Transcript #94: “Opioids Helped Me Work Again”- Lessons From An ADA Attorney

Flyer for Episode #94: "Opioids Helped Me Work Again"- Lessons From An ADA Attorney

Flyer for Episode #94: “Opioids Helped Me Work Again”- Lessons From An ADA Attorney


Guest: Kate Nicholson      Guest Title: Civil Rights Attorney, Speaker, Writer

Date: February 7th, 2018            Guest Company: ADA  

           

[Intro music]

 

 

Debra:              Hello, everyone. Good morning. Good day. This is Debra Ruh, and you are watching or listening to Human Potential at Work. I’m really excited about our guest today, Kate Nicholson. Also, special thanks to our producer, David Wolf, who’s behind the scenes today filling in for Doug Foresta, so thank you, David, but I’m really excited about talking to Kate.

                        Now, I had the pleasure to interview Kate on AXS Chat, A-X-S Chat, and her story just … In the first place, she taught me so many things that I didn’t know. I have been hearing a lot on the media about this topic, pain medication, opiate addiction, everything. We’re out of control all over the world, but here in the US … And Kate brings a very unique perspective to this topic that I really believe this audience needs to hear, so Kate, welcome to the program.

Kate:                Thank you, Debra. I’m happy to be here.

Debra:              Kate, will you take a few minutes and tell us who you are? You have, I think, a very impressive background, so tell us who Kate is.

Kate:                Okay. Well, I, probably most relevant to this audience, enforced the Americans With Disabilities Act in the Civil Rights Division of the Justice Department for more than 20 years. I started shortly after the law became effective. I drafted the current regulations, and am an expert in ADA law, so that’s really my background.

Debra:              So you’re a lawyer.

Kate:                I’m a lawyer. I am. Yes, indeed.

Debra:              We need people like you because, not only are you a lawyer, but you’re an advocate, and you’re really trying to make sure that we understand the full conversation. I think, so often, we get bits and pieces, and I know the opiate epidemic, looking from the lens of the United States, I’m hearing about it a lot. As an individual, I’m concerned that we have so much addiction to opiate. Oh, no, we’re in trouble, but there’s a whole nother piece to this story that is not being told that’s very, very important to many of us, including many people with disabilities. So you mind telling us more about your journey with pain and how you really became an expert in this conversation?

Kate:                Sure. Well, first of all, there is another side to opiates. They are the most powerful pain medicine we have. They are also potentially addictive, and those two things need to be balanced in treatment, but what’s happening today is that we are going so far in the direction of our concern about drug overdoses that we’re cutting off the access that people in severe chronic pain need to opioids and other pain medication.

                        My journey began about a year and a half into my job at the Department of Justice. I was sitting at my desk one day and finishing a brief that was due to court and, suddenly, I had a real horrible pain in my spine. My muscles seized and threw me right out of my chair, and I ended up on the floor curled up. It ended up that that ended up being my dominant posture for more than 20 years, what I wouldn’t have known at that time. I wasn’t able to sit, stand, or walk for the better part of 20 years, and it turned out it was because of a surgery I had had where a doctor had severed nerve plexuses in my spine, which are networks of thousands of nerves that enervate the spine.

                        I tried pretty much every kind of alternative treatment from acupuncture to sports medicine to physical therapy. I went to a pain clinic, and they did lots of nerve blocks, tried different medications. They even did a repeat surgery to see if they could sort of try and repair some of the damage. Over a year and a half, nothing really worked to sort of restore my function, and I had avoided taking opioids to that point. I was concerned about addiction and the things that I’d read. My doctors finally stopped me and said, “You know, it’s our responsibility to do no harm, and basically, we’re putting you through painful procedure after painful procedure, and it’s not working, you know, so you really need to try this,” and I did, and it ended up being incredibly restorative to my function.

                        I was bed-ridden completely, not sleeping for months at a time, just really in a desperate place. Once I started taking the medication, I was able to work and function as a very high-level federal prosecutor. I still had to argue from a folding lawn chair, and run cases from bed, and run negotiations through video teleconference, but my brain worked. I could function. I could have a good job and some quality of life, so for me, they were incredibly restorative. I was on them for a period of time, always with integrative treatment as well, not exclusively on the opioids, and that’s, I think, very important.

