A New Era in Addiction Medicine: A Trailblazing Doctor’s Legacy and the Ongoing Search for a Cure

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A New Era in Addiction Medicine: A Trailblazing Doctor’s Legacy and the Ongoing Search for a Cure



Marie Nyswander died in 1986. She’d achieved almost everything she had set out to do, but she wanted more: even better medications than methadone, fewer regulations and the holy grail—a cure for addiction. Addiction science has come a long way since Nyswander’s time, and it turns out that a lot of the field’s earlier assumptions were probably wrong. Neuroscientist Kent Berridge explains why wanting something isn’t the same as liking it. But a cure is still out of our reach.

[New to this season of the Lost Women of Science? Listen to Episode One here first, then to Episode TwoEpisode Three and Episode Four.]

EPISODE TRANSCRIPT

KATIE HAFNER: This is the fifth episode of our season about Marie Nyswander. If you haven’t heard the other episodes, you should go back to the first one and start there. Again, this episode contains adult content and language, including discussions of drugs.

PETER LEE: Marie Nyswander, medical pioneer, explorer in the field of human behavior and reliever of pain, was a distinguished American, but her death was a loss not only to her fellow countrymen, but to all, to all humanity, and particularly to those afflicted with drug abuse.

CAROL SUTTON LEWIS: Marie Nyswander died in 1986. She was 67 years old. A memorial service was held at Beth Israel Medical Center in New York. Her husband, Vincent Dole, her old research partner, Mary-Jeanne Kreek, and her mother, Dorothy Bird Nyswander, were in attendance. And over the course of an hour, a stream of friends and colleagues stood up at the podium to eulogize Marie. They told stories about her determination, her strange sense of humor, and her love of people and wildlife alike. 

PAUL BRODEUR: Marie, a joyful spectator of all of nature’s mysteries, providing free lunch to generations of raccoons, enchanted by the wild hen turkey, which suddenly appears at her bird feeder, concerned about its love life, anxious for it to find a mate.

CAROL SUTTON LEWIS: And they told stories about everything she’d taught them.

ANITA TOWNLEY: I learned the love of art, the love of music, the love of travel, how to best pack for travel, where to buy caviar in New York at reduced prices…

CAROL SUTTON LEWIS: Her friend and colleague, Anita Townley, had known Marie for 17 years.

ANITA TOWNLEY: But then when I thought of the most important thing I had learned, I remember the day a young man came to Rockefeller in trouble. He was badly disheveled and a sight for sore eyes and in need of help. In looking this fellow over, it was hard to find his attributes. But then Dr. Nyswander wanted to turn to me and said, Anita, don’t you wish you had beautiful black, curly hair like John has? And then John looked in the mirror and smiled, and the next day he came back neat and well groomed, feeling and looking better, and began to see a solution to his problems. And that’s what Dr. Nyswander wanted, taught me that everyone needs a boost in life, especially the fellow who gets so few. I miss her.

KATIE HAFNER: And then a man named Harold Trigg paid tribute to Marie’s crowning achievement: methadone maintenance.

HAROLD TRIGG: Methadone maintenance cannot be disemboweled even by the staunchest critics. And as far as Marie’s critics go, let me say on this occasion that there are always little poodles yapping at the heels of Great Danes.

KATIE HAFNER: Harold seemed a little obsessed with Great Danes, so this is the highest praise. He continued-

HAROLD TRIGG: Marie was a very Great Dane. The best of the breed and the best in the show

KATIE HAFNER: By the time Marie died in 1986, methadone maintenance was still controversial but widespread and becoming more established by the day. Since the Rockefeller team’s revolutionary experiments in the mid-1960s, an estimated 150,000 people had received it.

And methadone maintenance has continued to grow in the years since. Today, in the United States about 300,000 people are taking methadone for opioid use disorders, and more than half a million are taking a newer, related drug, called buprenorphine. Treating an opioid addiction with medication has become a standard approach, and for many patients, the most effective one—and all of this is thanks in large part to Marie Nyswander. 

