You will be entered to win a 100 visa gift card. Dr. Sederer will be signing books. This is a free event but helps the festival if youve the books from the speakers little make this festival possible and supports politic and prose, a wonderful, independent book store in the d. C. Area. So if book the book, please. Do okay. So, dr. Loyd sederer is an adjunct professor, a contribute you rite for u. S. News and world report and chief medical officer for the officeMental Health and a regular on in 2013 given an award for excellence in teaching residents about the American Psychiatric association which in 2009 gave him recognized him as psychiatric administrator of the year. His new book the addition solution which is what well be discussing today. Please join me in welcoming dr. Sederer. [applause] thank you for coming. So i like to start with a broad question and to get more specific. The field of addiction and the prevalence of addiction is a moving target and evergrowing and seems intractable sometimes. Why this book and why now . What were you hoping to add to the national conversation. Im a psychiatrist welcome, everybody. Its great to be here. Im honored to be here. Aim a psychiatrist and a Public Health doctor, and in both of those roles, i its my job, if you will to look at how peoples health, ill health and fatalities are ohe curing, in this case in my state, new york, and then throughout the nation. And i had covered a lot of about drugs over the year. Opioids, cannabis, methamphetamine, sin the sick synthetic marijuana and i saw the problem worsening when in fact we have a lot of slices using ask that prompted he a lot of solutions we arent using and i want to say were can get out this epidemic. You mentioned in he book that another interviewer asked you what would be the one piece of advice or change you would make and you said to avoid the Adverse Childhood Experiences that lead people sometimes down the path to addiction. Can you define what ac es or and give some examples. This is a Public Health doctor speaking. Ace, Adverse Childhood Experience are to thers andenses that Young Children have, three, four, five six years old, who are abused, neglected, multiple foster homes, parents in prison, and to or homes with domestic violence, and these accumulate. So theres a score how many Adverse Childhood Experiences that child is exposed so and four or more almost always predict biz the time theyre teenagers theyll have a variety of Mental Health problems, going to be obese, have diabetes, smoke, and to teenage pregnancy as well as addictions. So, one of the interventions that could make a difference with large numbers of children these are not infrequent ocurrents is to intervene, help families to better prevent the problems that are inescapable to them. To prevent those you would think it would require somebody detecting them. So, outside of the healthcare system, who should be on the lookout for the aces. Teachers or any concernedover adult . Who are the gate keepers. What a great question inch my day job with new york state i introduced a variety of screening tech nicks, example, for depression, substance abuse, and tarted the march toward trying to require speedattic practices, family practices, and schools, to screen for these Adverse Childhood Experiences, because were all socialized to screen. When you good to a doctor, you get a number, right . You get your weight, get your pulse, you get your Blood Pressure, you get your lipid levels, sugar levels, and all socialized to think, what is normal, what is not normal. So if you quantify a problem, it gets attention, and it is more likely that people will attend to it, and so thats the idea, which is in schools and in setting where, primary in care settingsing to scene for this and then link the families to services in the community which ares a metedly very sparse but never build until the demand occurs. Thats my view. Do you fine that pediatricians and schools are recep tonight this ideas in are they wellogy do this or just one more thing . Theyre actually quite different. Pediatricians recognize the problems problems problems and have published white papers not supporting the screening because they feel its not Good Services so its they can be trouble for doctor to identify a problem and not have a way of solving it. Schools on the other hand are mostly quite phobic but identify ing problems because theyre resources are limited. Something you wrote surprised my when you talked about 12 ten programs and na and aa. Theyre so ubiquitous, seem to be the Gold Standard and yet their success rate is incredibly one, one in 10 to one in 20 is success rate. Why is it the Gold Standard remain the Gold Standard. Something i learned recently from a colleague is that attendance also aa meetings has not increased in 40 years. Thats so maybe some of that is a reflection of our inaccessity but seem to be everywhere but few people respond to it. Aa these, recovery programs are good thing but not sufficient, and that is my one thing really try to message to you people, and to through the book, collision that you need to combine interventions with a complex problem. Its just as true with diabetes or heart disease, one intervention of medication alone is not enough. You have to combine recovery with medication, with therapy, with Family Support and get its much more likely someone will get better. In the research or data on the kind of person who is recep tonight a 12step program . A type of person who will installly benefit more from this type of program. Not Good Research base its anonymous. And its hard to track people in these programs, but you can appreciate that those people who have spiritual core to them, who believe that spiritual being taken being recognizing that spiritual presence and the a higher power will