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Opinion: What we can learn in the ‘era of cognitive challenges,’ when politicians and celebrities suffer from brain disorders

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Opinion: What we can learn in the ‘era of cognitive challenges,’ when politicians and celebrities suffer from brain disorders

Rock Hudson’s death in 1985 from AIDS started a robust and overdue public discussion about the disease. Until then, despite pleas from those in the most affected communities, AIDS had been in the shadows.

A decade later when Ronald and Nancy Reagan announced that the former president suffered from Alzheimer’s disease and would recede from public life, the result was similar: Suddenly a degenerative illness that had once been discussed in hushed tones, that for some had carried an unfair sheen of shame, was in the spotlight.

Today, as baby boomers reach senior citizenship and as diagnostics improve, we live in what you could call the Era of Cognitive Challenges. Again and again, politicians, actors and other public personalities wrestle visibly with brain disorders of varying levels of severity.

While there are many examples, even collectively they aren’t sparking productive conversations such as those after Hudson’s death and Reagan’s disclosure. When a brain disorder appears to manifest in the news — for instance the presidential front-runners misspeaking or Sen. Mitch McConnell (R-Ky.) freezing in front of news cameras — the medical community and the news media are broadly failing to advance the public’s understanding of these impairments and available treatments.

Such information could aid millions of people who are (or should be) diagnosed with the same diseases. Opportunities are being squandered to educate the world on highly complex conditions that many of us will one day face.

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The public saw 81-year-old McConnell freeze on camera this summer — not once, but twice. The Capitol physician, Brian P. Monahan, blew a golden teachable moment when he announced that the minority leader showed “no evidence” of having experienced a stroke or seizure and was cleared to return to work. That was it. Few suspicions were allayed. No useful information was conveyed. How did that serve the public?

I did not examine McConnell personally, but even from the video clips it is clear to me what happened. He experienced a type of seizure resembling a “petit mal” that occurs from time to time in older people. In fact, about 6% of the older population will experience seizures at one point or another.

It is eminently treatable if sufferers will only seek help. The right prescription will reduce these spells or even clear them up within days to weeks. Anyone going through what McConnell showed probably should receive such treatment and be barred from driving for at least 90 days while the drugs have a chance to do their work. Otherwise he is perfectly capable of doing his job.

Untold numbers of older Americans enduring similar lapses would also be capable of continuing their normal lives if they received a diagnosis and appropriate treatment. Far too many are going untreated because we aren’t having the conversations: We don’t know whether McConnell is allowed to drive. We don’t know whether he’s on anti-seizure medications.

Similarly, after then-Lt. Gov. John Fetterman of Pennsylvania suffered a stroke while running for the Senate, he disclosed little. He could have been more upfront, rather than acting as though the stroke and subsequent cognitive differences were embarrassing — but hey, that’s politics.

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He was later treated for severe depression, which he approached with admirable candor when he made the wise choice to be hospitalized. But once again, instead of thoughtful discussions about his physical and mental health challenges, much of the political world seemed more concerned with his Senate attire of hoodies and shorts.

Some physicians and news organizations did their best in these moments to advance understanding and public health, but overall the nation missed much-needed opportunities to improve diagnosis and treatment of common psychiatric and neurological conditions.

One reason many patients are hesitant to discuss cognitive issues, it seems, is that they strike at the heart of who we are, our very personalities, more so than conditions that are thought of as physical. When human lapses are exploited for political points, this stigma is only aggravated — as when President Biden speaks haltingly, or when former President Trump says “Sioux Falls, S.D.,” when he means “Sioux City, Iowa.”

Since actor Bruce Willis’ family announced his cognitive issues in 2022, they have given us a template for how to think and talk about cognitive health. The actor was first diagnosed with primary progressive aphasia, which can be an early harbinger of Alzheimer’s or frontotemporal dementia, which affects speech and the ability to communicate. This brought some attention to the disorder, although much of the public conversation focused on whether the star had been manipulated by producers.

