Research from Ohio State


New Scientific Research Shows Cleaning Fentanyl Spills with Household Product Effective

BOWLING GREEN, Ohio — Ohio Attorney General Mike DeWine and Bowling Green State University President Mary Ellen Mazey announced that researchers have determined that household cleaner OxiClean ™ has proven scientifically to be effective in cleaning up fentanyl spills.

Scientists with the Ohio Attorney General’s Center for the Future of Forensic Science and the Chemistry Department at Bowling Green State University performed an experiment with OxiClean Versatile Stain Remover™, a household cleaning product, and certified through instrumental analysis that it can be used effectively to clean up fentanyl spills. The product contains sodium percarbonate, a chemical which, in previous research, had been shown to oxidize and break down fentanyl.

“This new scientific research is great news for Ohio’s first responders, and responders across the nation, as we are all forced to deal with the day-to-day reality of the opioid epidemic,” said Ohio Attorney General Mike DeWine. “This is the kind of research that can make a difference for Ohioans, which we plan to do more of at the Ohio Attorney General’s Center for the Future of Forensic Science, alongside our amazing scientific partners at BGSU.”

The Ohio Attorney General’s Bureau of Criminal Investigation (BCI) sent out this bulletin to more than 900 Ohio law enforcement agencies. The bulletin explains cleanup instructions, including supplies needed and proper protective gear that should be worn.

The research was conducted by Dr. Travis Worst, BGSU instructor of forensic science, and Noah Froelich, a BGSU junior majoring in chemistry and forensic science.

“This project perfectly illustrates what we envisioned when we partnered with the Attorney General to create this center,” said BGSU President Mary Ellen Mazey. “Together, we are providing our faculty and students with tremendous opportunities to conduct valuable research that has real-world benefits for law enforcement.”

“We plan on publishing our research findings, but we wanted to get the word out about our scientific research as quickly as possible to help those who have to clean up this very dangerous substance,” said Dr. Jon Sprague, Director of The Center for the Future of Forensic Science.

First responders with any questions regarding the instructions should call BCI at 855-BCI-OHIO.

Ohio State’s Total Health & Wellness Center to expand services with new federal designation

Center recognized as provider of high-quality preventive and primary health care to patients regardless of ability to pay

COLUMBUS – The Ohio State University Total Health & Wellness Center at University Hospital East has qualified to provide expanded primary care services to patients regardless of their ability to pay after receiving a significant federal designation.

The Total Health & Wellness Center (THW), established in late 2012 as Ohio State’s first health practice to be run entirely by nurses, has been awarded Federal Qualified Health Center Look-Alike status by the Health Resources and Services Administration Bureau of Primary Health Care. Under this designation, THW is recognized as an organization that provides high-quality preventive and primary health care to patients regardless of their ability to pay.

With Look-Alike designation, THW will receive increased reimbursements, improve access to qualified health care providers, and develop a pharmacy with reduced pricing on prescription and non-prescription medications for patients.

“We are very dedicated to continuing to provide critically needed comprehensive primary care services to optimize health and well-being in our community,” said Bernadette Melnyk, vice president for health promotion and dean, College of Nursing. “Our team approach to care is led by nurse practitioners and includes interprofessional health professionals who are dedicated to providing the best evidence-based physical and mental health care.”

THW is located at University Hospital East and operated by The Ohio State University College of Nursing. Led by Director Candy Rinehart, the center offers a distinctive nurse practitioner-led comprehensive primary care practice with a multidisciplinary team providing an evidence-based approach to integrated physical and mental health care for people across the life span. The staff at the center is composed of family nurse practitioners, psychiatric mental health nurse practitioners and mental health counselors, pharmacists, dietitians and social workers, as well as nursing and other health science students.

“The Total Health and Wellness Center provides timely access to comprehensive health care for our local community for both prevention and chronic disease care,” said THW Board President Carolyn Slack. “The community’s response has been exciting and the practice is growing, primarily by word of mouth. The center and Ohio State are strong assets that our community trusts.”