make a difference, theyre much more apt to respond to aa and na, gambling anonymous and so forth. What i read is that spiritual doesnt really mean religious. Yes, thats often confused. He see myself as a spiritual person who does not follow a religion. Spiritual to me means that we think that there is a high are power, that there is a sense of connectedness, of continuity in life, and i think thats to me closer to what spiritual means. You had referenced the multifacetted approach to treatment and why thats so important. One thing you pointed out is being the standard of universality is the motivational interviewing, or mi. Can you explain what that and is what it looks like. Yes. So, imagine a mother who comes to her pete trix, bringing her child we pediatrics with her child who has earaches and the pediatrics uncovers that the mother is a smoker and smoking is associated with ear infections and the doctor starts to berate the mother. Dont you know that smoking is related, probably causing your childs earaches and shes trying to get out of the office. Thats know motivational interviewing. Motivational interviewing is understanding, youre a single mom, a lot of stress on you. I see that you smoke. How is that helpful to you . And what when do you spoke . Why do you smoke . And so she is the doctor is siding with the person and recognizing that tobacco use or opioid use, cannabis use, is serving a person. Thats the premise. Behavior serves a purpose. Hey not be very good. The best that someone has and motivational interviewing is getting behind, appreciating that somebody is doing something that seems to destructive but its useful to them and when you do that, thats how people begin to then feel more trustworthy and more able to say, well, wait a minute, its not that its so helpful to me and thats the tourneying point. Dogs that give you a sense of motivational interviewing. It does but i read the book. I already know. Guess like in the scenario with the pediatrician, almost like the doctor is planting the seed in the parent and they hopefully take ohm take home and act on. How do you quantify the success of motivational interviewing and you may not see the result . A good. We its hard to do research on Program Interventions where youre trying to train a group of pediatricians or primary care doctors other doctors to use this approach. Theres no funding foris, and its hard to track actually where it made a difference as opposed to maybe something else. They got housing or Something Like that. So its very hard, but experientially, manning many doctors and many people say this makes a differs and its goes back many, many years and first used with addictions and now used with a variety of behavioral problems like eating too much. Smoking, sedentary lifestyle, as a way of helping somebody get on the other side of what is a problem behavior. Another thing you mentioned, another part over the multifaceted approach, theres Promising Research in using psychedelic jugs like lsd. What is it that makes them use ful in addiction. Its mere drug called psilocybin than lsd. It is like lsd. Its a softer form of lsd and comes from mushrooms. Another term for it is called magic mushrooms. And we dont have we have some good treatments but we dont have as many effective treatments as we would like, nor do we have interventions where you do one thing or two things, the same thing twice, and its turns the course of somebodys life. The psilocybin causes a trip that last six hours, and when done under the safe circumstances this has been studied in four august medical centers, Imperial College of london, nyu, hopkins, and stanford. First with people who were terminally and i will were in a crisis. Huge disstress but facing death and over 500 people were given psilocybin under the conditions and without one bad reaction. Its pure stuff. Nicer a protected environment and theyre guided, and 80 of those individuals went from being in extreme distress to reconciling themselves with the circumstances, with their own death. And what is reported here is that people have this experience, and i dont know how many of you have had trips, whether its lsd or psilocybin or beladona which is the trip was bill wilson started aa went on. That is you get a sense of wonder or you restore a restored sense of one doctor, being one with the universe and youre not dying, youre continuing and that one trip, maximum of two, is lasting with that experience, with death. So you can go to your local drug dealer to buy some. Im not suggesting that. Im saying that we a good idea for the medical and the general public to be open to the idea that addiction is a really tough problem and maybe for some people this will actually turn their minds into away from addiction towards a life, a different kind of life. So, mostly, its still largely fear or stigmatized, but as more is learned about it, i wouldnt be surprised if more people began to say that this is maybe for me. Have any of your own patients benefitted from that kind of therapy . No, i have not in my i dont have i have 700,000 patients every year, thats how many people are served by my agency in new york state and to my knowledge, and ive certainly not prescribed it for any of them, perhaps some have done it, i dont know. I only know whats been done under controlled research conditions. You talk in the book about how so often addiction and Mental Illness go hand in hand. But there are separate conditions, there are two separate problems and you add q advocate for good mental care and if you had two areas of the Health Care System hardest to find either access to or enough doctors or rehab beds, any of those things, how realistic is it that people who need that sort of concurrent Mental Health care or substantial abuse care are going to get it . What a great question, and