Advice on activism waswise
A trial at West Virginia University is testing the potential of ultrasound treatment in reducing the cravings that are part of drug addiction, writes David Ovalle.
Despite letters to the contrary yesterday, I applaud Robyn O’Brien’s advice (Letters, May 7). Any protester, if they wish to be successful rather than just play to their support base, should heed it.
Angry activism rarely leads to anything other than more anger. To effect good change a wise protester will listen to, and understand, what the average person their intended audience - thinks and feels.
Anger is too easy a trap to fall into. Anger is what is “weaponised” in the Middle East to try to justify the unjustifiable on both sides.
Israel should know that an increasing number of people around the world abhor the violence; essential aid from long-term supporters will dry up if Israel disregards innocent lives, not out of antiSemitism. Yet some protests can include very anti-Semitic elements, and in the USA especially that spills over into racial violence. If the peaceful 95% don’t clearly reject that element the whole protest can seem what the Israeli government always claim protests to be when rejecting them out-of-hand, and many reasonable people will think the same.
If you want your protest to be effective you have to be prepared to reject guys behind you shouting “kill all [some race] at birth!” If you excuse them by saying they were pushed to such anger by what is going on, aren’t you also justifying those you are protesting against?
Mark Aitchison, Sydenham
When Cyclone Gabrielle tore through the Central North Island locals living near forest blocks said it sounded like guns were going off as the winds snapped thousands of trees in half or ripped them right out of the ground. As the winds died down, the scale of the devastation to the forests around Tūrangi became clear. About 3.4 million cubic metres of wood – 6500 hectares (about 13,000 rugby fields) – had been damaged by the storm. This began a race against time for the forest owners, and NZ Forest Managers which manages the forests for them. They need to harvest the trees as quickly as possible before they degraded and lost value.
That meant roughly six years worth of harvesting work had to be done in about 16 months – which would require massively scaling up the harvesting and roading operations.
The fact that NZFM is on track to achieve this goal, and has been able to do it without compromising the safety and wellbeing of its contractors and their workers, reflects significant developments in the forestry industry over the last decade. NZFM has recorded only two minor lost time Injuries to workers involved in the salvage work, despite the number of crews swelling from eight contractors prior to Cyclone Gabrielle, to about 40 at the peak of the work. The operation’s lost time injury frequency rate (LTIFR) – a main measure of health and safety performance – actually dropped from a rate of 11 (per 200,000 hours worked) before the recovery work began, to 1.6 in March 2024. While no injury at work is acceptable, that performance was well below the industry wide LTIFR of 5.6.
I’ve first-hand experience of just how dangerous it can be to salvage stormdamaged trees, having harvested them using a chainsaw years ago, early in my forestry career. The toppled trees often end up tangled and under tension, so when you cut them they can release and spring up explosively.
The forests NZFM has been harvesting are full of trees like this, along with stems that have snapped but not yet fallen, meaning they could come crashing down at any time. There are giant holes in the ground from uprooted trees big enough for machines to fall into, and the angle at which many of the trees have fallen makes it slow, frustrating work to extract them.
On top of these physical dangers, NZFM has faced all the additional risks of scaling-up an operation quickly, including having to bring in harvesting and trucking contractors it doesn’t normally work with. Some of these contractors are from Gisborne and Hawkes Bay, who were left without work when cyclone damage brought forestry operations to a halt in their regions.
NZFM’s success in salvaging the wood safely reflects three significant developments in forestry over the last decade or so. Back in 2013, despite many individual forestry businesses operating safely, 10 workers were killed in our forests, making forestry New Zealand’s highest risk industry.
Without a doubt the biggest improvement is the now widespread use of machines to harvest the trees. This has greatly reduced the number of workers on the ground doing the high-risk tasks of falling trees with chainsaws and manually hooking them up to machines to be dragged out.
NZFM’s approach is that, where possible, all harvesting must be done by machines. Where trees can’t be brought down by machines they are either left, or where that’s not possible for safety or environmental reasons, they’re brought down by specialist manual fallers working under strict safety conditions.
This shift towards predominantly harvesting with machines is now fairly widespread in the industry, and has been a huge contributor to improvements in safety in forestry over the last decade. However, manual falling remains the industry’s biggest critical risk, and was involved in both of the industry’s fatalities last year.
The second big change that supported NZFM was the existence of an industry-wide certification scheme for forestry contractors. Safetree Contractor Certification, introduced in 2018, gave NZFM confidence that certified crews it brought in from other regions to help with the salvage had been independently assessed as having robust safety systems and work practices.
The third change was a more sophisticated “safety culture” that reflected changing attitudes towards worker safety and wellbeing. Stronger leadership from the top is a good example of this change in culture. For example, before the salvage job began, the forest owners and NZFM set two over-arching objectives - to minimise value loss and to complete the work safely.
A more sophisticated attitude towards safety was also seen in the way the harvesting crews adapted to the high standards of compliance and safety expected of them – even when this required them to change the way they worked.