                        Years later, I got a medical device called a spinal stimulator. My doctor had been reluctant for me to try that in my early 30s, but the mechanism had improved, and that tended to also to help my pain and, over a period of time, I was able to sort of get out of pain and get off of opioids. That was actually a fairly anti-climactic and simple process too. I had to taper because people who take opiates, like people who take certain antidepressants or certain blood pressure medication, become what they call dependent. That doesn’t mean you’re addicted. It just means that your body habituates to the medication, so you can’t abruptly stop. You have to taper slowly to avoid withdrawal signs and side effects. I did that. I ended up off of opioids, and hiking in the mountains, and doing much better, so it was a long journey, for sure.

Debra:              It is a long journey. I have had just some small personal experiences. I know my father had a lot of pain problems because of the spine, and two of my sisters and my brother-in-law, and they have each had different interesting journeys with opiates and even a little bit of some addiction problems. I know my father had a little bit addiction because he … As you said, your body adapts, and it needs it, and it reduced the pain, but he started feeling afraid they were going to take it away from him. How prevalent is pain and its consequences, and I don’t want to say it like this, but why should we care? Of course, I understand why we should care, but I think it’s so easy.

                        You said something to me. We were talking the other day about the show, and you said something to me that I was fascinated with because when we talk about … We are actually, in the United States, having a war on opiates, and you were talking about the deaths that have happened because of opiate addiction, and you said, but the reality is, you look at this, and the studies show this, and there’s a whole lot of other factors besides opiates that we’re not considering.

Kate:                Absolutely.

Debra:              Do you mind just talking about how prevalent it is and maybe explain a little bit more about this particular thing? Are opiates just … Do we need to take them out? We’re done with them?

Kate:                Well, first of all, pain is pretty prevalent. Severe chronic pain or persistent pain affects about 25 times the number of people who are affected by opioid abuse. There are about 50 million in severe or persistent pain in America. It’s the number-one cause of disability in America. One-third of work jobs are lost just to back pain, so it is very prevalent and serious. It costs the US economy upwards of $600 billion a year in lost work time and costs, so it’s a very prevalent problem, and when it’s not treated properly, the consequences are fairly dire.

                        Suicide is a very high risk with people in chronic pain, second only to bipolar disease, and loss of function, loss of work time, effect on relationships. Because of those things, the quality of life of someone with moderate or severe pain is actually usually described as akin to late-stage cancer, so it could be very affective. It can also cause premature death in other ways. People with severe or moderate pain that’s not treated well have about a 50% higher risk of death through heart disease and other causes, so it’s prevalent and it’s serious, that’s for sure.

Debra:              Yeah. It affects the quality of life and everybody around you and your ability to work.

Kate:                It does.

Debra:              I like how when you were explaining your story, the reality is, regardless of having chronic pain, you want to contribute to society. You want to work. You want to make a difference in the world. I mean you are a very smart, accomplished woman, and you want to manage the pain in the most effective way.

Kate:                Right.

Debra:              I know you’re very concerned about the current regulatory climate and why they say it’s hurting the treatment of pain, so do you mind addressing that a little bit?

Kate:                Not at all. Let me back up a minute so people sort of understand how pain became sort of associated with opioid abuse. Basically, in the 1990s, there was a recognition that pain was undertreated, and doctors at all levels started to, every time they met with someone in a doctor’s office, in an emergency room, asking them, as the fifth vital sign, sort of where they would rank their current pain on the scale of 1 to 10, and that was primary care physicians. It wasn’t necessarily the care of chronic pain, but we became aware that this was an undertreated and important problem.

                        At the same time, pharmaceutical companies were heavily marketing drugs like Oxycontin, and there was some that … It was some sort of convolution where drug companies actually sponsored some of the pain studies. It led to a situation where doctors were prescribing opioids far more regularly than they had in the past, and that caused more to be sort of found in medicine cabinets in the country, not necessarily because of chronic pain, often because someone had a small procedure or went to the emergency room. They used one or two pills. They were left in a medicine cabinet. Most studies show that 70% of the people who misuse opioids didn’t ever had a valid prescription for them. They got them out of someone else’s medicine cabinet. They got them from family and friends. They bought them on the streets. There was an oversupply problem, but that was then.