After additional tests, and the disease’s relentless march, Willis is now confirmed to be living with frontotemporal dementia, which can affect a person’s ability to communicate and organize the day, as well as insight into their own illness.

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The actor’s wife, Emma Heming Willis, was recently on “The Today Show” to talk about her husband’s struggle, with an eye toward educating the wider world about frontotemporal dementia. At her side was Susan Dickinson, the chief executive of the Assn. for Frontotemporal Degeneration.

Heming Willis was calm and cool as she discussed what must be a painful time for everyone involved. Because she is sharing her experience, others may receive a diagnosis and treatment — and feel less alone. We can all learn from her act of service.

Keith Vossel is a professor of neurology at UCLA.

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There's a reason you can't stop doomscrolling through L.A.'s fire disaster

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There's a reason you can't stop doomscrolling through L.A.'s fire disaster

Even for those lucky enough to get out in time, or to live outside the evacuation zones, there has been no escape from the fires in the Los Angeles area this week.

There is hardly a vantage point in the city from which flames or plumes of smoke are not visible, nowhere the scent of burning memories can’t reach.

And on our screens — on seemingly every channel and social media feed and text thread and WhatsApp group — an endless carousel of images documents a level of fear, loss and grief that felt unimaginable here as recently as Tuesday morning.

Even in places of physical safety, many in Los Angeles are finding it difficult to look away from the worst of the destruction online.

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“To me it’s more comfortable to doomscroll than to sit and wait,” said Clara Sterling, who evacuated from her home Wednesday. “I would rather know exactly where the fire is going and where it’s headed than not know anything at all.”

A writer and comedian, Sterling is — by her own admission — extremely online. But the nature of this week’s fires make it particularly hard to disengage from news coverage and social media, experts said.

For one, there’s a material difference between scrolling through images of a far-off crisis and staying informed about an active disaster unfolding in your neighborhood, said Casey Fiesler, an associate professor specializing in tech ethics at the University of Colorado Boulder.

“It’s weird to even think of it as ‘doomscrolling,’ ” she said. “When you’re in it, you’re also looking for important information that can be really hard to get.”

When you share an identity with the victims of a traumatic event, you’re more likely both to seek out media coverage of the experience and to feel more distressed by the media you see, said Roxane Cohen Silver, distinguished professor of psychological science at UC Irvine.

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For Los Angeles residents, this week’s fires are affecting the people we identify with most intimately: family, friends and community members. They have consumed places and landmarks that feature prominently in fond memories and regular routines.

The ubiquitous images have also fueled painful memories for those who have lived through similar disasters — a group whose numbers have increased as wildfires have grown more frequent in California, Silver said.

This she knows personally: She evacuated from the Laguna Beach fires in 1993, and began a long-term study of that fire’s survivors days after returning to her home.

“Throughout California, throughout the West, throughout communities that have had wildfire experience, we are particularly primed and sensitized to that news,” she said. “And the more we immerse ourselves in that news, the more likely we are to experience distress.”

Absorption in these images of fire and ash can cause trauma of its own, said Jyoti Mishra, an associate professor of psychiatry at UC San Diego who studied the long-term psychological health of survivors of the 2018 Camp fire.

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The team identified lingering symptoms of post-traumatic stress disorder, depression and anxiety both among survivors who personally experienced fire-related trauma such as injury or property loss, and — to a smaller but still significant degree — among those who indirectly experienced the trauma as witnesses.

“If you’re witnessing [trauma] in the media, happening on the streets that you’ve lived on and walked on, and you can really put yourself in that place, then it can definitely be impactful,” said Mishra, who’s also co-director of the UC Climate Change and Mental Health Council. “Psychology and neuroscience research has shown that images and videos that generate a sense of personal meaning can have deep emotional impacts.”

The emotional pull of the videos and images on social media make it hard to look away, even as many find the information there much harder to trust.

Like many others, Sterling spent a lot of time online during the early days of the COVID-19 pandemic. Back then, Sterling said, the social media environment felt decidedly different.