THW serves neighboring communities in Columbus and Franklin County, including patients covered by commercial insurance, Medicaid or Medicare, and the uninsured. Services include:

  • family practice care to individuals of all ages, including children and adolescents
  • health and wellness screening and education
  • management of new health concerns
  • care and ongoing management of chronic conditions such as diabetes, asthma, heart failure and others
  • routine physical exams, health and wellness screenings and vaccines
  • basic women’s services, including pap smears and birth control, as well as plans to soon provide prenatal care
  • health education to help reach optimal wellness
  • mental health counseling and evidence-based programs for conditions such as depression and anxiety
  • healthy lifestyle programs

The THW is the 50th health center in Ohio to receive FQHC designation, which indicates it meets all of the eligibility requirements of an organization that receives a Public Health Service Section 330 grant, but does not receive grant funding. With this designation, the THW will ensure health care for underserved communities and vulnerable populations.

THW has provided nearly 16,000 patient visits since it was established.

For more information, visit nursing.osu.edu/thw.

Algal blooms cost Ohio homeowners $152 million over six years

Property values fall, as do fishing license sales, two studies find

COLUMBUS —In a new study, researchers at The Ohio State University estimate algal blooms at two Ohio lakes cost Ohio homeowners $152 million in lost property value over six years.

Meanwhile, a related study suggests that algae is driving anglers away from Lake Erie, causing fishing license sales to drop at least 10 percent every time a bloom reaches a moderate level of health risk. Based on those numbers, a computer model projects that a severe, summer-long bloom would cause up to $5.6 million in lost fishing revenue and associated expenditures by anglers.

Those are the main findings from the first two studies ever to put a precise dollar value on algae impact, both on Lake Erie and two recreational lakes in Ohio. One study appears in the journal Ecological Economics, and the other in the Journal of Environmental Management.

“Our biggest takeaway is that efforts to prevent and mitigate algal blooms have real, tangible benefits for Ohioans, including property values,” said Allen Klaiber, associate professor of agricultural, environmental and development economics at Ohio State.

In the first study, he and doctoral student David Wolf found that property values near two algae-infested lakes in the state’s interior fell $152 million from 2009 to 2015. Sale prices for homes within one third of a mile of a lake fell 11 to 17 percent during that time, while prices for lake-adjacent homes fell more than 22 percent.

A number of additional factors that influence property values were included in the analysis to ensure that the observed losses in property values were directly attributable to changes in water quality. For example, seasonal trends in the housing market, differences in structural characteristics across homes, and spatially varying provision of public services such as school quality were all controlled for in the analysis.

Most of the losses were felt by residents around Buckeye Lake, just east of Columbus. There, residents collectively lost $101 million in home sales over six years. Grand Lake St. Marys in northwest Ohio felt a smaller but still significant loss of $51 million.

Turning to Lake Erie, the researchers teamed with doctoral student Will Georgic to examine state revenue from sport fishing, which contributes to a $1.7 billion tourism industry. They found that once algae levels reach a “moderate” threshold as described by the World Health Organization (WHO), fishing license sales within 12 miles of Lake Erie dropped 10 to 13 percent.

The researchers further simulated what would happen if a severe algal bloom—similar in extent to the one experienced in 2011 which covered 45 percent of the lake—struck Lake Erie today. In that case, the researchers projected that as many as 3,600 fewer recreational fishing licenses would be sold, and as much as $5.6 million in associated fishing expenditure would be lost in just one summer.

The researchers hope their work will give policymakers the information they need to address algae prevention and cleanup. For instance, the state of Ohio has already invested $26 million to clean up Grand Lake St. Marys, but that amount equals only a little more than half of the lost property value there.

The two studies are part of an ongoing project to gauge not only the costs and benefits of fighting algae, but also the public’s algae tolerance: how much is too much, before people decide to buy homes or go fishing elsewhere?

As it turns out, people have a pretty low tolerance for algae. They devalued a lake property the moment the Ohio EPA announced that the water was unsafe to drink—the lowest warning level by WHO standards—even though the lakes included in the study were recreational and weren’t used for drinking water. They began fishing elsewhere after the warning level rose to “moderate” risk for incidental ingestion of the water. In both cases, higher algae levels didn’t seem to matter.

Wolf summed it up this way: “What seemed to matter most for property value was simply whether the algae levels were perceptible at all, not how bad they got after they became perceptible.”