So in many ways, Marie achieved everything she had worked for. But she wanted more: Fewer restrictions around methadone, even better medications, and beyond that, she wanted a cure. She’d come up with a treatment, but addiction was still an incurable chronic condition and poorly understood.

CAROL SUTTON LEWIS: Well, addiction science has come a long way since Marie’s death in 1986. And it turns out some of the field’s most basic assumptions were probably wrong.

[THEME MUSIC] 

CAROL SUTTON LEWIS: This is Lost Women of Science. I’m Carol Sutton Lewis. 

KATIE HAFNER: And I’m Katie Hafner. Today, the final episode of The Doctor and the Fix, our series about Marie Nyswander.

CAROL SUTTON LEWIS: So remember that experiment with rats we talked about in the second episode? 

KATIE HAFNER: I certainly do.

CAROL SUTTON LEWIS: Well, for those who don’t, I’ll refresh your memory. In the 1950s, a pair of researchers at McGill University implanted electrodes in rats’ brains. And rats would do just about anything to activate those electrodes: press levers, run through mazes, and even endure electric shocks. 

KENT BERRIDGE: So it was thought this was a super pleasure, and that was the essence.

CAROL SUTTON LEWIS: Kent Berridge is a professor of psychology and neuroscience at the University of Michigan.  

KENT BERRIDGE: And if drugs were super pleasant, then that would be the essence of that kind of addiction too. 

CAROL SUTTON LEWIS: It was an understandable assumption. Why would a rat do something over and over if it didn’t feel good?

KENT BERRIDGE: There were science fiction books written in this 1960s and seventies of, um, stories where people might have pleasure electrodes that, you know, would lead them to just, uh, basically press themselves to death without ever going up to eat or drink or do anything else because the button was so rewarding.

KATIE HAFNER: But we have reason to believe something even more nightmarish was going on in these rats. Within a few years of the rat experiments, a doctor named Robert Heath started implanting electrodes in people.

KENT BERRIDGE: The human patients were institutionalized psychiatric patients who were having various problems in their life. And Robert Heath was sort of a- adventurous entrepreneur of a neurologist and psychiatrist. And he thought, well, why don’t we just implant some of these electrodes and see if we can use them in therapy.

KATIE HAFNER: His most famous patient was a man he referred to as B-19, in the early 70s. And this experiment gets dark. B-19 had a whole host of problems—he had epilepsy, he was abusing drugs, he was suicidal—so things he might have wanted treated. 

CAROL SUTTON LEWIS: But I just have to add this disturbing side note, B-19 also had what Robert Heath called “homosexual tendencies” and one of the things Heath was trying to figure out was whether deep brain electrode stimulation would make his patient heterosexual.

KATIE HAFNER: So that’s appalling. And it’s a part of this particular story that sometimes gets skipped over, and it really shouldn’t. What’s more often remembered is the part of the experiment that’s relevant to addiction research—and to our story today. The experiment worked like this. B-19 was given a box with a button that he could press as much as he wanted. Whenever he pressed it, he got a little electric jolt in what was believed to be the pleasure center of the brain.

KENT BERRIDGE: and he would press it up to over a thousand times in a- a couple of hours. To when he was allowed, and then when you took away the button box saying, we’re gonna end the session now, he’d say, no, no, please, a few more, a few more, I wanna press it a few more times.

KATIE HAFNER: So the obvious interpretation is that B-19, like the rats, was pressing the button because it felt good. But something odd was happening. Robert Heath noticed that as much as his patients asked for the button, they didn’t actually express any pleasure when they pressed it.

KENT BERRIDGE: They never said, wow, that’s nice, or whewf. They didn’t say those things that they could have said with pleasure. And he asked, why didn’t they say these things?

CAROL SUTTON LEWIS: Fast forward to the 1980s. Kent Berridge was a new assistant professor at the University of Michigan, studying pleasure in rats. He’d give them food, see if they were enjoying it. Which is kind of a funny thing. I mean, how do you tell if a rat is enjoying its food? 

