Oct 1st 2016 by bustead • 22 Questions • 3934 Points
Hi Reddit. As the title says, my name is Dr. Lynn Webster. I’m VP of Scientific Affairs at PRA Health Sciences (PRAHS) and a past president of the American Academy of Pain Medicine. Much of my life I have worked to develop new, safer medications for pain and addiction. One of the areas of my research is to test abuse-deterrent formulations of pain medications. We’re in the middle of conducting these types of studies right now.
It’s no secret there’s an opioid/painkiller abuse crisis in the United States. A disturbing number of people have died due to abusing opioids. A recent report from the Centers for Disease Control and Prevention estimates the financial cost exceeds 78 billion dollars annually. But, of course, far more important is the cost in human lives. The CDC states opioids are involved in 40 deaths each day in America. This is a staggering number. It is equivalent to a jumbo jet airplane crashing every 10 days. No wonder every governmental agency, including the White House, is involved in trying to curb this epidemic.
Nearly everyone in America knows someone who has developed an addiction or overdosed on opioids. There is no discrimination with this disease. It affects every social economic class. While opioids are necessary and help some people, they can be dangerous if not taken as directed. They can also be made safer.
The good news is that we are working hard to make opioids and other medications safer and more effective. The company I work for, PRA Health Sciences, is continually exploring ways to make existing and new drugs safer.
The way we study the abuse potential of drugs is to give the drugs to people and ask them how much they like the drug. The goal is to reduce “liking” in drugs while retaining the needed effect on pain receptors. We have volunteers compare the new drug, or drug formulation, with a drug that is commonly abused. The FDA requires that we conduct these studies in people who use these drugs for recreational purposes. These are people who are not addicted to the drugs but who are using the medication without a prescription.
In the past few years, the FDA has approved several of these abuse deterrent formulations. Early research suggests the abuse deterrent formulations are safer and associated with less harm.
It is my hope that, one day, we will have medications that cannot be abused but will provide relief to those who need the help.
In the meantime, I am happy to respond to your questions. Ask about the clinical trials, types of drugs we study, risks of opioids, addiction, or anything in the field of pain management or addiction. I will do my best to answer your questions.
Additional Reading and Verification:
Edit: Thanks for your time, Reddit! This was a lot of fun. Thanks to everyone who asked questions–I hope it’s been informative. Feel free to continue to answer questions and I’ll try to answer as many as I can over the next day or so.
Will they "punish" you if you refuse to bow to Kim Il Sung and Kim Jong Il's statues?
in Dick Tracey, there was a scene where Dick Tracey jumps on top of a pole and slides down. And everytime I watch this movie I notice how hard the stunt double hits the pole. Did you watch this happen?
What evidence is there for the external validity of tests like the IAT? Are we certain we're studying biases rather than familiarity for example?
Additionally, as someone pursuing a career in science, how can I make sure I view others based on the merits of their work, rather than letting my unconscious bias take over?
What do you think about cannabis research as a potential alternative for opiates?
Yes. You will be asked again to bow. If you refuse again you will:
Be locked in your hotel room for the entirety of the trip and be sent home knowing that you will never be able to go to DPRK again.
Be forced to write a letter explaining your actions and apologizing to "the people of DPRK" and give that to your guides. They may also get into trouble for your actions.
If you fail to write that letter or if you do anything more to incite DPRK further, you maybe arrested and by that point, you will most likely be sentenced to hard labor or shot.
Daily life is taking more than you're giving yourself; whether work, personal situations, etc. It's crucial to find something that fulfills -whether reading, gaming, creating, volunteering, working out, etc. The more you do for you, while still making sure to be considerate of the people around you, the easier it is to combat and keep depression at bay.
(Disclaimer: we are not medical professionals and the above advice is to be taken with a grain of salt. If you're truly going through a hard time: friends, family, and professional assistance can help).
Hi! As a nerd I appreciate your question on external validity. Instead of re-inventing the wheel I'll direct you to project implicit's IAT FAQs https://implicit.harvard.edu/implicit/demo/background/faqs.html But I will say that this test is highly controversial, so it has gone through the validity ringer more so than many other reputable psychological measures ( I have also linked other comments to our state of the science reports, a few of them have entire sections dedicated to the IAT/measurement for future reading)
As for your second point, this is a lifelong journey that we all must approach with a ton of humility and patience. But getting out of your comfort zone and interacting with folks that come from different background and being more mindful of your decisions is a great place to start!