what ive learned from patients and families, is if they have to go two different places to get care for two different conditions. They probably dont go to any or they may only go to one. And that has led to more and more efforts to provide onestop shopping, if you can be cured for for your diabetes, and cared for for your depression and you can be cared for for your cannabis addiction or narcotic pill addiction, all in the same place. And thats principally in primary care, which is where most people go. Very few people go to a psychiatrist or Mental Health clinics and far fewer go to addiction centers. So, one stop shopping actually is what were trying to develop in terms of services because thats what people will take, will accept. Would that require sort of the wholesale retraining of primary care doctors to because Mental Illness is its own thing and its not simple and its certainly not one size fits all and its also a moving target. How do primary care physicians and nurses become equipped to spot it and treat it . Well, its easy to spot or easier to spot it than it is to treat it because we have the screening instruments, just like a cuff for your Blood Pressure or just like a lab value for your sugar. We have a questionnaire, very reliable questionnaires for mood problems, for substance problems and so, and when those are introduced, the standard operating procedure, you fill out this simple questionnaire. You fill it out, its not youre not asked by a clinician, you feel it out and it goes to the doctor. It goes into medical and then thats, requires a change in practice, but that can be done. What most general practices need are the presence of a Mental Health person or addiction counsellor because these are tough conditions and in rural areas, its even harder urban areas cant bring in Mental Health specialists and rural areas are even harder. And well see that Problem Solved over the years ahead by whats called telehealth theyll punch in on screen and a protected type of skype or facetime for the patient and doctor to speak on expertise. You hear often about, especially in rural areas, and less populated areas, because theres such a lack of, you know, beds for Treatment Facilities and things like that, an addict will go to the emergency room, they have no reason to keep him or her because theyre not in crisis at the moment and what they need is a bed in that facility and they dont have one and thats happening constantly in this country. What changes could they do now to sort of fill the gap until they can get more facilities . What can they do at the local clinic or the local hospital . Well, sometimes theres more available than people imagine, and some of the most inspirational communities that i have visited, communities where there have been high rates of overdose deaths, families lost a child, families lost a brother or a sister, they two things happen. The families came together, not only to support themselves, but to be a channel for people in trouble to get care and to link those people, literally by hand to services. Thats one thing, and the second thing is Police Departments that start arresting and charging people with drugs and it is a and the authority of a Police Department to determine whether to charge somebody. Once they charge somebody, its out of their hands, it goes to the d. A. , but many Police Departments, Fire Departments now in a variety of states are saying, if you show up and you have a drug problem, and you want to surrender your drugs, we will not press charges, instead, we will call other families that are affected and they will help you get care, literally, at that time. Not tomorrow, at that time. And those are those are grass roots activities that have yet to explode in this country, but i imagine well see more of that because those really work. And they are out of the ashes of tragedy that families create these programs and police join them in the process. Sort of dovetailing on that with police not making arrests. You acknowledge in the books where countries where drugs are illegal or decriminalized where the incidents of the negative behavior with overdosing, contracting hiv, crime related or drugrelated crime goes down and yet, you yourself say youre not an advocate for legalizing drugs across the board and even marijuana. Can you explain why that is . Yes, im an advocate for decriminalization, and not incarcerating people with disease, which is addiction is a disease. And also, incarcerating people with addiction means the hammer will fall dispoe portion natalie on poor people and people of color. And thats who is in for drug crimes. Incarceration is not a solution, and its not a solution for dealers who are users. If youre a user, you make a living or you cover your habit in three ways, you steal, you prostitute yourself, or you deal drugs. So, decriminalization, including decriminalization and treatment for dealers who are users. Legalization means that the more substances available in a community, the more its going to be used. Thats a Public Health principle. The more accessible something is, whether its tobacco or alcohol or opioids, the more it will be used and with cannabis, we now have a number of states that have legalized recreational marijuana, and ive covered that story, visited those states, and when theyre honest, theyll say, we still havent figured out how to do this and we still havent figured out how to get the quality and dosing safe. We were not making as much money as we thought we would make, and were spending a lot more money because of enforcement because theres still a cartel and theres a lot of home grown stuff thats being sold. So, the states in five years now, in colorado, they havent figured it out. So, we even saw a substance like cannabis where we need to know a lot more and we dont have