[music stops]

KATIE HAFNER: I know when a rat’s enjoying its food. I used to have a pet rat named Peanut Butter and yeah, and you could really- you knew when Peanut Butter was happy with it- his food- her. Peanut Butter was a woman rat. Anyway.

CAROL SUTTON LEWIS: Well, in a human baby, you can tell from its facial expressions.

KENT BERRIDGE: -by maybe just giving the infant just a little taste of the food and seeing what the infant does. Does it sort of smile and lick its lips, the baby, or does it kind of gape and shake its head and not like the food? And it turns out that even rats—they will show facial expressions too to sugar, like licking their lips or to bitterness, like gaping.

KATIE HAFNER: Told you!

CAROL SUTTON LEWIS: Well, there you go! So back to Kent Berridge. Kent teamed up with two other researchers to understand how dopamine affected that pleasure. This was one of the most important discoveries in the field of addiction since Marie’s time—that dopamine was the neurotransmitter involved in pleasure—or so it seemed.

KENT BERRIDGE: So a rat who’s lost its dopamine, it just sits there. Um, it’ll never spontaneously eat. It’ll never spontaneously drink, even if it’s getting hungry and thirsty. It’ll just sit there. The usual interpretation of the time was they didn’t want food, they didn’t want anything because they probably didn’t like anything

KATIE HAFNER: So what would happen if they didn’t have dopamine? Kent and his colleague’s prediction was straightforward: if you give rats dopamine blockers or kill the dopamine-producing neurons in their brain, and then you give them sugar, they won’t enjoy the sugar. But when they ran the experiment, no effect. The rats would show the same positive facial expressions. But they didn’t seem to pursue it. They’d just sit there and let the sugar come to them. It was like they liked it, but they had no motivation to actually get it. 

KENT BERRIDGE:  That was the beginning of our sort of revised hypothesis that maybe dopamine isn’t so important to the actual pleasure liking of rewards, but it is important to translate liking into the wanting for that same reward.

KATIE HAFNER: So this is the key thing Kent found. Dopamine appeared to mediate wanting, not liking. And wanting and liking were separate things. It’s a strange thing to wrap your head around this, I know. Usually we want things because we like them, and we don’t want things we don’t like. 

This echoed something that Marie and her colleagues at Rockefeller had noticed in their interviews with patients. Sometimes the patients would say they didn’t even enjoy heroin that much anymore. But even so, they had this powerful urge to take it. Which reinforces this idea that liking and wanting weren’t the same thing.

So if addiction isn’t about pleasure, what is it about? One potential explanation for addiction is that it’s not about feeling good. It’s actually about escaping bad feelings, avoiding pain. That was the dominant theory in the 1980s, that addiction was driven by the agony of withdrawal.

KENT BERRIDGE: Of course, the logic of methadone treatment is precisely to remove that withdrawal distress. And that was a- a compelling explanation except that of course it is well known that lots of people who are addicted can go through detox programs, where they come through withdrawal, they come out of withdrawal, they come back into the world, and yet many of them are still very, very vulnerable to relapsing again, even if there’s not particular distress in their life at that time. So what’s happening there?

CAROL SUTTON LEWIS: In the early 90s, after more experiments, Kent and his colleague, Terry Robinson came up with an alternative—and almost unpronounceable—explanation. They called it the incentive sensitization theory of addiction. The idea was that there’s a change that happens in some people’s brains, after they take drugs. Their brains start to release more and more dopamine whenever they encounter those drugs, or cues that they’re about to get those drugs, triggering more of the craving each time. It doesn’t necessarily affect whether they like the drugs. That pleasure can stay the same or diminish, but their desire for them goes into overdrive. Now, this doesn’t happen to everyone. For example, 70% of people who try cocaine don’t become addicted long-term. And we’ve identified factors that make some people especially vulnerable, like genetics, major life stresses…

Kent’s theory actually sounds a lot like Vincent and Marie’s old theory from the 60s, the so-called “metabolic theory.” Though for Vince and Marie, it was just the basic scaffolding of a theory. They had none of the modern neuroscientific evidence to back up these ideas. By the time Kent Berridge was doing his work in the 80s and 90s, he knew about dopamine, where and when it was released in the brain, and how it corresponded to behavior.