This is something that I've been recommending for some time. I've recommended the DEA reschedule cannabis so that research can be conducted more easily. It may well be a good substitute for opioids. BUT we need the research.
Thanks for the explanation. I was wondering about this ever since I found out you could actually go to NoKor as a tourist.
One more thing: Were you told what things you were not allowed to bring? Say, anything SoKor-made, etc.? Are the guides strict in implementing rules?
What is your best memory about filming Bonnie and Clyde? Best regards for you and your wife from a fan of both in Mexico.
That my mother and father visited me on the set for the first time since it was the first movie I produced. My mother was a smoker. She and my father sat in and witnessed a production meeting. I saw her smoking and I asked her in front of the group if she loved me. There was an embarrassing silence. She said to me, ‘Of course, I love you. Why would you ask a question like that?’ I then said, ‘Well if you love me, will you put that cigarette out and never smoke another one?’
She stared down at the cigarette in her hand for a while and then she put it out. She never smoked another cigarette.
Another day Another mystery
The spider crawls from within history
OUCH! another bite
The spider hides again
Not sure what that was
Is this even a Haiku?
How sick and tired are you of people asking if Ned Beatty is your brother? Have you two met?
I actually can't remember someone ever asking me that question. Ned Beatty and I don’t know each other very well but I admire his work.
How many days did you stay there?
Were you on an organized tour or what? Did you have any chance to just walk around on your own?
Do you speak any Korean?
What inspired you to make Reds?
I found a study online where you were supposed to press right for good or bad things, then press right for homosexual or heterosexual things. I guess it was trying to see if you implicitly wanted to say one sexuality or another was good or bad.
Are you familiar with the study? I think it came from Harvard. What do you think about that as a methodology?
The answer is as easy as the inquiry ;)
Truthfully, we had a few friends over and were playing a few card games. A bottle of scotch, some laughs, some dialogue, and the idea came.
The replies we usually get it "What a simple concept" -because it is.
Now, this isn't to discredit the work which followed. Having ideas is the easy part. Putting them into motion, all the way through the end is the part which we're proud of. From Trademarking, Registering businesses in the proper states, Legalities, Contracts with freelancers, Site / Marketing concepts, finding the right models and honing in on a specific tone (vintage/grindhouse, etc) all took months; even after our first release, there was much work to do -improving, editing, amending, and trying our best to grow.
Concept was quasi-easy / Road to completion is continuing process.
I really think part of the problem is they cannot easily differentiate in a blood test. Fentanyl breaks down into morphine and down the opiate line. All they can really tell is that it was an opioid OD. There are always a slew of different forms in the system.
I can't tell you that as I don't want to cause them any trouble (I am a smuggler right?) but I can recommend a Hong Kong based company for you:
To stop thinking about trying to come across as charismatic and engaging.
It wouldn't be the first time. All depends on your Grannie's humor ;)
Some cards would be a bit awkward, we imagine.
So, how cool is this Grandma?
Great! Here's a link to a buzzfeed video that included other factors like gender, class etc. As a research conscious person I won't go on record for vouching for buzzfeed's reporting accuracy, etc., but it is a good illustration of how privilege intersects multiple identities. Additionally, a lot of research focuses on the Black-White dichotomy, but there are a good bit of studies that go into the types of implicit biases that we all hold for other groups--one example is a study that showed that kids as young as middle school internalized the stereotype that Asians are good at math. A write up of the article is found on page 34 of our review: http://kirwaninstitute.osu.edu/wp-content/uploads/2015/05/2015-kirwan-implicit-bias.pdf
Actually, the CDC cannot usually determine cause of death. They can report if an opioid is present, contributes, or probably caused a death. In most instances, deaths are associated with multiple drugs. It's also true that heroin metabolizes to morphine. In June 2016, the CDC revised the unintentional overdose deaths downward by almost 4,000 annual deaths to take into account the probably involvement of heroin–rather than morphine–in the overdose deaths. Yet even one death is tragic.
Dr. Webster, when do you foresee the government doing anything to help chronic pain patients who are now going from functioning to bedbound due to discontinuance of their pain meds?
I may if I am to go back to NK in a later date. We will see
What were the people like towards you? We're they hostile or very friendly? Where did you stay? I imagine there aren't too many hotels in an isolationist country.