Much Research on this because its whats called a schedule one drug. So, we dont know what potency, what mixture of the plant is useful for what, and dangerous for others. We have so much limited information to just barrel ahead and say lets make this available to everybody, seems not a very thoughtful approach. How much time do you think it would reasonably go by until you have a feel for how legalized marijuana, say, in colorado. Its effects. Ten years, 20 years . Five, maybe five more years because theres such a focus on it and theres such a march by so many states to legalize it that, theres a lot of going on in terms of driving under the implants r influence, access by teenagers and the whole financial aspect and the whole Quality Control aspect. Thats under the lights right now and i think well learn more in the next few years so that if we go ahead, well go ahead in a much more informed way. Okay. I was struck in your book, generally by your kindness toward addicts and youre not judgmental and you even write that addiction pirates the brain, but it need not pirate our humanity towards those affected and yet there is who wrote that . Thats pretty good. [laughter] yeah, pretty good, youre a good writer, you should buy his book. No, you wrote it, you wrote it. So, do you think that over time, as people because of the Opioid Epidemic is so ubiquitous and so many families are affected, that more people are turning towards passion versus judgment . Because right now when you say this is a crime, people think then punishment, but is that changing as people realize that while Everybody Knows somebody now who is addicted and this is a disease, its not a crime . I think thats right. I think that because so many families, almost every family knows somebody who is has an addiction, whether its alcohol or opioids and sees the tragedy of that has started to realize, we have a real big Public Health problem here. We have a disease that has gone unchecked and the answer is not more law enforcement, the answer is more prevention and treatment. One sort of heartbreaking example in your book sort of as the poster child how life can spiral from addiction is billy holiday. Can you tell people what her story is and how it illustrates every bad thing that can happen in an addicts life. Im a big fan of billy holiday, i think shes arguably one of the greatest blues singers in this countrys history and she grew up not far from here in baltimore. Her mother was a prostitute. She grew up on the streets of baltimore, living that life as the child of a prostitute when she was a ten, she was raped. And they are screams brought the local police, who took her to be a prostitute, and arrested her and she spent a year in juvenile corrections. She wandered around for a while. She followed her mother to harlem. Her mother went to work in a brothel there and her mother wouldnt take her in and she was 14, and had no home, and she began as a prostitute herself. After a while, she got arrested as a prostitute. She went to predecessor institution to rykers island and when she got out, she had only one goal, which was to get as far away from her interior experience of neglect, abuse, rape, incarceration, and she turned to high proof alcohol and to heroin and she used those for the rest of her life. Shes an example of Adverse Childhood Experiences in spades and she and she died when she was 44 in a hospital from cirrhosis. Shes an example of someone whose early life and whose trauma put her on a path to addiction that she could never escape and in some ways, i think its a miracle that so many other people who have lives like hers, worse or not so bad, escape addiction. Okay. I was also struck in the book, thinking back to sort of the crack epidemics in the 80s. And it seems like with crack its a crime wave and with opioids, its epidemic. Is society changing and understand things better or why the disparate . I think that crack had more to do with neighborhoods of poverty and neighborhoods of color, just like heroin in the past, and then it used to be a problem of inner city poor and people of color. And so, crack didnt it was sensational because of the stories and particularly crack mothers and crack babies, but it never got that kind of appreciation that this, too, is an addition, that, this, too, is a disease and it was mostly that these are people that are doing this to themselves and in some respects, it was a darwinion approach to crack addiction, i think. We have about ten minutes left and i wanted to ask if anyone in the audience had any questions for dr. Sederer. I see we have a microphone for you. Sir, i think were going to give you a mic. Yeah. So you mentioned Adverse Childhood Experience as a root cause that we should alleviate to help address the Opioid Epidemic, but thats been going on since humanitys different, its different from the narrative weve heard for the media and other researchers saying that lack of Economic Opportunity and like the eastern heartland, cheap access coming from mexico and theres another one, but an overprescription of opioids from doctors, specifically, i mean, a lot of these opioids are going on the street are coming from a small subset of doctors. How do those issues compare fot childhood experience as its doing right now . Thank you for bringing up, in some ways, its a considerable overlap. What youre describing is what gets called now the social determinenates of health and Mental Health. Loss of job, loss of opportunity, c. Neighborhood or your city is infused with substances, opioids, this is the story in the midwest, this is the story in the south, in the northeast, that you have a whole a deeply vulnerable population. And you know, having social despair because of their circumstances, loss of jobs for themselves, loss of prospects for their families, that