“This time around I think I feel less informed about what’s going on because there’s been such a big push toward not fact-checking and getting rid of verified accounts,” she said.

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The rise of AI-generated images and photos has added another troubling kink, as Sterling highlighted in a video posted to TikTok early Thursday.

“The Hollywood sign was not on fire last night. Any video or photos that you saw of the Hollywood sign on fire were fake. They were AI generated,” she said, posting from a hotel in San Diego after evacuating.

Hunter Ditch, a producer and voice actor in Lake Balboa, raised similar concerns about the lack of accurate information. Some social media content she’s encountered seemed “very polarizing” or political, and some exaggerated the scope of the disaster or featured complete fabrications, such as that flaming Hollywood sign.

The spread of false information has added another layer of stress, she said. This week, she started turning to other types of app — like the disaster mapping app, Watch Duty — to track the spreading fires and changing evacuation zones.

But that made her wonder: “If I have to check a whole other app for accurate information, then what am I even doing on social media at all?”

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Pink Fire Retardant, a Dramatic Wildfire Weapon, Poses Its Own Dangers

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Pink Fire Retardant, a Dramatic Wildfire Weapon, Poses Its Own Dangers

From above the raging flames, these planes can unleash immense tankfuls of bright pink fire retardant in just 20 seconds. They have long been considered vital in the battle against wildfires.

But emerging research has shown that the millions of gallons of retardant sprayed on the landscape to tame wildfires each year come with a toxic burden, because they contain heavy metals and other chemicals that are harmful to human health and the environment.

The toxicity presents a stark dilemma. These tankers and their cargo are a powerful tool for taming deadly blazes. Yet as wildfires intensify and become more frequent in an era of climate change, firefighters are using them more often, and in the process releasing more harmful chemicals into the environment.

Some environmental groups have questioned the retardants’ effectiveness and potential for harm. The efficiency of fire retardant has been hard to measure, because it’s one of a barrage of firefighting tactics deployed in a major fire. After the flames are doused, it’s difficult to assign credit.

The frequency and severity of wildfires has grown in recent years, particularly in the western United States. Scientists have also found that fires across the region have become faster moving in recent decades.

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There are also the longer-term health effects of exposure to wildfire smoke, which can penetrate the lungs and heart, causing disease. A recent global survey of the health effects of air pollution caused by wildfires found that in the United States, exposure to wildfire smoke had increased by 77 percent since 2002. Globally, wildfire smoke has been estimated to be responsible for up to 675,000 premature deaths per year.

Fire retardants add to those health and environmental burdens because they present “a really, really thorny trade-off,” said Daniel McCurry, an assistant professor of civil and environmental engineering at the University of Southern California, who led the recent research on their heavy-metal content.

The United States Forest Service said on Thursday that nine large retardant-spraying planes, as well as 20 water-dropping helicopters, were being deployed to fight the Southern California fires, which have displaced tens of thousands of people. Several “water scooper” amphibious planes, capable of skimming the surface of the sea or other body of water to fill their tanks, are also being used.

Two large DC-10 aircraft, dubbed “Very Large Airtankers” and capable of delivering up to 9,400 gallons of retardant, were also set to join the fleet imminently, said Stanton Florea, a spokesman for the National Interagency Fire Center in Boise, Idaho, which coordinates national wildland firefighting efforts across the West.

Sprayed ahead of the fire, the retardants coat vegetation and prevent oxygen from allowing it to burn, Mr. Florea said. (Red dye is added so firefighters can see the retardant against the landscape.) And the retardant, typically made of salts like ammonium polyphosphate, “lasts longer. It doesn’t evaporate, like dropping water,” he said.

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The new research from Dr. McCurry and his colleagues found, however, that at least four different types of heavy metals in a common type of retardant used by firefighters exceeded California’s requirements for hazardous waste.