And today, we understand even more. We have brain imaging technologies. We know which brain receptors are activated by each kind of drug and in which neurons. We have both pharmacological and psychotherapeutic interventions, and we know which interventions work best for nicotine versus alcohol versus other drug addictions. Scientists are even developing vaccines that block the action of some drugs, including opioids.  But even with all this, we still haven’t found a cure for addiction.

JENEEN INTERLANDI: Cure, I think is the wrong way to think about it. 

KATIE HAFNER: Jeneen Interlandi is a staff writer at the New York Times Magazine. She covers public health.

JENEEN INTERLANDI: Think about a chronic condition and like what if we just said addiction was a chronic condition? Nothing that we do makes sense if we think of it as a chronic condition, right? When you think of somebody that has diabetes, it’s not like the goal is to graduate from insulin therapy, so you don’t need insulin therapy anymore. You think about ongoing care, you think about peaks and valleys, you think about helping the person stay alive, live stably, and be able to sustain their well-being even though they have this underlying condition that they’re gonna have to deal with on and off for the rest of their life.

KATIE HAFNER: Obviously, an actual cure would be fantastic for someone with diabetes, but that’s a job for scientists. We don’t tell patients, hey, when are you going to quit that insulin? Why can’t you make it without insulin? But people treat addiction differently.

JENEEN INTERLANDI: When you think of addiction, we say, we know it’s a chronic illness, but we still expect people to recover from it forever and ever. And when you frame it that way for the person who’s struggling with it, then every relapse becomes a failure instead of just part of their condition, right?

Having said that, long-term sobriety is much more possible than I think a lot of people have been conditioned to believe. So it’s like, yes, you’re gonna relapse. The average person, I think, relapses six or seven times when it’s opioid use disorder before they achieve long-term sobriety. So it’s not that you should say long-term sobriety is not a reality, it’s something that can never happen. But I think you have to stop thinking of that as the goal. You have to think of as much stability as we can manage, as much stability as we can achieve with the understanding that you’re going to have these peaks and valleys. 

KATIE HAFNER: And then there are people who can’t seem to achieve sobriety, even when they really want to, whether it’s something about their genetics, their circumstances, or something else. So in the absence of cures, we have to turn to whatever treatments exist. And when it comes to opioid addiction, for almost 60 years, we’ve turned to Marie Nyswander’s treatment, methadone maintenance. But it hasn’t worked out exactly as she had hoped.

======= BREAK=====

SORAYA AZARI: Everything’s getting started. Do you guys want to take the stairs or do you want to take the elevator?

KATIE HAFNER: One morning early this spring, I met Soraya Azari at Zuckerberg San Francisco General hospital. It’s a public hospital affiliated with the University of California, San Francisco. Soraya’s a doctor and associate clinical professor in the Department of Medicine at UCSF. I should say that my husband, Bob Wachter, is the chair of the department and actually Soraya’s boss. Just by way of full disclosure. Anyway, on this day, Soraya is taking us up to Ward 93–the opiate treatment outpatient program. 

SORAYA AZARI: The classic thing to do with the elevator is to actually time it. This is known for being a very slow elevator, and this is a source of consternation for people waiting to get upstairs to, uh, get their medication. I’ll tell you, when it finally comes to get us, how many minutes it takes us

KATIE HAFNER (off-mic): It takes minutes?

SORAYA AZARI: It’s pretty slow. (fades)

KATIE HAFNER: When we finally reach Ward 93, it’s bustling. Patients approach the window and drink methadone from a plastic cup, along with some juice and snacks.

NURSE: You want some snacks? Mm-hmm.  Graham crackers? Apple Juice?

KATIE HAFNER: And they actually have to stand there and drink it as the nurse, behind the window is watching.

NURSE: Can toss that cup in the trash. All right, have a good one. 

PATIENT: Thank you. 

NURSE: Hi.