                        What happened in response to that is we started really heavily prosecuting physicians when their patients sold the opioids they prescribed. In some situations, there were what they called pill mills. I mean if you read the book Dreamland, the author describes … which is about opioid abuse in America. The author describes a doctor, who he calls Liberace, who was really just a drug dealer, and that did happen, but if you really look back at many of the cases that I’ve read, a lot of the people who were prosecuted were actually good doctors treating people in pain.

                        What started to happen, as those prosecutions went higher and higher, was sort of a perverse result. Doctors became afraid to prescribe opioids for people. A lot of pain doctors shut their practices down, abandoned patients. They stopped prescribing, and there are already way too few pain doctors, that is, doctors who specialize in pain management. There are only a few thousand to treat tens of millions, so that’s a problem already, and there is a pretty wide recognition that pain is underrepresented in medical education, so primary care physicians, ER docs don’t really get trained in how to treat pain. That was also part of the problem with overprescribing. People were prescribing who really weren’t trained in the sort of pharmacological results.

                        There’s a fair amount of evidence that if you’re treated by a chronic pain physician, they’ll often do a psychological screening before they start you on opioids to assess risk factors. I had that. Then it requires a lot of follow-up care after, and they’re still a medication of last resort, but if those two things are done, the risk of addiction goes down dramatically.

                        What started to happen is this problem with prosecuting physicians escalated a lot, and it really escalated in 2016 when the CDC issued guidelines, and the guidelines were designed to address this problem with primary care physicians not being sort of educated in how to treat pain. They were promulgated as guidelines for primary care physicians, not pain specialists, but what has happened is that certain elements of those guidelines have now been adopted by states with the force of law and by pharmacies and other things, so I want to talk about three basic things that are really hurting the treatment of pain today that come out of those guidelines.

                        The first is limits on filling pharmaceuticals. There are two kinds of limits. The first is many states have enacted day limits, so you can’t get more than three or seven days, in many states, worth of opioid medication. That was designed to address the problem of acute pain where people got medication, and they ended up in medicine cabinets. It is a disaster for people with chronic pain, and it’s not just states that are requiring this. CVS pharmacy, one of the biggest pharmacies in the country, has enacted a policy like this, and a lot of insurance companies, even though some states have exceptions for chronic pain, a lot of insurance companies are denying payment. The other thing is there was a recommended dosage level that you wouldn’t want to exceed in this guideline. That’s also been enacted, so people can’t get a certain dosage filled. Then, finally, there was a recommendation that people be tapered off of opioid use if the risks outweighed the benefits, which is what all medicine is about, right?

Debra:              Right, right.

Kate:                Any medication come with risks. Proper treatment with the physician is going to be a risk-benefit analysis, but many primary care physicians and many physicians felt like this issuance from the CDC meant that they had to sort of obey the letter of the law, and so they started force tapering people from their pain medication.

                        Even in the last week, there have been additional regulations. I mean the FDA just held a hearing to maybe ban all opioids over a certain dosage from the market entirely. CMS has decided that they will start looking at all doctors, all patient information that comes through Medicare and Medicaid, at the levels that doctors are prescribing in terms of numbers and dosage. The danger with these sort of rigid ways of applying this is it’s not taking into account variability in who these doctors are treating, the severity of their condition, the fact that people metabolize opioids differently. Doctors are very much under siege.

Debra:              I want to make a couple of comments.

Kate:                Yeah.

Debra:              In the first place, I personally do not want my government in between me and my doctor. I just don’t want it, and so I have a problem with that because I go to my doctor because I trust my doctor. One of my doctors retired and, wow, I went through quite a journey to find another doctor that I actually trusted, I believed we had similar beliefs. I also want to talk just for a minute about the oversupply. I just want to comment on a couple of personal experiences I had.

Kate:                Okay.