Are you going to be in any Marvel movies or Star Warses?
Are you surprised Mickey One never found a big, cult audience?
I have not, nor do I know of any. Because of how psychological research is conduct, studies almost always rely on a random sample or a sample similar to that being tested (e.g. matching participants based on race or gender). So I don't think the field as a whole knows much about individual differences in the population.. That is a very interesting point!
There is up to a ten-fold difference in response to the same level of pain stimulus from one individual to another. It is unfair to judge somebody else's response to pain based upon your response. I'm glad you are doing well.
Got any good Hunter S Thompson stories?
Advice on how to deal with this on-again-off-again-mostly-mist bullshit storm we are stuck with for the next couple days? The storm is ruining one of the last fun outdoor weekends of the year.
What are some small steps that people can take to minimize the negative effects of implicit bias in hiring?
Did you get sick from the food? I heard some tourists get sick from the seafood there.
Tell us about working with Lily Collins. She seems like an actress with a lot of talent who hasn't gotten a chance to showcase it. Thoughts?
Why is it we haven't seen such a major push of guidelines with regards to other types of controlled substances such as stimulants/adhd medications? I've heard some chatter about more restrictions for some people on them but for the most part there aren't expensive urine screens, regular pill counts (if any at all), or the requirement of needing a visit every 28-30 days for a new script. I'm curious about the focus on opioids only when there are many other types of meds that are able to be "abused".
Didn't try seafood so I don't know about that. However I can tell you that food is more than enough for all of us. We were stuffed from the first meal to the last. While it was not the best in the world, it is certainly good. For example this is what we ate in Kaesong, a city near 38th line: http://imgur.com/a/7ToJ8 Steamed insam chicken big enough for 3 people to share.
I feel Lily Collins has an unlimited potential in movies. She makes brave choices, it's hard to take your eyes off of her on screen and her chemistry with Alden Ehrenreich was both hilarious and moving.
Are you into Horror? If so, what type / decade? Literally staring at a massive DVD collection and would be happy to pick something appropriate ;)
Ronald Reagan. Or maybe Barack Obama. I might add that Ronald Reagan, who was a friend of mine, once said to me (not joking) that he did not know how anyone could be President now without being an actor.
here we go....
- Hollywood Chainsaw Hookers (some vintage silliness)
- Dead and Breakfast (if you like Shawn of the Dead)
- Street Trash (Oldschool Splatter)
- Jack Frost 2 (it's like Saved By The Bell meets Leprechaun)
- Tromeo & Juliet (Troma - doesn't get any better/weirder ..+ LEMMMY for Motorhead)
- Zombi 2 (Italian Zombie film that takes place on an island)
- Frankenhooker (NYC Times Sq Sleeze and Comedy; also see Basket Case)
- Dead Alive (Peter Jackson before he became THE Peter Jackson)
- Diabolical Dr. Z (Oldschool B/W film; trippy and was introduced to us by a Satanist on the Lower East Side.lol)
- Prince of Darkness (John Carpenter film that's part of his endof the world trilogy of films: The Thing and Mouth of Madness being the other ones. People give this one shit, but we found it terrifying. Mouth of Madness is awesome too.
- ANY of the Return of the Living Dead films (funny, entertaining ..BRAIIINSS)
- Cannibal Ferox (a less appreciated film, in the vein of Cannibal Holocaust)
- Brainscan (A cheesy semi-slasher flick, featuring the kid from Terminator 2; great 90's flashback)
Could. Go. On. Forever. :)
Great question. This reasoning is exactly why desegregation occurred in the first place. The iconic doll study (more modern recreations shown here https://www.youtube.com/watch?v=tkpUyB2xgTM .. sorry for bad video quality) Gave evidence of the harm in internalizing negative stereotypes. This isn't implicit bias research, but stereotype threat research shows just how detrimental those internalized biases can be for our young people.
Belbuca and Bunavail are buprenorphine formulations. Buprenorphine is an opioid. Belbuca is for chronic pain and Bunavail is for opioid addiction. I think both can be effective in a subset of the population. They appear to have less risk than other types of opioids.
Did you find out if supreme leader actually poops or not?
There is a long standing rumor in the imdb trivia section that you were at one time working on a Pokémon movie. Is there any truth to that rumor?