KATIE HAFNER: If you have an opioid use disorder, you cannot get a prescription for methadone, you know, where you go to a pharmacy and pick up your medication like any other drug. You can only have it directly dispensed to you. So typically, patients have to come to the clinic and take it under supervision. But if a patient has been in the program for a while, they can get take-home privileges, like this one patient Soraya met with the day we came.

KATIE HAFNER: Is it every day? Do you have to come in-

PATIENT: No, I only come Monday, Wednesday, Friday. I would like to get that reduced to more take-homes. 

KATIE HAFNER: We were actually sitting in Sariah’s office when she met with this patient and she was giving them a lot of encouragement for doing as well as they’re doing. And this patient explained to us that right now they can come on a Monday, get a bottle of methadone to take it home on Tuesday, then come back to the clinic Wednesday. But they used to come to the clinic every single day.

PATIENT: It took, like, forever to get even, like, weekend take-homes. 

SORAYA: Totally. What’d it feel like to, like, have to come every single day?

PATIENT: Oh, it sucked.

KATIE HAFNER: All of that was before the pandemic hit. Soraya explains:

SORAYA: So it used to be that we had really high standards for getting any take home bottles, including very long times in treatment, and then complete sobriety based on urine toxicology results, and then evidence of rehabilitation, like getting a job or having some dramatic change in your life. There were a lot of really high thresholds, and now that changed with Covid for good. 

KATIE HAFNER: Then Soraya turns to the patient.

SORAYA: You’re such a good example of that, like you are doing great. You don’t miss, and you have some freedom to not be here every single day 

KATIE HAFNER: With the Covid pandemic, federal regulations were relaxed for the first time, temporarily. More and more people could get take-home supplies of methadone, so they didn’t have to come to the clinic every day. That made some people nervous—what if that methadone was diverted for illicit use? What if people took too much and overdosed? It’s been disputed whether the data bears out these concerns. Some studies found there was little or no effect of the new policy on overdoses. But at least one recent study found there was an increase. And a review in the Lancet concluded there were some risks in relaxing methadone policies, but they had to be weighed against the benefits. And for people like this patient, it’s a tremendous relief.

PATIENT: It was, like, pretty quick to get take-homes this time. Like, I got them first over Christmas, so very exciting.

KATIE HAFNER: Soraya tells us there was a time her patient was sick and almost died-

SORAYA: But now, you’re working, you’re, like, getting your health conditions taken care of, uh, so from this vantage point, you’re looking pretty amazing. 

[both laugh]

PATIENT: Thank you.

SORAYA: So, um, uh, this is, uh, just one last thing for us to do. [fades]

KATIE HAFNER: As I said, my husband Bob is Soraya’s boss, so I can’t call myself a strictly independent observer here, but I was very impressed. When Soraya meets a patient, she’s not just looking at how they’re doing on methadone. She’s also looking at their overall health, checking in on any chronic conditions and making sure they’re connected to care. The clinic also has psychiatrists on staff for patients with severe mental illness. It’s a classic holistic approach, and all of this is essential for a good life—and for a methadone program to work! For example, if you’re suffering from untreated hepatitis C or schizophrenia, how are you going to make it to a clinic every morning at 7 am?

In a lot of ways, this is exactly what Marie would have wanted, a clinic that looks after the entire person, that treats patients like people. But not all treatment programs run this way. Across the country, most are private, and more than half are for-profit. On top of that, private equity is getting into the methadone clinic business in a big way, making it more and more about the bottom line. Holistic schmolistic as far as they’re concerned.

BRUCE TRIGG: And uh, what we’ve seen unfortunately in, in many situations is that even non-for-profits are essentially driven by the same market forces, and they act like for-profits. 

CAROL SUTTON LEWIS: Bruce Trigg is a doctor and addiction medicine specialist who worked with the New Mexico Department of Health for 26 years.

BRUCE TRIGG: they would only hire physicians to work part-time, very part-time maybe. Why is that? Maybe one or two half days a week. Because physicians are higher cost than the counselors who were, who were incredibly underpaid, and the nurses and the other people who ran the clinic. That’s what you get. You get what you pay for.