“People make decisions based on their perceptions, and they get their strongest perception of algae at the beginning, when they first see news stories about the water being unsafe to drink,” Klaiber said. “And that poses a real challenge, because once a lake has an algae problem, it’s really difficult to clean it up enough to make the algae imperceptible again. That’s why we think the biggest ‘bang for the buck’ in regards to state policies would come from preventing algae levels from becoming perceptible in the first place.”

For fishing, aesthetics definitely plays a role. At the “moderate” algae level, water becomes noticeably cloudy. And then there’s the smell.

“People say it smells like sewage or rotten eggs,” Wolf said. “You can’t miss it.”

“These are things that would not contribute positively to the aesthetics of your walleye trip,” Klaiber added.

Ohio is one of the first states to compile this kind of data, because the Ohio EPA set up a special working group in 2008 to take precise measures of algal levels in Lake Erie and all major inland lakes.

Further, Ohio is a “public disclosure” state, meaning that financial information for all property transfers and sales are publicly available. Most Ohio county auditors posts the data on their websites, making it easy for anyone to access.

Klaiber and Wolf stressed that they didn’t collect any information about who owned the houses they studied—just the property values, sale or transfer prices for properties that changed hands during the study period, and the distance from those properties to the affected lakes.

The Nature Conservancy: Elephants Will Have a Say in Mapping Kenya’s Future

Elephant movement data is helping the Kenyan government site big development projects.

If we could all be a bit more “elephant,” there might be fewer of us walking into lampposts as we check Google Maps. Elephants have it all in their heads: complex maps of vast landscapes that include water points, saltpans, and even danger zones. Youngsters learn these routes from their mothers and, in turn, pass it on to their own offspring.

As Kenya pursues national development goals, the maps being drawn by urban planners and businesses could look very different to those of the elephants. Kenya’s “Vision 2030” looks to create a country with a strong economy, world-class transport links, and improved energy infrastructure — where citizens have secure job prospects, and access to good education and healthcare. Development is inevitable, necessary, and happening.

The Kenyan government is increasingly looking for opportunities to achieve this prosperity while minimizing damage to the wildlife and natural resources that are essential to its economy and the livelihoods of its citizens. Could elephants, with their complex mental maps of rivers, forests, and fertile grassland, contribute to smarter growth for Kenya?

With a little help from TNC’s scientists, we can make this happen.

Our partner Save the Elephants has collared and tracked 144 individual elephants in the Samburu region of north Kenya since 1998, providing one of the most comprehensive datasets on elephant movements in any area in Africa.

Save the Elephants is analyzing this data to help define key elephant habitats and the corridors that link them. As well as funding this work, TNC is helping to package this data in a way that can help inform large-scale development. This could make the difference between a new highway cutting off a vital elephant refuge, or being built away from wildlife at a site that opens up business opportunities for a rural Kenyan town.

As Kenya sketches its future, we want to bring elephants to the table.

Kenya’s National Environmental Management Authority (NEMA) has a mandate to ensure all development projects have taken environmental considerations into account. TNC’s new partnership with NEMA, lead by our Director of Smart Growth Anne Trainor, will enable us to use the wealth of data from Save the Elephants and translate it into maps that show elephant routes alongside human settlements and planned infrastructure all in one. This will help NEMA make more informed decisions on where to site future development projects.

This is important because, unlike Google, elephants don’t have route options with less traffic — all they know is straight. A herd will plough through most fences, roads, or farms in their way. This is leading to an increasing number of elephants being killed as people try to protect their livelihoods.

The team from NEMA have chosen a pilot site in Isiolo County, north Kenya, to trial this new use of animal movement data in infrastructure planning. This region is dotted with community conservancies and wildlife reserves, and acts as a vital corridor for thousands of elephants as they move from the fertile slopes of Mt. Kenya to the open grasslands farther north.

It is also the site of a newly built international airport, and marks the beginning of one of the best tarmac roads in the country. There are high levels of interest in this area from the energy, hospitality, and business sectors, and NEMA will be required to balance their complex needs with the integrity of Isiolo’s precious natural resources.