Federal data shows that more than 440 million gallons of retardant were applied to federal, state, and private land between 2009 and 2021. Using that figure, the researchers estimated that between 2009 and 2021, more than 400 tons of heavy metals were released into the environment from fire suppression, a third of that in Southern California.

Both the federal government and the retardant’s manufacturer, Perimeter Solutions, have disputed that analysis, saying the researchers had evaluated a different version of the retardant. Dan Green, a spokesman for Perimeter, said retardants used for aerial firefighting had passed “extensive testing to confirm they meet strict standards for aquatic and mammalian safety.”

Still, the findings help explain why concentrations of heavy metals tend to surge in rivers and streams after wildfires, sometimes by hundreds of times. And as scrutiny of fire suppressants has grown, the Forestry Service has set buffer zones surrounding lakes and rivers, though its own data shows retardant still inadvertently drifts into those waters.

In 2022, the environmental nonprofit Forest Service Employees for Environmental Ethics sued the government in federal court in Montana, demanding that the Forest Service obtain a permit under the Clean Water Act to cover accidental spraying into waterways.

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The judge ruled that the agency did indeed need to obtain a permit. But it allowed retardant use to continue to protect lives and property.

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2024 Brought the World to a Dangerous Warming Threshold. Now What?

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2024 Brought the World to a Dangerous Warming Threshold. Now What?

Source: Copernicus/ECMWF

Note: Temperature anomalies relative to 1850-1900 averages.

At the stroke of midnight on Dec. 31, Earth finished up its hottest year in recorded history, scientists said on Friday. The previous hottest year was 2023. And the next one will be upon us before long: By continuing to burn huge amounts of coal, oil and gas, humankind has all but guaranteed it.

The planet’s record-high average temperature last year reflected the weekslong, 104-degree-Fahrenheit spring heat waves that shuttered schools in Bangladesh and India. It reflected the effects of the bathtub-warm ocean waters that supercharged hurricanes in the Gulf of Mexico and cyclones in the Philippines. And it reflected the roasting summer and fall conditions that primed Los Angeles this week for the most destructive wildfires in its history.

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“We are facing a very new climate and new challenges, challenges that our society is not prepared for,” said Carlo Buontempo, director of the Copernicus Climate Change Service, the European Union monitoring agency.

But even within this progression of warmer years and ever-intensifying risks to homes, communities and the environment, 2024 stood out in another unwelcome way. According to Copernicus, it was the first year in which global temperatures averaged more than 1.5 degrees Celsius, or 2.7 degrees Fahrenheit, above those the planet experienced at the start of the industrial age.

For the past decade, the world has sought to avoid crossing this dangerous threshold. Nations enshrined the goal in the 2015 Paris agreement to fight climate change. “Keep 1.5 alive” was the mantra at United Nations summits.

Yet here we are. Global temperatures will fluctuate somewhat, as they always do, which is why scientists often look at warming averaged over longer periods, not just a single year.

But even by that standard, staying below 1.5 degrees looks increasingly unattainable, according to researchers who have run the numbers. Globally, despite hundreds of billions of dollars invested in clean-energy technologies, carbon dioxide emissions hit a record in 2024 and show no signs of dropping.

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One recent study published in the journal Nature concluded that the absolute best humanity can now hope for is around 1.6 degrees of warming. To achieve it, nations would need to start slashing emissions at a pace that would strain political, social and economic feasibility.

But what if we’d started earlier?

“It was guaranteed we’d get to this point where the gap between reality and the trajectory we needed for 1.5 degrees was so big it was ridiculous,” said David Victor, a professor of public policy at the University of California, San Diego.

The question now is what, if anything, should replace 1.5 as a lodestar for nations’ climate aspirations.

“These top-level goals are at best a compass,” Dr. Victor said. “They’re a reminder that if we don’t do more, we’re in for significant climate impacts.”

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The 1.5-degree threshold was never the difference between safety and ruin, between hope and despair. It was a number negotiated by governments trying to answer a big question: What’s the highest global temperature increase — and the associated level of dangers, whether heat waves or wildfires or melting glaciers — that our societies should strive to avoid?