Hey i'm a former opiate junkie, wasted away my 20's.
I've been clean for 2 years, but rely on my CBD oil for sleep, and also THC oil and vape flower for daily anxiety/depression. It has been wonderful!!
So my question, can CBD lower you THC level in your body?? I've read this and just wondering if it's rumors or what?? Could you expand a little. Thanks for doing this AMA <3
Nope. I am not allowed to question the authority of NK propaganda... I mean news reports.
one of my fave lines from REDS - 'well its Thanksgiving - why don't you come as a turkey" Written or from history?
Everyone talks about how authoritarian the NK regime is, lots of government involvement in peoples lives. When you were there, did you see a lot of government influence? If you did, what was the craziest thing that the government tried to influence?
You've been such an influence on my personally since Dick Tracy when I was 12. My passion for film and acting are thanks to you. Also your love of politics encouraged me to vote at 18. How do you feel about this years election??
I’ve spent a lot of my life in political activism. I campaigned for Jack Kennedy, I campaigned with Bobby Kennedy and quit movies for a while to work with George McGovern and help him try to get us out of Vietnam. I’ve remained a lifelong Democrat although I have as many friends who are Republicans. What concerns me most at the moment is that the commercialization of the use of technology may be creating a cacophony of opinions that obliterates voices of wisdom.
Sending our cards-concepts/images to manufacturers, and receiving letters of rejection was rather funny. Even US based companies, they outsource overseas -and a lot of countries in Asia have very strict rules with XXX material. We still have those rejection letters; definitely something to laugh about. We're happy with our current printer/model and, until given any reason to leave, we'll stay with them. At the moment though, we may start looking for alternatives as we've been getting some attractive offers. Funny how that works, huh? lol
I have additional question: How often do you run these trials and how do you ensure they're safe? Given that opiates are pretty addictive, this seems like a pretty big concern, recreational users or not.
Some may I guess. Heavy propaganda+good life=genuine loyalty to Kim. Most people in NK will most likely not be able to enjoy that sort of living standards though.
Bob Altman was a lot of fun to work with. He was brilliantly flexible and improvisational.
- About 6-9 months until the first prototype was delivered.
- and, sure, always open to hear of any offers and symbiotic partnerships. Feel free to send us a message.
Exactly! Not everyone has all of the same biases, but there area certainly overarching trends, I will say that biases are a part of being human so we do all have them to some extent, but it may not be toward those identities that are highlighted in the media
One, we are conducting trials on a continual basis. Our trials are not just about opioids. We may study antidepressants, stimulants, benzodiazepines, cannabinoids, new chemical entities, etc...
And two, safety is our number one concern. We are very familiar with the doses that are administered and monitored continuously during a clinical trial. Furthermore, the FDA reviews all protocols to be sure they are safe for the subjects.
Who is an actor that you admired starting out, that doesn't get their due?
What was the your scariest or most intense moment you had while in NK?
To me there is something special about Shampoo that I can't put my finger on. Would you say that It's a Hal Ashby movie or Hal Ashby/Warren Beatty movie? What was your involvement behind the scenes?
How did you guys get on to this job? i.e. game developer What made you want to do this?
I took an implicit bias test online. There were a variety of different tests to determine (for example) whether you had an implicit bias as women being less competent than men, and one to see if you saw blacks as more dangerous than whites. There was no IB test regarding if you see men as more dangerous than women, though. This is a significant stereotype that seemed to be missing from the tests.
Have you ever studied whether people have an implicit bias to see men as more dangerous than women? If so, what were the results? If not, why not?
Were you ever worried for your safety/life?
Do they still put up this big show of perfection?
Have you managed to truly interact with any North Koreans, or was it all just a part of the show?
So Dick Tracy reboot?
That's actually one thing we have yet to delve into. People have suggested getting involved with streamers, yet it's uncharted territory for us. Any other people you would recommend? Thanks for the question ....and for the tip! -pun not intended, but we can roll with it ;)
a laptop with a game that is banned in NK. I was really scared when I went through the border checks but I made it out alive :D
What we're the security checks like on the way out, and what game?
Do you ever miss living in Virginia?
I love Virginia but I love where I live – California.
Thanks for the referrals ;) xoxo
To delete all my photos and take away my stuff. Really that's all I can do. Come to think of it I was beyond stupid
If you only knew how much we love Burritos....