CAROL SUTTON LEWIS: So clearly a lot of clinics have issues, but an equally big problem? We don’t have ENOUGH clinics. According to a 2019 Congressional Research Service report, only 20% of counties nationwide have opioid treatment programs.

JENEEN INTERLANDI: So lots of people have to travel really far to get to the methadone clinic. 

KATIE HAFNER: That’s Jeneen Interlandi again, the New York Times writer. She says sometimes people have to travel hours to get to their nearest clinic.

JENEEN INTERLANDI: And if you are a single mom who is just trying to hold onto a job and trying to live stably, and you’re recovering from something like addiction, imagine how hard that is to have to do that every day, right, so we’re setting these people up for failure

CAROL SUTTON LEWIS: And really, no one’s happy about this situation. In East Harlem, for example, where Marie started her work, there’s a high concentration of drug treatment facilities.

JENEEN INTERLANDI: All of these people with substance use disorders are coming from outside of East Harlem into East Harlem to get their methadone. That creates a draw for drug dealers. It makes that space a very dangerous space because you have lots of people coming to get methadone treatment. And it’s dangerous for them because the- the drug dealers are out there preying on them, like right on that street. 

What’s the solution to that? Have more methadone clinics so everybody doesn’t have to come to East Harlem. You know, East Harlem isn’t wrong to not want that there, but it’s also not the choice of the, the people with substance use disorder, that they all wanna go to East Harlem to get their methadone. They- they probably don’t.

KATIE HAFNER: Can I jump in here, Carol, and just say that I, this is so sad to me because it’s- it’s what Marie for, was methadone clinics, but then look what it did to East Harlem, which she felt so

CAROL SUTTON LEWIS: Yeah, you know, it’s a- it’s a tough situation because neighborhoods that are filled with methadone clinics, even if you can understand objectively that a lot of people are getting the help they need, it’s not always easy, as Jeneen says, to live in a place where so many people with addictions are coming in, and you know, just crowding around these clinics.

KATIE HAFNER: And Marie and Vince were already seeing these problems in the early days. They published a paper in 1976, and I’m just going to read you this bit: “to succeed in bringing disadvantaged addicts to a productive way of life, a treatment program must enable its patients to feel pride and hope and to accept responsibility. This is often not achieved in present-day treatment programs. Without mutual respect, an adversary relationship develops between patients and staff, reinforced by arbitrary rules and the indifference of persons in authority. Patients held in contempt by the staff continue to act like addicts, and the overcrowded facility becomes a public nuisance. Understandably, methadone maintenance programs today have little appeal to the communities or to the majority of heroin addicts on the streets.” 

CAROL SUTTON LEWIS: But now, in 2023, change is afoot. As Soraya Azari at UCSF mentioned earlier, rules were relaxed during Covid, making it easier, for example, for patients to get their methadone without visiting a clinic every day. And the Biden administration is proposing to make those changes permanent. Back in June, Biden’s current drug czar, Rahul Gupta, spoke at a congressional hearing:

RAHUL GUPTA: Thank you, Madam Chairman- Chairman We have had significant progress made, in fact, that now there are telehealth provisions that allow the providers to treat, um, addiction across the country, especially in rural areas, underserved communities, and behind the walls.

CAROL SUTTON LEWIS: He went on to explain how they’d provided mobile vans for methadone, and more take-home methadone. And all of this would probably make Marie Nyswander very happy. But at this meeting, a question came up that plagued Marie from the start.

STEPHEN LYNCH: I appreciate that, doctor. I really do. But I’m just telling you, I’m trying to give you a little feedback. It’s not working where I am, it’s not working in the eighth congressional district of Massachusetts.

CAROL SUTTON LEWIS: Stephen Lynch, a Democrat from the Boston area, went on to describe some of the problems his district was having with opioid treatment programs.

STEPHEN LYNCH: I’ve got tent cities. I got hundreds and hundreds and hundreds of people all together right, right next to the suboxone clinic, right next to the methadone clinic that, uh, are shooting up and you know, they’re shooting up five or six times a day. And, uh, you know, it’s just a- a very bad situation. 