In April, TNC signed a formal agreement with NEMA to move forward with this pilot. The agreement sets out the scope of the spatial mapping work in Isiolo, as well as how TNC will share scientific and technical skills with NEMA staff so that they can capitalize on a host of other available data.

There are multiple NGOs collaring and tracking different animal species across the country, generating a wealth of information just waiting to be tapped. This pilot project has the potential to prove that animal movement data can be a key piece of the puzzle for Kenya’s smart, sustainable development.

Let’s get a bigger table, because the elephants are coming.

The Nature Conservancy is a nonprofit, tax-exempt charitable organization (tax identification number 53-0242652) under Section 501(c)(3) of the Internal Revenue Code. Donations are tax-deductible as allowed by law.

On the darknet, drug buyers aren’t looking for bargains

Trust is vital on drug-dealing sites, and key to disrupting them

COLUMBUS – When drug users go online for the first time to buy opioids, they aren’t looking for the widest selection or the best prices for their illicit purchases, a new study suggests.

Researchers found that first-time drug buyers who visited one marketplace on the “darknet” cared only about finding trustworthy sellers – those who would deliver what they promised and keep the buyers’ identities secret.

“When opioid users are making that first purchase, price doesn’t matter at all,” said Scott Duxbury, lead author of the study and doctoral student in sociology at The Ohio State University.

“If they come back to buy again, price matters a little, but trust remains their primary concern.”

The study also found that while most of this drug-dealing marketplace could be susceptible to crackdowns by law enforcement, the core group of repeat buyers and sellers would be much harder to shut down.

“This core group could be less vulnerable than their real-world counterparts to disruption by law enforcement,” Duxbury said.

Duxbury and Dana Haynie, professor of sociology at Ohio State, conducted the first study to investigate the network structure of an encrypted online drug distribution network, examining the web of connections between buyers and sellers.

“The accessibility and ease of purchasing illegal drugs online opens up a global market where buyers and sellers are no longer constrained by locality and buyers have more options and diversity in product selection,” Haynie said.

They presented their research Aug. 12 in Montreal at the annual meeting of the American Sociological Association and in a paper published recently in the Journal of Quantitative Criminology.

The researchers collected data on all transactions in a six-month period involving opioid dealers on one large drug distribution market, which they called “Cryptomarket.” This market exists on the darknet – a largely hidden part of the web that can be accessed only through Tor, software that allows anonymous transactions and communication.

All the information the researchers collected was available to anyone on Cryptomarket, including usernames for all buyers and sellers and evaluations that sellers and buyers give each other for every transaction. All sellers had reputation scores based on these evaluations, which the researchers used to measure trustworthiness.

The study included 57 sellers and 706 buyers. The researchers found that there were 36 unique communities formed around prolific vendors. The largest community had 146 members.

The overwhelming majority of buyers on Cryptomarket made only one purchase – just 18 percent bought drugs two or more times. But the most enthusiastic buyers made more than 20 purchases during the six-month study.

Duxbury said it is hard to say why most users bought only once. Some may have just been experimenting, or had a bad experience. Some may be making more purchases, but not within the six months covered in this study.

Once buyers found a seller they trusted, they didn’t shop around much, the study found. Only 30 percent of those who bought more than once sought out new vendors.

The fact that most Cryptomarket buyers purchased only from one seller means that the overall network is not very resilient and could be disrupted relatively easily by taking out a few of the most prolific vendors.

“If you eliminate several large sellers, all their buyers are stranded without a seller on the market that they have used before,” Duxbury said.

Another way the researchers measured the resiliency of the Cryptomarket network was by the number of components – a group of buyers and sellers who are connected to each other, but separated from all other groups. More components suggest a more fragmented, weaker network.

The researchers calculated what would happen if they eliminated various combinations of three sellers in the Cryptomarket. In that scenario, the number of components would increase by as much as sevenfold, a major blow to the network’s strength. And the number of buyers alone in the network with no seller they are connected to would increase up to tenfold.

But the core network of sellers and buyers who were involved in more than one transaction (174 of the 763 individuals) would be much more resilient, Duxbury said.

When the researchers eliminated three sellers from this core group, the number of components and the number of buyers with no connected seller both increased by just 30 percent.

“There is less impact on these more highly connected buyers when you take out sellers,” Duxbury said.