If you're in New York, we got you covered! (The good shit! we promise.)
What is your connection to Nova Scotia?
We know a few spots in New York that airmail their delicious Pizza -maybe we can find one that'll speed air-freight a killer Burrito?
For your first question, North Korea is one of the safest countries to visit, simply because you are watched 100% time.
What is your favorite memory filming Ishtar?
Hi! This is one of those things that bugs me...as a professional, how nasty is that gray area of "Is this implicit bias, or are we jumping at shadows?" I'm wondering what a professional's perspective is, since it's a perspective I don't (and can't, as it's not my line of work) have.
To give a little more insight into the context I'm working with...as someone who isn't a professional, especially coming from a position where the most visible are those who come at it with a "this is a foregone conclusion, and now have to justify it" approach, it seems to be pretty common among the laymen; that worries me, since it seems like it would undermine all you guys are trying to accomplish.
One of my friends left a smartphone in a pizza restaurant. He got it back 4 hours later. That will not happen in Vietnam!
Standing holding two camels on a street in Marrakesh with Dustin Hoffman staring at one another.
Well the very nature of implicit bias makes it difficult to identify. Without research I doubt someone could definitively point it out in ow others act, much less in their own actions. That being said, so much about mitigating bias depends on building those safeguards so we don't have to always analyze every single decision we make to try to identify bias.. that's not a good use of anyone's time.. well maybe it's a good use of my time but I digress... haha
edit: just wanted to say this comes up a lot in our work and I want to stress that preventing bias and "jumping at shadows" or even feeling like the sky is falling, can be a fine line.. it takes some delicacy and humility and practice. Great observation/question!
What Jay Bulworth is saying is very, very different from that which Mr. Trump is saying.
I mainly focus on education, and somewhat housing. Not sure if fascinating in the right word but education is always depressing and full of disparities haha-- but i love the neuroscience and perception work, it really demonstrates how automatic processes are impacted by race--e.g. we're really bad at accurately perceiving the emotions of faces that are outside our racial group.
Blinding resumes is a great tool but even that isn't perfect--our job experience and activities may provide information that cues the reader to think about our gender or race. But anything to reduce distractions/ cognitive load and keep the evaluators accountable (e.g. utilizing data) decreases the likelihood that someone will rely on their biases when making decisions. I gave some feedback specific to hiring elsewhere in this thread if that's what you're interested in!
The IAT tests both evaluations (good vs bad) and stereotypes (gender-career association) but doesn't have any application in the test itself. However other researchers use the IAT to examine how our biases predict those actions.
What was your favorite location to film in?
What is the best thing about getting paid to make things up?
I have found yellow submarine somewhere in the grand people's study house, as well as some old Chinese songs. NK citizens can also watch selected Chinese TV programs (eg CCTV documentary about World war 2) but that's about it. You can, however, watch RT, BBC and CCTV programs in your hotel room.
Well fortunately for me, my main job is conducting literature reviews that consist of really innovative work being done across the country-- so all volumes of the State of the Science are stuffed full of citations and only contain our perspective if noted.. so there's really not too many opportunities to make stuff up on my end ;)
How were the people there? Did they treat you any differently from what you expected?
Also how was the food?
Food is, as I said above, more than enough. In the first night in Pyongyang we had dinner in our hotel and we were surprised by the quantity of food they were offering. I was stuffed after the first round but then they served us a second round. I did felt guilty that we didn't finish all of the food, especially while we were in NK
I hope you didn't already answer this but what are some things we outsiders believe about North Korea that are false.
What were the people you met like?
- People tend to think that everyone in DPRK is poor as F*** but in reality some parts of Pyongyang can be rich! For example see here:
Looks modern enough to me. Of course it is reserved for the elites.
- They are more knowledgeable than I thought. They spoke good English (or Chinese) and some of them can be friendly. I would say people I met in grand people's study house seemed to be good people to me. The guides are friendly and funny either! I remember one of our guides got drunk with us. We taught her to swear in Chinese and Russian and she started her oral practice immediately by cursing her ex for 5 minutes non-stop!
What can imperialist swines do to be more like great Korea?
What can imperialist swine leaders do to imitate success of our Glorious Leader?
Start by using all their money on nukes instead of feeding their own people. Then build death camps everywhere.
The glorious leader can never be imitated!