when they try an opioid, which theyre often given by doctors because they have chronic pain, theyve injured themselves, they have arthritis, they discover that suddenly theyre transported away in a way theyve never known before, from not only their physical pain, but their psychic pain. So, you have and could convergence here of social malaise, social disease, if you will, with physical pain and with the availability of a substance thats very effective, at least at the beginning, in taking people away from their suffering. Next question. Yes, a number of commentators have said that or suggested that the Large Pharmaceutical Companies have played a role in the opioid addiction. I was wondering if youd like to share your thoughts on that. Thats certainly the case, and thats a story that goes back 20 years to the late 90s. Ap one company in particular called purdue pharmaceuticals, the manufacturers of oxycontin. They had a drug that had been used for terminally ill pain, people with terminal illness and pain, and they suddenly began to market it for any kind of pain, and so they used fictitious reports in some journals to say nobody gets addicted to this stuff. So, and they had a huge work force of what are called drug detailers, that people go to doctors offices and say, here is what your patients need, its safe, they dont have to suffer any more. So, pharma has always played an Important Role in terms of promoting drugs and in this case, opioids, and there are only two countries on earth that allow whats called direct to Consumer Advertising and thats what you see when youre listening watching tv or listening to the radio, direct to Consumer Advertising, the United States and new zealand. And what the reason its so popular is because if we are exposed to a drug that offers a solution, whether its for pain, whether its for erectile dysfunction, whether its for diabetes, directly exposed will be much more likely to go to a doctor and ask, can i get this . Most doctors are decent people and they want to make their patient happy. They want to give their patient what the patient wants. So, these are slippery slopes, and pharma and this company settled a suit for bad advertising, 600 million a couple of years ago, but that was a pittance compared to the billions they made over the years. I think we had a question in the back. Actually have a point to make and wanted to get your response and then i had a question. As far as marijuana legalization, or decriminalization could you hold it closer to your mouth . Thank you. Sure, as far as marijuana decriminalization, i think you have a good point making sure its safe, but i feel like people have been using it for a long time, maybe not legally and i think it would be fair to say its at least as safe as alcohol, if not safer. People dont die from blood poisoning from it or overdoses. And i think one of the issues with decriminalization as opposed to legalization is that people can still lose their jobs over using it. It stays in your system for so long so there are some challenges as far as thats concerned so i was wondering your thoughts on that and also wondering if youd heard of ibagain and wondering what your thoughts are on that. The cannabis is not good for the developing brain. So, our brains are under construction into our 20s through a process by which we cover the nerve fibers. So, when a brain is under construction, its very vulnerable to substances, particularly potent stuff, thc, the active ingredient in cannabis is 60 times more powerful today than it was when i was smoking pot in college. Its really strong stuff, and when a child, a youths brain is exposed to it, that can interfere with the normal development of the brain and also for youth who have some underlying Mental Illness, it runs in their family, its apt to unleash that. So thats another reason to be careful about not just not decriminalization, but legalization because when its more available, it will get in the hand of kids and none of these states have controlled access. They it costs them a lot of money to enforce, trying to prevent kids from buying this stuff, so, its you know, its a complicated problem. You know, and its safe for a lot of of people and it works for a lot of people both in terms of anxiety or pain, what have you. Ipagain is another psychedelic drug, but very limited use as far as i understand it in this country. Oh. I was just going to ask about some of the new pharmaceuticals that are coming along to help like break the addiction cycle and how you feel about them and does that really have a purpose or is somebody better off going cold turkey and treating another problem by another pharmaceutical . This is called medication treatment and in the 60s, methadone, an alternative to heroin. Its a way by which people dont use dirty needles, steal to pay for their habit ap since 2002, weve had another medication similar to methadone, but safer called suboxone. And for some people its a way to detoxify and for some people its a maintenance drug like methadone, but its safer, its very, very hard to overdose on it, and which means it doesnt stop you breathing. And its but its hard to get off of. So, no solution is perfect, but for some people, this is life saving and i wanted to give an example because you mentioned Emergency Rooms before and i know you have contact with the hospital if thats the case. Emergency rooms are where people are taken, often, after an overdose or during an overdose and they are given an antidote to the opioid called narcan. And what narcan does, it helps them start breathing again, but it puts them into immediate withdrawal and that is not deadly, but that is extremely uncomfortable. And then the person is discharged from the emergency room and the first thing they want to do is get a fix because they feel so