“You might have a buyer who has made five purchases from one seller, three from another seller and two from a third one. If you take out one of those sellers, they still have others to go to.”

While officials around the world have made headlines by shutting down darknet drug-selling sites like Silk Road and AlphaBay, Duxbury noted that new sites pop up nearly immediately to replace them.

This study’s results emphasizing the importance of trust may provide the best avenue for at least interrupting the cycle, Duxbury said. Law enforcement should go after the reputation of the sellers, which is easiest when new marketplaces are starting up, he said.

“If officials can find a way to flood a network with bad evaluations when it is first starting, that will make it difficult for buyers to make informed decisions. That could stop markets when they are just beginning,” he said.

But, for now, the results have some troubling implications for the future of illegal drug sales, said Haynie, who is also director of Ohio State’s Criminal Justice Research Center and a member of the university’s Translational Data Analytics Institute.

“With the opioid epidemic underway in the United States and health care professionals limiting the number of opioid-based medications being prescribed, a major concern raised by our study is that more opioid users will turn to the darknet to acquire drugs,” she said.

“We are currently collecting longitudinal data on the online drug market to determine whether this is the case.”

Defenders of Wildlife Announces New Satellite Data Program to Track Wildlife Habitat Loss

By Julia Travers on August 11, 2017

(EnviroNews Nature) — On Aug. 3, 2017, Defenders of Wildlife (Defenders) released a pilot report demonstrating how satellite data, remote sensing and cloud computing can be used to monitor wildlife habitat loss. Defenders’ Center for Conservation Innovation (CCI), which focuses on the use of technology and data in protecting endangered species, relied on figures from NASA and the European Space Agency along with Google Earth Engine to measure habitat disturbances in the range of the lesser prairie chicken (Tympanuchus pallidicinctus). Specifically, the new method detects three forms of habitat disturbance: oil and gas well pads, wind turbines and agricultural conversion.

“Using satellite data to document habitat loss can provide more accurate and up to date information, which is critical for making informed decisions about how to protect and recover these species,” Defenders Conservation Data Specialist Michael Evans told EnviroNews. Evans co-authored the report with Ya-Wei Li.

In a press release, Jamie Rappaport Clark, Defenders President and CEO, states the technique “can even help determine whether developers are complying with their [Endangered Species Act] (ESA) permits, thereby increasing protections for imperiled species and their habitats.” She also described the initiative as “a new and cost-effective way to monitor wildlife habitat.”

In the study, Monitoring Habitat Loss for Endangered Species Using Satellite Data: A Case Study of the Lesser Prairie Chicken, Defenders used algorithms developed in-house to measure habitat disturbance of the lesser prairie chicken between September 2015, when ESA protections for the species were removed, and April 2017. It was determined that more than 258,000 acres of habitat were lost in the species’ ranges within Colorado, Kansas, Oklahoma, New Mexico and Texas. The majority of this loss resulted from agricultural conversion, while the development of oil and well gas pads and wind farms also caused habitat disturbances.

In the release, Defenders “encourages renewable energy developers to identify suitable, wildlife-friendly sites for wind and solar development through its ‘Smart-from-the-Start’ program.” It also calls on the U.S. Fish and Wildlife Service (USFWS) and the National Marine Fisheries Service (NMFS) to embrace “open data and technology” by posting all ESA plans and permits online. Defenders says this transparency would empower it and other stakeholders to monitor the footprints of various projects impacting wildlife habitats and to in turn notify relevant government agencies of violations.

In the future, Defenders plans to launch an online search tool for the remote-sensing and satellite data. Evans explains:

The idea is that someone can choose an area of interest – either a species’ habitat or an area undergoing development – and get notifications in real time when habitat changes are detected… Given the large number of permits and agreements issued annually, a tool that can be used by both the Services and conservation partners to quickly and efficiently detect agreement violations by permittees would be an important step toward ensuring endangered species receive the full benefits of ESA protections.

He adds that making the tool available to the public will enable Defenders to “recruit the public to help the Services identify violations of ESA regulations, and fill important knowledge gaps about the status of habitat for imperiled species.”