Debra:              First of all, I have a very dear friend of mine whose husband was addicted to opiates illegally, was illegally, and she’s … it wound up ruining their marriage, but they came over to our house to … Our kids were playing together and everything. My husband had, about six months before, hip surgery, and he had been given opiates because, you know, hip surgery. As you said, he’d used a couple of them, and he wasn’t really needing them, but he had them sitting on the counter, and her husband actually stole the whole bottle, and he had done it to another friend, and so my husband, couple days later, happened to notice it was missing. I felt so sorry for her and sorry for him because this man has a problem.

Kate:                Sure.

Debra:              Another thing that happened that … Unfortunately, my mother passed away about a month ago. When she passed away, and the police were there and the medical examiner and everything, the police asked to see her medications, and I was, obviously, in a blur, so I get out her medications. My mother had diabetes, kidney problems, blah, blah, blah, blah, but my mother was afraid of pain medication because, even though she was in severe pain for her back, she was afraid of pain medication because my father struggled with it, so my mother refused to take it even though it would have improved the quality of her life, so there was some mental health backlash for her, which I thought was very sad.

                        What I didn’t realize until later was the reason why the police officer was looking at my mother’s medication was they wanted to make sure if there were any, I assume this, any opiates in there, that they were going to take the opiates so that … They were doing their job, and they were lovely and wonderful, but that’s just a couple of small experiences that I’ve had. I think you take this, and you start multiplying this my millions, and it seems like taking away opiates from the doctor-patient relationship for people that really need them just continue to make this problem worse. What in the world is happening to patients that are in pain now? What’s going to happen to them?

Kate:                Well, I do want to talk about that, but before, let me talk a little bit about the issue of the supply. I mean we really need a public health sort of campaign to teach people about proper disposal of unused medication and proper storage. I always left mine in a safe because my doctor said, “You don’t want someone to get this who could be harmed by it,” and so I was very careful, but I had a doctor who impressed that upon me. In the past, you’d have to take unused medications to the pharmacy. That’s a hassle. People are often unwilling to do that, but [crosstalk 00:19:35]-

Debra:              Yeah, and we don’t know what to do.

Kate:                Right, but recently, some things are happening. I mean Walmart Drugs just came up with a gel that you could put in the medication, and it will turn it into a biodegradable, something that you can dispose of at home, so I do think there’s some hope on the horizon for dealing with this problem if people become educated about it.

Debra:              I want to ask you a question before you leave this topic.

Kate:                Yes.

Debra:              For example, my mother, she has medicine that is unused. She was a diabetic. I hate to throw this medicine away when I know there are people that could use this very expensive insulin. Another thing I want to tell you that’s going to … I know that this is not going to surprise you, but I have another friend of mine whose father died, and she gathered his medicine, and she went to the dump. We live in the country, so we go to the dump, and the man told her at the dump, “Just throw it on the ground. Just empty it out all on the ground.” She said, “But what about the water table, and what about animals that are going to come up and …” He was like [inaudible 00:20:34]. So we don’t know what to do, and that’s just regular medicine. That’s not even the opiates.

Kate:                That’s right. There are actually exchange programs that people have developed for this situation where you have high-cost medicines that could be reused. I mean it’s complicated, but there are those things, but in general, there are places in every state where you take your medication for disposal, and I think very few people actually do that. You can’t flush them down the toilet. It enters the water supply.

Debra:              Yeah, or know about them.

Kate:                Yeah. I think we need to educate ourselves about that.

Debra:              We need a campaign on this because there are so many people that want to do the right thing, and I know, even if it was a bit more hassle, it would feel like I was honoring my mother a little bit to take the extra steps. I wouldn’t mind it, but I don’t know, right?

Kate:                Exactly, exactly. I think we do need education about that, but you asked me earlier about the effect on pain patients, and it’s been pretty dire. Forced tapering has caused people to go into premature withdrawal. The lack of access to pain medicine has lost people’s jobs and functionality, and we’re seeing a pretty significant uptake in suicide. Now, these are hard to track because the only ones that we’ve actually tracked specifically to people being cut off of pain medicine that we’re sort of monitoring are people who used a weapon because they didn’t use the drugs because you can’t tell the intention sometimes, people who are recently denied pain medicine, and people who indicated in a note or to a relative that this was the reason they were taking their life, but there has been a huge uptick in suicide.