CAROL SUTTON LEWIS: And he wanted to know—what about the other solution? What about abstinence?

STEPHEN LYNCH: We seem to have gone from a policy where we tried to get people clean and sober to a policy where we now try to get them off one drug and put them on another drug.

CAROL SUTTON LEWIS: It’s that core argument that won’t go away: what is recovery? If drug addiction is the problem, is getting off drugs recovery? Or can it look like something else? And there was one particular story that’s stayed with me.

RUTH POTEE: You know, one day I was sitting with an older woman, she was a grandmother, and I was asking her, she’d been on methadone for a year, and I said, tell me- tell me about your life now. 

CAROL SUTTON LEWIS: Ruth Potee is an addiction medicine doctor who works in Western Massachusetts.

RUTH POTEE: She said, I still use sometimes, but I went to the ATM the other day, and I had money in my account. I actually had money. I took it out with my card and I went to the store, and I bought my grandkids back-to-school clothes. And she started to cry, and I started to cry. And she said, in the old days i.e over a year ago, I would go to the ATM machine and I would withdraw all the money, and I would give it to my drug dealer, and that was what my life was like. I worked so hard. She cleans hotel rooms at a local hotel, and all of her money was gone the minute it was deposited. So that’s her recovery. And so do I sit there and say I’m mad at you ‘cause you still use sometimes? Absolutely not. Our goal is to get people to have control of their lives again. 

KATIE HAFNER: And for Soraya Azari in San Francisco, it’s these kinds of transformations that make her work feel important.

SORAYA AZARI: I think that you have the opportunity to really partner with a person and witness the most profound thing in the world, which is change, right? So I watch people change their lives every day. How often do you get to see that? I mean, I, I, you know, it’s- it is sort of profound. It’s sort of magical. And to see people overcome incredible odds and make those changes is, like, even more, awe-inspiring.

KATIE HAFNER: Soraya told me she wishes she could prescribe what she calls a social medicine polypill. A polypill is a real thing; it’s an all-in-one pill to treat common illnesses like heart disease and high blood pressure. Soraya said the social equivalent of this would not be a literal pill, but a one-stop shop where, together with drugs like Methadone and buprenorphine, people could also address their social needs, things like housing and food and safety. 

While Soraya was saying this, I thought of Marie and her own holistic view of her patients, and Soraya’s comment about seeing people overcome tremendous odds made me think of something Marie said to David Courtwright 42 years ago. In the final minutes of their interview, David Courtwright asked Marie if she had any regrets.

MARIE NYSWANDER: No, nothing. Uh, I think it’s just been one of the most fortunate things that ever happened. As a doctor, you have to work with some group of patients and I can’t tell you what a rewarding group of patients these are. Anybody who’s worked with them will say the same thing. This isn’t just me. Um, it’s just a very rewarding group of people and they’re so brave and there’s magnitude of change, As I said before, there’s nothing like it. And requires very little work. I think I must be lazy because they mainly do it themselves.

CAROL SUTTON LEWIS: If we’re looking at Marie and we’re looking at the arc of her life, there’s some things that we can draw inspiration from. She started out as this Park Avenue psychiatrist, and she saw people suffering, and she pretty much changed the whole trajectory of her career to figure out how she could be helpful. And she was deeply helpful in that she pushed all the opportunities to figure out how to make things better, she dove into the science, and she came up with a solution, while not the perfect solution, it was a solution that helped so many people and continues to help people. The- the truth of the matter as well though is that drug addiction is complicated and difficult, and there is no one answer.

KATIE HAFNER:  Marie was a huge figure in her time. She was the subject of a sprawling, two-part New Yorker profile, and she made a huge, huge, huge mark. So why are we profiling her on Lost Women of Science? Because now, nobody knows her name. Uh, I mean, a few people do, but those are people who either are much older or specialize in addiction medicine. Otherwise ask anybody, do you know who Maria Nyswander was, and you get a completely blank look. And that pisses me off. And I, I’m a little sick of being pissed off. So what can we do for her? What we can do for her is tell this story.