horrible. Now the some Emergency Rooms are trying the practice of giving this medication, this is a film tab, a few days of it, to somebody who has taken an overdose and is in withdrawal because they know that that person is likely to be back in three days. So, its a life saving measure, but also, Emergency Rooms have enough patients than those that they send out knowing that theyre going to come back. So, this is another innovation and its one that is it should be carefully considered because it is not easy to get off of it. But it is life saving. Check . Okay, yeah. I had a chance to interview a few Homeless People recently and one of the issues they told me they had was getting medicine for their Mental Illness, the cost was so high. If the medical marijuana was grown on a farm and would that be more Cost Effective . In my year ive had a lot of contact, you as well, in new york city were seeing people who are homeless, poor with Mental Illness, smoking synthetic marijuana, k2, spice, and it is really cheap compared to just even illegal joint and, but its it drives these people even crazier than they are, many of them are now coming to Emergency Rooms and some of the latest concoctions are very sedating, so some people have gone into coma with it. But it i see this, also, as their effort to medicaid themselves, to try to feel some relief from the pain and hopelessness that they experience. Is that what you experienced . A question back here, i think. Can you shed some light on microdosing people . On can you shed some light on microboasting micro dosing . Yes. Micro dosing is small doses of lsd. Ten micrograms taken every few days rather than 100, or 150 taken for a trip and doesnt cause a hallucinatory state but it has become pretty popular and is an alternative to adderall and ritalin in financial communities where performance is every thing, and the word out that this and ables, 2 outofthebox. It is not easy to get and you dont know what you are going to get when you buy it. And an attorney or federal attorney like waltman wrote a book about micro dosing, a very good day, chronic depression, with micro doses of sd. I had a couple friends who passed away as a result of this disease, and it seems when soldiers come back from vietnam and many doped on heroin and they were offered morphine at morphine clinics and it became expensive so they moved to methadone and that became expensive. My question is do you think it is a better alternative than other humane medications . That is a really good question and it depends on the person. That story, the vietnam story is a really important story, apocalyptic story because in 1971 the department of defense became concerned about how many soldiers in combat in vietnam using apps which was cheap, high potency and sent to drug experts with two questions, what is the next will you send will they bring the addiction home, and over 20 were using this high potency heroin, 3 to 7 days a week but also predicted it wouldnt bring the same rate back home and the theory about that was sometimes drug use is a way of coping with the environment and using heroin as a way of making time go away which is important when you think youre going to be killed by an unknown enemy living in the jungle and an award that is not supported at home. The rates dropped but didnt drop for the normal population. Over the years we often try to find less toxic, less destructive substances, like the progression you described to go from heroine to methadone, each of these is safer but none of them is safe and none is a life without being under the influence to some extent so that is why i say keep an eye on it because you addition to maintenance treatments, it is for some people the difference whether they have it or not. What one or 2 policies would you like to see the president or Congress Make a real dent in the opioid problem . I have no hope for this administration to do the right thing. That was one of the reasons i wrote the book. Many states are trying to do the right thing in terms of prevention, treatment, but it takes a huge amount of federal money and you can think of the hivaids epidemic is a type of uprising around the Public Health crisis that became a movement and we have yet to see that with opioids and more people are affected. Tremendous amount of money was mobilized for hivaids for treatment and virals and the amount of money mobilized by the Trump Administration is what the New York Times called a pittance, 1 billion over two years. Estimates are the amount of money that needed to be invested is 80 100 billion over the next few years which sounds like a lot of money but isnt when you think about how much money is being spent on emergency services, hospital services, disability, family disruption, incarceration. I have no hope whatsoever that will happen. Weve seen the opposite with the Trump Administration declaring something a Public Health emergency and putting 50 million behind it. It is nonsense what is going on. I dont have hope until the administration has changed, for congress to be changed, for there to be enough resources to make a difference. On that d pressing note. Families and communities are making a difference. We are out of time, thank you for coming today. [applause] the new cspan online store has booktv products, go to cspanstore. Org to check them out. See what is new for booktv and all your cspan products. Weeknights of this week, we feature booktv programs showcasing what is available every weekend on cspan2. Tonight the theme is a religion. In the immoral majority, whether evangelicals are changing political power over christian values. Highroller was, professor of history in idaho talked about his book there is a god, how to respond to atheism in the last days. Columbia journalism review contributor reports on faith