                        There is a little bit of interesting hope on the horizon in this front, though. The Department of Veteran Affairs was one of the first organizations to start tapering people off of opioids, and they did it in a good way in the sense that they also provided all kinds of access to integrative treatment, which is often denied people because insurance doesn’t cover a lot of those treatments, so they did. They did it, but they also tapered people off, and they recently did a study and found that what happened was not an elimination in overdoses or opioid abuse but a significant uptick in suicide, so they have actually made a finding, and they are going to discuss it and evaluate it. This is happening quickly, but there is starting to be some recognition of the dire effects on people’s lives with severe pain.

Debra:              Let me just ask you or make a comment. If that’s not bad enough, what you just said, that people are being denied this and committing suicide, I know from living with somebody that had severe mental health problems, it’s so much worse, even, than that because what happens is, when you’re in chronic pain all the time, you’re not in a good mood because you feel horrible, and so the consequences in the workplace, in the homes, in the family situations, to the … Of course, the worst is suicide, which a lot of us can’t get over when that happens to a loved one, so what could we have done, blah, blah? But it’s such a bigger problem than we can even put our finger on because we can say, like you said, “Well, in the suicide note, they said this.” Okay, so we can make a direct correlation, but what about the ones that didn’t say it? What about the costs to families? It’s such an important subject, which is why I wanted to have you on. Do you think our current policies are helping people, at least with addiction problems?

Kate:                I actually don’t think they’re serving, really, either people in pain or people with addiction. I mean there certainly has been an effort to get [naxolone 00:24:22] into clinics and into police stations so that people don’t die of overdose in that moment, but that is a very limited part of treatment. We know how to treat addiction, and it needs to start well before it heads to that level.

                        The other thing that’s going on is that the face of the opioid crisis has really changed in the last five years. The prescribing of opioids has fallen every year since 2012, but drug overdoses have escalated, and there’s now growing recognition that a lot of these overdoses are related to black tar heroin and illicit fentanyl. Even though it is true that in the ’90s and in the early 2000s there were too many opioids prescribed, our policy is looking backward at prosecuting doctors, at prosecuting pharmaceutical companies. It’s not looking at the current face of the crisis.

                        The other thing is that people have sort of started to look at the numbers. I mean, the CDC said that in 2015, which was the last bit of data that they based their guidelines on, 15,000 people died from a prescription-related opioid death, but if you really look at what that means, you have to go to … All that data comes from state coroners, and different states define it differently, but most of them say that, basically, if any level of prescription opioid is in the system, it’s a prescription-opioid-related death.

                        What we found is that most of these are kind of like the Tom Petty situation that we heard about in the news recently. Most of the deaths involve five or more drugs. A lot of them are prescription opioid with street kind of opioid with benzodiazepine, sometimes and in combination with alcohol, and we still lose significantly more people to alcohol every year than we do to drug overdose, so it’s a much more complicated and nuanced situation than the reporting or the policy is acknowledging.

                        The other thing that’s interesting is there is also a growing recognition that some of the deaths from overdose may not be accidental, that suicides are high with people with chronic pain, but they’re also very high with people with addiction. The American Psychiatric Association says that people with addiction have like a 50% higher risk for suicide, so I don’t believe that our policy or media coverage of this issue is really dealing with the nuance and complexity involved.

Debra:              Once again, we’re sensationalizing things.

Kate:                Yes.

Debra:              I immediately think of some … Heath Ledger, Michael Jackson, Prince, and I, of course, am going to use a term that I heard from the media, cocktails. They had drug cocktails in them and all these different things. I know with Michael Jackson, and I don’t know enough to make a judgment call on this, but I know his doctor was accused of being very … He was being negligent, blah, blah, blah. I don’t even want to comment on the merit of that case, but I do think it’s wrong to be attacking our doctors. I think most doctors-

Kate:                I think so too.