CAROL SUTTON LEWIS: Yes, notwithstanding all the complications of Marie, what’s clear is that she helped a lot of people, and she had a huge impact, and people should know her name.

KATIE HAFNER: And can I just, uh, give a tip of the hat to Vince here? Her husband, who not only supported her, but always made sure that her name came first in things. This came up at her memorial.

SPEAKER: In 1983, another award was given to Vince and Marie, the first Dole-Nyswander Award, given by the New York State Division of Substance Abuse Services in the Urban Coalition. Vince, on accepting the award, immediately changed the name to the Nyswander-Dole Award, and very appropriately so. 

KATIE HAFNER: Now, we normally don’t do this at Lost Women of Science- is give the husband the last word, but in this case, I think it’s totally appropriate. At the memorial service for her, he got up and spoke- 

VINCENT DOLE: She’s alive in my heart, and as usual, her plan is to have me do the talking. And if she were here, she’d be sitting with the staff up in the upper tier trying to be inconspicuous, but feeling very deeply the, uh, warmth and the love that’s expressed here.

KATIE HAFNER: He talked about her unusual ability to relate to everybody no matter what their station. She saw the inner person and the struggles that all of this gave her an immense compassion, compassion without sentimentality, and then he said this:

VINCENT DOLE: She frequently said when we talked about one or another clinical problem, to live a full life is not a small thing. And I think if there’s one word that I would leave identified with her is the very same thing. It’s not a small thing. Thank you. (applause)

Credits:

CAROL SUTTON LEWIS: The Lost Women of Science podcast is hosted by me, Carol Sutton Lewis.

KATIE HAFNER: -and me, Katie Hafner. This episode was produced by Elah Feder, our senior producer and Zoe Kurland with help from Alexa Lim and Mackenzie Tatannani. All of our music is by Lizzy Younan. D Peterschmidt mixed and designed the sound for this episode. 

CAROL SUTTON LEWIS: Once again, a very big thank you to everyone on the Lost Women of Science Team who helped make this season happen.

KATIE HAFNER: Yes, and there were many! We can’t name everyone, but we want to give a shout out to Nora Mathison, Mike Fung, Janice Fung, Dominique Janee, Jeannie Stivers, Eowyn Burtner, and Bob Wachter. We also want to thank all the fantastic people who spoke to us whose voices you didn’t hear, but who really helped inform the podcast: Nick Rosenlicht, Damon Harris, Nick Voyles, Marty Wunsch, Lawrence Brown, and Nora Volkow.  

CAROL SUTTON LEWIS: And David Courtwright. So much of the archival audio we heard is from the incredible Addicts Who Survived oral history collection.

KATIE HAFNER: We are incredibly grateful for our publishing partner, Scientific American, and especially to Jeff DelViscio, Chief Multimedia Editor, who has been supporting us and giving us notes every step of the way. 

We are funded in part by the Alfred P. Sloan Foundation, and Schmidt Futures. Our podcast is distributed by PRX. And as always, I would like to thank my co-executive producer at Lost Women of Science, Amy Scharf.

CAROL SUTTON LEWIS: For show notes and more about the whole team that makes this show happen, visit lost women of science dot org. 

KATIE HAFNER: And a head’s up, we’re already working on our next season and lots of shorts, but in the meantime leave us a review, tell all your friends, tell just as many total strangers, and send us suggestions for scientists you want us to cover! Contact us through our website, lostwomenofscience.org

Further reading/listening

Episode Guests

Kent Berridge is a professor of psychology and neuroscience at the University of Michigan 

Jeneen Interlandi is a member of the New York Times editorial board and a staff writer at The New York Times Magazine.

Soraya Azari is a clinician educator at the Zuckerberg San Francisco General Hospital and Trauma Center and an associate professor of general internal medicine at the University of California, San Francisco.

Bruce Trigg is a public health physician who worked at the New Mexico Department of Health for over two decades.  

Ruth Potee is an addiction medicine doctor and family doctor in Massachusetts.



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