Evans says the CCI will be applying this technique to other endangered or imperiled species, including the greater sage grouse (Centrocercus urophasianus), which is threatened by “increasing attempts now to conduct oil and gas leasing in its habitat.” In early August, Department of the Interior Secretary Zinke announced plans to revise the historic 2015 sage grouse conservation plan – a move that has conservationists and stakeholders across the board concerned.

Smartphone tracking shows fear affects where youth spend time

Over an hour less spent each day in areas with fearful residents

COLUMBUS – Youth spend less time in their neighborhoods if area residents have a high fear of crime, according to a new study that used smartphones to track kids’ whereabouts.

Researchers found that adolescents aged 11 to 17 spent over an hour less each day on average in their neighborhoods if residents there were very fearful, compared to kids from areas perceived as being safer. Higher fear of crime was linked to high-poverty neighborhoods.

This is the first study to use smartphone data to track a large, diverse sample of young people to determine where they spend their time, said Christopher Browning, lead author of the study and professor of sociology at The Ohio State University.

“It is clear that kids who live in high-poverty areas are spending less time in their neighborhoods and that is linked to a collective fear of crime,” Browning said.

“This has never been tested before with GPS data that tracks movements on a minute-by-minute basis.”

Browning presented the research Aug. 14 in Montreal at the annual meeting of the American Sociological Association.

This preliminary data is from the Adolescent Health and Development in Context study, which Browning leads. The study is examining the lives of 1,402 representative youths living in 184 neighborhoods in Franklin County, Ohio. This includes the city of Columbus and its suburbs.

In this study, which was conducted April 2014 to July 2016, participating adolescents were given a smartphone that they kept with them for one week. The GPS function on the phone reported their location every 30 seconds.

Overall, results showed youth spent an average of 52 percent of their waking time each day at home, 13 percent in their neighborhoods, and 35 percent outside of their neighborhoods. About 27 percent of the time when they were not at home while awake, they were in their neighborhoods.

All caregivers of youth in the study were asked to rate how afraid they were to walk in their neighborhood.

Results showed that caregivers’ ratings were only weakly connected to how much time their own children spent in the neighborhood. But the collective fear ratings of all the caregivers who lived in or regularly visited a neighborhood was strongly linked to the amount of time kids spent close to home.

“Once enough people stop spending time in a neighborhood because they are afraid, others will withdraw, whether they are afraid or not,” Browning said.

“If teens go to the local playground and there’s no one to play pickup basketball with, they will go outside the neighborhood to find their friends, or spend more time at home.”

The study looked at whether the presence or absence of amenities like schools, community centers and stores could explain why youth in high-poverty neighborhoods spent less time there. But this factor explained little when compared to the collective fear of crime.

“Many cities have social services like recreation centers that are targeted for disadvantaged neighborhoods,” Browning said.

“But our results suggest these amenities may be underutilized because young people are withdrawing from the neighborhood. Whether they are afraid to go there or just following their friends elsewhere, young people spend less time in disadvantaged neighborhoods.”

Upcoming studies using this same data set will examine whether kids in disadvantaged neighborhoods spend their extra time at home, or outside of their area.

Browning, who is a member of Ohio State’s Translational Data Analytics Institute, co-authored the study with Ohio State colleagues Catherine Calder, professor of statistics, and Bethany Boettner, senior research associate at the Institute for Population Research; and Anna Smith, post-doctoral research scientist in statistics at Columbia University.

Ohio State’s Institute for Population Research sponsored and helped support the study. The research was also supported by the National Institute on Drug Abuse, the National Science Foundation and the W.T. Grant Foundation.

Democrats in Congress Explore Creating an Expert Panel on Trump’s Mental Health

There is also a bill aimed at establishing a “commission on presidential capacity”

By Sharon Begley, STAT on August 16, 2017

Scientific American

Three congressional Democrats have asked a psychiatrist at Yale School of Medicine to consult with them about forming an expert panel to offer the legislators advice on assessing President Trump’s mental health.

Yale’s Dr. Bandy Lee told STAT that over the last few weeks members of Congress or their staff have asked her to discuss how members might convene psychiatrists, psychologists, and other mental health professionals “to review the president’s mental health, and review it on a periodic basis.” The closed meeting is expected to take place in September, she said.