The result, as codified in the Paris agreement, was that nations would aspire to hold warming to “well below” 2 degrees Celsius while “pursuing efforts” to limit it to 1.5 degrees.

Even at the time, some experts called the latter goal unrealistic, because it required such deep and rapid emissions cuts. Still, the United States, the European Union and other governments adopted it as a guidepost for climate policy.

Christoph Bertram, an associate research professor at the University of Maryland’s Center for Global Sustainability, said the urgency of the 1.5 target spurred companies of all kinds — automakers, cement manufacturers, electric utilities — to start thinking hard about what it would mean to zero out their emissions by midcentury. “I do think that has led to some serious action,” Dr. Bertram said.

But the high aspiration of the 1.5 target also exposed deep fault lines among nations.

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China and India never backed the goal, since it required them to curb their use of coal, gas and oil at a pace they said would hamstring their development. Rich countries that were struggling to cut their own emissions began choking off funding in the developing world for fossil-fuel projects that were economically beneficial. Some low-income countries felt it was deeply unfair to ask them to sacrifice for the climate given that it was wealthy nations — and not them — that had produced most of the greenhouse gases now warming the world.

“The 1.5-degree target has created a lot of tension between rich and poor countries,” said Vijaya Ramachandran, director for energy and development at the Breakthrough Institute, an environmental research organization.

Costa Samaras, an environmental-engineering professor at Carnegie Mellon University, compared the warming goals to health officials’ guidelines on, say, cholesterol. “We don’t set health targets on what’s realistic or what’s possible,” Dr. Samaras said. “We say, ‘This is what’s good for you. This is how you’re going to not get sick.’”

“If we were going to say, ‘Well, 1.5 is likely out of the question, let’s put it to 1.75,’ it gives people a false sense of assurance that 1.5 was not that important,” said Dr. Samaras, who helped shape U.S. climate policy from 2021 to 2024 in the White House Office of Science and Technology Policy. “It’s hugely important.”

Scientists convened by the United Nations have concluded that restricting warming to 1.5 degrees instead of 2 would spare tens of millions of people from being exposed to life-threatening heat waves, water shortages and coastal flooding. It might mean the difference between a world that has coral reefs and Arctic sea ice in the summer, and one that doesn’t.

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Each tiny increment of additional warming, whether it’s 1.6 degrees versus 1.5, or 1.7 versus 1.6, increases the risks. “Even if the world overshoots 1.5 degrees, and the chances of this happening are increasing every day, we must keep striving” to bring emissions to zero as soon as possible, said Inger Anderson, the executive director of the United Nations Environment Program.

Officially, the sun has not yet set on the 1.5 target. The Paris agreement remains in force, even as President-elect Donald J. Trump vows to withdraw the United States from it for a second time. At U.N. climate negotiations, talk of 1.5 has become more muted compared with years past. But it has hardly gone away.

“With appropriate measures, 1.5 Celsius is still achievable,” Cedric Schuster, the minister of natural resources and environment for the Pacific island nation of Samoa, said at last year’s summit in Azerbaijan. Countries should “rise to the occasion with new, highly ambitious” policies, he said.

To Dr. Victor of U.C. San Diego, it is strange but all too predictable that governments keep speaking this way about what appears to be an unachievable aim. “No major political leader who wants to be taken seriously on climate wants to stick their neck out and say, ‘1.5 degrees isn’t feasible. Let’s talk about more realistic goals,’” he said.

Still, the world will eventually need to have that discussion, Dr. Victor said. And it’s unclear how it will go.

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“It could be constructive, where we start asking, ‘How much warming are we really in for? And how do we deal with that?’” he said. “Or it could look very toxic, with a bunch of political finger pointing.”

Methodology

The second chart shows pathways for reducing carbon emissions that would have a 66 percent chance of limiting global warming this century to 1.5 degrees Celsius above the preindustrial average.

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