NZFM also invested in looking after the crews’ mental wellbeing by providing things like a free employee assistance scheme and having Safetree staff regularly visit crews to talk about mental wellbeing.
A decade ago, this level of pastoral care and commitment to high health and safety standards, while present in some businesses, was not a hallmark of the industry as a whole. There was no industry-endorsed certification scheme and while harvesting machinery was starting to be adopted, it was not used widely across the country.
These three advances - mechanisation, certification, and a more sophisticated safety culture - have had a significant impact on the industry’s resilience. They were crucial in NZFM being able to respond as quickly, and successfully, as it did to the challenges delivered by Cyclone Gabrielle.
Joe Akari is chief executive of the Forest Industry Safety Council/Safetree.
Nestled inside a giant MRI machine in Morgantown, West Virginia, the woman wears a helmet outfitted with special probes. Peering through high-tech goggles, she sees images designed to trigger the awful, familiar cravings that have wrecked her life.
Heroin residue on tin foil. Lines of powder cocaine. Pain pills scattered on a table.
At the same time, scientists buzz around a small observation room, scrutinising brain scans on computer monitors, calibrating measurements, tweaking data points. Beams of ultrasound waves fire into a tiny sector of the woman’s brain by the hundreds – an experimental treatment that researchers hope will essentially reset her mind and ease her cravings for drugs.
The April clinical trial session at West Virginia University’s Rockefeller Neuroscience Institute opens a window into a growing school of research that repurposes a tried-and-true scientific tool, ultrasound, in a more focused fashion.
The use of the high-frequency sound waves is being adapted to treat Alzheimer’s disease, tumours and psychiatric disorders. Now, researchers are studying whether ultrasound can be deployed against an especially implacable foe: addiction to opioids and other substances.
“It’s basically doing brain surgery without the surgery,” said Ali R Rezai, director of the Rockefeller Neuroscience Institute.
Researchers are finishing the initial phase of the clinical trial, funded largely by the National Institute on Drug Abuse. This month, they hope to start the next phase, which will include patients who receive the ultrasound treatment and, crucially, participants exposed only to placebo sound waves, to better gauge the effects of the treatment.
Scientists caution that research into focused ultrasound – including for ailments of the mind, such as substance use disorder – remains in its infancy. They warn that the treatment for addiction is not a cure-all and would be used alongside other therapies. Even if the technology pans out, it could be years before the Food and Drug Administration approves ultrasound for treating addiction.
The challenges were underscored during the session for the 20-yearold woman, who is battling a fentanyl addiction that fuelled multiple overdoses and who was not identified by researchers because of privacy concerns. It was not as simple as flicking a switch. The software, ultrasound machine and MRI used to guide the waves were not designed for this use. So researchers adjusted settings, revving up the system like an old car to reach sufficient wattage.
Amid the hum of the machine and beeps of heart monitors, Rezai analysed readings alongside team members.
“We’re not getting enough dose in her,” Rezai told them.
They zapped her in blocks of five minutes. After each, the woman used handheld controllers to rate drug cravings on a zero to 10 scale, a rough but real-time estimate of the ultrasound’s impact. Her answers flicked on the screen. At one point early on, her desire to use heroin stood at 6.5. For pills, the reading was 9.
They’ve got the power
For decades, researchers aiming to treat neurological and psychiatric conditions have harnessed energy to stimulate the brain. Several methods are used with mixed success.
The oldest, electroconvulsive therapy – ECT – treats major depression, schizophrenia and bipolar disorder by sending electrical currents through the brain, prompting seizures. Another treatment, transcranial magnetic stimulation, or TMS, employs magnetic pulses to stimulate nerve cells in the brain.
With deep brain stimulation, or DBS, surgeons implant a neurostimulator that delivers electrical pulses into the brain. It is approved to treat conditions including essential tremors, Parkinson’s disease and obsessive-compulsive disorder.
During one highly touted study involving deep brain stimulation, researchers at the Rockefeller institute implanted stimulators into a handful of opioid-addicted patients. The results seemed promising, but the centre has pivoted away from that research because major invasive brain surgery is risky and because focused ultrasound may prove safer and more affordable, Rezai said.
In all, the FDA has green-lit focused ultrasound to treat nine conditions, including essential tremor and non-cancerous uterine growths. Regulators have approved it for 32 uses worldwide, according to the Focused Ultrasound Foundation, which facilitates and funds research.
Focused ultrasound is being researched and developed for more than 180 uses, said Neal F Kassell, the group’s founder and chairman and a former neurosurgery co-chair at the University of Virginia.
“Ten years ago, there were only three” uses being researched, he said. “That gives you an idea of how rapidly the field is growing.”
At higher intensity, the beams burn away tissue. At low intensity, they can stimulate or restore abnormally functioning tissue. The Rockefeller institute is also involved in trials using low-intensity ultrasound to help the brain better absorb Alzheimer’s medications.
