house, Abraham Rogatnick needs no introduction. He is a regular, with his table, his chair. On a sunny afternoon not long ago the owner looked up as he came through the door. She smiled sweetly with a tiny bow of the head, disappeared into the back, and quietly returned with the Yellow Pages for him to sit on.

Rogatnick is an elfin man. Wearing a neatly knotted black tie and white shirt under a red sweater, he could be Billy Crystal’s dad. His face rings a bell, the way character actors’ faces do, though you can’t be sure where you’ve seen them. In Rogatnick’s case, it could have been the crime drama Just Cause, in which he played a nutty old judge on a couple of episodes. Since he broke into acting around 1998, at age 74—propelled by a love for the language of Shakespeare, and with a little more time on his hands at last—he has been steered by his agent away from the stage and into movie and TV roles, more Lear than Romeo.

“I’ve played old men,” he said. “Usually dying old men.”

It occurred to him, as he worked on his chicken soup, that he’d eaten here for four consecutive days, with a different companion each time. Though he retired from the architecture department at UBC in 1985, academics and artists and former students seek him out. Something about him invites questions.

His face registered his pleasure with the soup. “It’s so good today,” he said. “It’s better than it has been for a long time. It must be a new batch.” It was the soup of the day, the soup of the place. If you tried to take it home it wouldn’t be the same soup. He lingered over it. “I eat very slowly,” he said. “I just can’t swallow as fast as everyone else.”

There are people who visibly wield power. And then there are the people who quietly prop them up. Sometimes the backroom partners emerge with a bit of a profile of their own—Raymond Carver’s editor, Helen Keller’s teacher, George W. Bush’s pastor—but more often they don’t. Influence that isn’t particularly interested in fame can easily stay hidden. It’s a different kind of power, exerted by sitting on design panels or crafting inspirational lectures that ignite promising students or eating dinner with men who buy ink by the barrel—but it’s vital to the forward movement of the culture.

Abraham Rogatnick (“Abe” is reserved for his oldest friends) is an architect, a historian, a professor, a public intellectual. Newspaper reporters sometimes reach for goofy catchall phrases like “octogenarian livewire” to describe him because no single label captures him.

Behold Abraham Jedidiah Rogatnick. Who trained at Harvard’s Graduate School of Design under the directorship of Walter Gropius—the Bauhaus founder and one of the pioneers of modern architecture. Who popped into town in the fall of 1955 for a quick visit and was welcomed by the arts community the way a drowner welcomes a floating barrel, and just never left. Who pretty much explained modern-art to Vancouver—after opening the doors to one of the first contemporary art galleries in Canada. (This was six weeks after arriving.) Who helped create what became the Arts Club Theatre, and was parachuted in to restore stability to the Vancouver Art Gallery after its Watergate in 1974. Who invented a “studies abroad” program for architecture students, so they could live in some of the world’s great cities. (When you leave home, as the poet said, you see your own home.) Who chose a water-squeezed tourist mecca for the first platoon of outgoing UBC architecture students—and became one of the world’s foremost authorities on Venice. (That there are plenty of lessons Vancouver can learn from Venice has been one of his chief preoccupations.) Who walked its streets with Buckminster Fuller and Louis Kahn, as their interpreter. Who may have covered more of Vancouver on foot than anyone else alive. Who hiked the Chilkoot Trail with Pierre Berton. Who met Bill Reid when Reid had only recently learned he had some Haida blood in him (and so was phasing out of a career as a CBC broadcaster to explore his roots in art). Who would stand at the intersection of a sample of some of Vancouver’s most important architects and painters of the last century: the landscape architect Cornelia Oberlander, architects Arthur Erickson and Ned Pratt and Ron Thom and Barry Downs and Fred Hollingsworth, painters Bert Binning and Jack Shadbolt and Gordon Smith. Who was present at the birth of West Coast modernism—the closest we have come to an indigenous art movement—and managed to keep his eye on the ball as a new bunch of artists emerged to put Vancouver on the map again. (He remains good friends with Jeff Wall, Stan Douglas, Rodney Graham, Ken Lum, Ian Wallace, Attila Richard Lukacs.) Who is one of a very few men in this city who can get away with wearing a cape. Who tipped the last Vancouver mayoral election. And who claims to be puzzled that people think he’s worth writing about.

Full post:

www.vanmag.com/News_and_Features/City_Life/Father_Abraham?page=0%2C1

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