The request came from three current congressmen and one former member, she said. She declined to name them, saying they told her they did not wish to be publicly identified yet.

The invitation comes as 27 representatives, all Democrats, have co-sponsored a bill to establish “a commission on presidential capacity.” The commission would carry out a provision of the 25th Amendment, which gives Congress the authority to establish “a body” with the power to declare a president “unable to discharge the powers and duties of his office.” Under the bill, H.R. 1987, eight of the 11 members of the commission would be physicians, including four psychiatrists.

STAT contacted the sponsors’ offices, which either did not respond or declined to comment.

Trump has not released his medical records beyond a brief summary from his physician last year. He has said he never sought or received a mental health evaluation or therapy.

But since his election and, increasingly, his inauguration, a number of mental health experts have spoken or written about what Trump’s behavior and speech suggest about his cognitive and emotional status, including impulsivity and paranoia, with some offering formal diagnoses, such as narcissistic personality disorder.

In a book scheduled for publication in October that was edited by Lee, 27 experts offer their views of what Lee calls “Trump’s mental symptoms,” including his impulsivity, “extreme present focus,” pathological levels of narcissism, and an apparent lack of trust that is a sign of deep paranoia. The book is based on a small meeting Lee organized at Yale in April on whether psychiatrists have a “duty to warn” about any dangers Trump poses because of his psychological make-up.

If members of Congress form an expert panel like the one Lee has been asked to advise on, psychiatrists who participate would be at risk of violating a decades-old ethics rule imposed by the American Psychiatric Association on its members. Called the Goldwater rule, it prohibits APA members from diagnosing the mental health of public figures whom they have not examined. (Sharing such a diagnosis of someone they have examined would, of course, violate a different ethical rule, on patient confidentiality.)

In March, after growing criticism that the Goldwater rule was essentially a gag order that prevented the public from hearing from experts, the APA not only reaffirmed the rule but extended it. Now, in addition to the prohibition against suggesting that someone might (or might not) have a specific mental disorder, APA members are barred from “render[ing] an opinion about the affect, behavior, speech, or other presentation of an individual that draws on the skills, training, expertise, and/or knowledge inherent in the practice of psychiatry.”

While there is an exception for court-ordered evaluations and for consultations even without personally evaluating someone, there is no explicit exception allowing psychiatrists to tell elected officials, in public or in private, their views of a public figure’s mental state. Last month, the American Psychoanalytic Association, another psychiatrists group, sent an email to its members reiterating that they are not bound by the APA’s rule.

Lee, whose academic research focuses on prison reform, recidivism, and the causes of violence, said she “kept with the Goldwater rule’s original conception of refraining from making diagnoses, but speaking to dangerousness and the need for an evaluation.”

The expert panel that Lee was asked to discuss convening would have several members, she said, but it remains to be worked out who would serve, how and by whom they would be chosen, what their mandate would be, and how and when they would offer their opinions to Congress, should the proposal even get off the ground.

Lee and four other psychiatrists sent a letter to all members of the U.S. Senate and House arguing that Trump exhibits “severe emotional impediments that … present a grave threat to international security,” and asking Congress to “take immediate steps to establish a commission to determine his fitness for office.” The letter signers are staunch Trump opponents and believe his presidency should end.

The letter echoed one that Lee and a slightly different group of colleagues sent to Congress in July. The most recent one came in the wake of Trump’s reportedly ad-libbed statement that if North Korea carries through on its nuclear threats, “they will be met with fire and fury and frankly power the likes of which this world has never seen before.” After North Korean leader Kim Jong-Un threatened to bomb the American territory of Guam, Trump said, “Maybe that statement wasn’t tough enough.”

Lee and the other signers of the new letter, including Dr. Lance Dodes, recently retired from Harvard Medical School, argue that Trump’s “alarming patterns of impulsive, reckless, and narcissistic behavior — regardless of diagnosis … put the world at risk,” posing an “imminent danger” that psychiatrists are ethically obligated to warn about.

“The role of honor or, rather, perceived humiliation is often overlooked as a powerful stimulant of international violence,” they write, adding that the “president may not have the capacity to consider an array of possible choices, due to his own emotional needs.” They ask Congress to “take immediate steps to establish a commission to determine his fitness for office.”

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