Some 2000 miles (3200 kilometres) away from West Virginia, researchers are also using lowintensity ultrasound, but without the giant MRI. At the University of Utah, researchers invented a headphones-style device that delivers the same low-intensity waves without using an MRI. They are testing it on patients to treat major depressive disorder and expect to soon start trials involving food addiction, opioid use disorder, post-traumatic stress disorder and Alzheimer’s.
The device, dubbed DIADEM, will be more affordable than using “completely impractical” and expensive MRI machines to guide the sound waves, said Jan Kubanek, a Utah neuroscientist helping lead the research who believes the approach has the potential to be used at a large scale.
Participants do not have to shave their
heads as they do with MRI procedures, which is done to help the sound waves better penetrate the skull, Kubanek said.
At the University of Virginia in Charlottesville, scientists have treated six patients with ultrasound and reported no harmful side effects, said Nassima Ait-Daoud Tiouririne, director of the university’s Center for Leading Edge Addiction Research. Unlike the opioid study in neighbouring West Virginia, it is targeting users who prefer cocaine.
“There is no medication for cocaine,” she said. “It’s really hard to treat.”
The researchers focus on a part of the brain known as the insular cortex, which is believed to play a key role in heightening the sensation of drugs. Researchers at the Neuromodulation Clinic at the Washington VA Medical Center in DC are studying how focused ultrasound also affects that area of the brain in veterans addicted to nicotine.
By contrast, the West Virginia researchers target the nucleus accumbens, part of the brain’s reward circuitry. Researchers say repeated drug use can electrically and chemically alter the nucleus accumbens.
It remains unclear what the sound waves are doing inside the brain. Rezai suspects the vibrations alter the membrane of the nucleus accumbens, changing the functioning of cells and essentially resetting the brain. Whatever the mechanism, he said, bursts of the sound waves over 15 to 20 minutes show rapid reductions in cravings.
Rezai said patients have not reported adverse effects from the procedure.
The hot zone
The story of a 29-year-old mother, who spoke on the condition of anonymity because of the sensitivity of her condition, is achingly familiar in West Virginia, a hot zone of the opioid crisis ignited by prescription pain pills flooding the state.
As a teen, she took opioid pills recreationally with friends, then cocaine, along with other substances. In her 20s, she moved on to heroin and fentanyl pressed to look like pain pills. While still grappling with drugs, she gave birth to a baby, lost custody of the boy to social services and wound up in rehab, where she was offered a slot in the ultrasound study.
“I’m willing to do anything. I want my family back,” she said of the decision to volunteer. “I don’t want to use anymore. I just want to be happy and healthy and be a good mom and be a good person.”
Like all study participants, she was stable and on medication – in her case, buprenorphine – designed to reduce cravings and stave off withdrawal symptoms. Researchers acknowledge it can be difficult to disentangle the separate effects of the medications and the sound waves.
But for patients on medications alone, photo prompts of drug use still activate cravings, said James Mahoney, a clinical neuropsychologist at West Virginia University working on the research.
The mother recalled seeing photos in the study that showed baggies of fentanyl and people smoking heroin. “I would get this feeling throughout my body, like I was about to jump out of my skin because I wanted to do it so bad,” she said.
During the roughly two-hour session in the MRI machine, she said, she wasn’t sure when the ultrasound was administered. But toward the end, her body suddenly “felt warm and fuzzy, and I felt like calm”.
In the hours and days afterward, she said, the pictures no longer triggered her. She worried the cravings would return. More than eight months later, she said, they have not. Her crippling anxiety has dissipated. She is living with her boyfriend and has reunited with her toddler son.
For Patient 19, the woman who underwent the procedure in April, the results didn’t seem as clear-cut at first.
Pierre D’Haese, director of imaging analytics, peered at a 3D model known as tractography, which shows bundles of neon pink, green and purple strands inside her head depicting neural highways connecting parts of the brain. The model helped them target the nucleus accumbens, buried nine centimetres deep into the skull. Precision was imperative: A tad in the wrong direction might trigger activity on the highway that regulates anxiety, he said.
“We’re trying to fine-tune 1mm at the same time,” D’Haese said.
Inside the control room, Rezai and his team – including engineers from the ultrasound machine manufacturer Insightec monitoring remotely from Israel – activated the device during a series of five-minute sessions. Images of drug use flashed in the woman’s goggles. Sixty watts. Seventy. Eighty. The waves weren’t maintaining a high enough wattage. During the final session, they adjusted the target in the brain slightly. The pulses reached more than 90 watts consistently. The team breathed easier
Results fared better. From inside the MRI machine, the woman indicated her craving for heroin had dropped to just 3, pills to 6.
It’s not unusual for patients to report the greatest effect days later. Researchers will pepper the woman with questions, and scan her brain, for days, weeks and months.
On this day, the woman emerged from the MRI smiling – something Mahoney, the neuropsychologist, hadn’t seen in their earlier meetings.
“After the procedure, she was definitely much, much brighter,” he said.
“I’m willing to do anything. I want my family back. I don’t want to use anymore. I just want to be happy and healthy and be a good mom and be a good person.”