Debra:              They’re in this business because they want to make a difference, and they want to help people, and they really care about the Hippocratic Oath, but why do you think pain is so undertreated, and why do we not look at it as a public health problem? I know that when I get pain, I don’t have it chronically, thank goodness, but it’s very … I can’t work. I can’t think right. I’m not in as good a mood. I don’t like being in pain, and so why do we think this is not a health issue?

Kate:                Well, I think there are a lot of reasons. I mean, part of it is that everyone does experience pain. It’s so ubiquitous. It’s so across the board that a lot of people don’t understand chronic pain or severe pain unless they’ve experienced it directly or have watched a loved one experience it. When pain has lasted three to six months or longer, it can really shift from a symptom of a problem to a disease, and I think that shift in consciousness hasn’t really happened. I mean it hasn’t even happened at the level of public health or our medical system even though we have more people in pain than are affected by heart disease, or diabetes, or cancer, or stroke. About 1% the budget of NIH is on primary pain research, so there’s a real gap.

                        A lot of it goes back to our allopathic medical model that really look at sort of body parts, and is it looking at systemic problems? But, in general, more and more, and this is true in any sort of developed economy, more and more of our issues and our illnesses are chronic. Our system’s really buckling under the weight of chronic illness, and we really need to shift the medical model to adapt to that, but that hasn’t happened, and it’s a lot harder than it might seem to change medical education. I mean, like anything in life, people have their areas. They teach their areas, and there’s not … In order to add a course, you have to drop another one to add something new to the curriculum. It’s very difficult to make these shifts in how medicine is practiced.

Debra:              Right. Plus, you have the perception of … We all have different perceptions.

Kate:                Right.

Debra:              Like you said, we all have pain. I don’t know, personally, well, for my own self, what it’s like to live with chronic pain, but I have actually watched family members, and I don’t imagine I’m that uncommon. I mean, in my family, I have five siblings and … But it has affected a lot of members of my family, and I also don’t believe that it’s because my family’s more addicted than other families. I think I’m a very typical family, but … So this is the really big question, certainly. What can we do? What should we do?

                        I also want to take that a little but further and say Kate, I know that you are advocating. You are a voice. You’re a very important voice. What do we do to support you? Also, is this just a US problem? I’m saying that because this program is listened to in 83 countries, which is a blessing, but are people in other countries saying, “Whoa. What you doing over there in the US?” I assume it’s not just a US problem.

Kate:                It is not. It’s a bigger problem in the United States. We definitely use more opioids than other countries, but similar laws that have been enacted in the United States are being enacted in Canada. There are similar laws in Australia. It’s definitely affecting a lot of countries. Some countries don’t take a War on Drugs approach to this. Some countries have recognized that prohibition doesn’t really work-

Debra:              Work?

Kate:                … to cut supply. I mean, the Global Commission on Drug Policy, which included some of the architects of the original War on Drugs in the United States, like George Schultz, found that that war did absolutely nothing to curtail either supply or use, so we know that model doesn’t work, but we’re applying it to doctors now in the United States. There are other countries like Portugal. There are other countries that are taking a different approach, both to treatment and to pain, so it is a problem worldwide. Pain is undertreated worldwide to a greater degree in the rest of the world, really, than in the United States. It’s a very serious worldwide problem, and countries are dealing with it a little differently, but yes, it is absolutely a problem across the globe.

                        In terms of what we can do, I do think it’s really important for … I mean, I think changing the narrative when everything is going in one direction is important, and that’s why I’m advocating and writing a book, but I also have found that the audiences that are really willing to talk about this issue are people, even newscasters, who have had the experience of having severe pain themselves or a family member in pain. I mean I spoke very early on on The Roy Green Show, which is syndicated throughout Canada. He was interested in the chronic pain aspect of this because his wife died of cancer and had a very painful death, and he watched that process.

Debra:              Yeah, so sad.

Kate:                I think that just gives you a different view. Of course, there are degrees of all these different kinds of things. I mean, the Institutes of Medicine in the United States said that 100 million people have chronic pain of some sort. I use the 50 million figure just because I want to at least distinguish sort of the more severe cases and the more persistent cases, but that’s still a … It’s still an enormous number of people. I think just sharing and listening, I think it’s … Yeah, I can’t tell you how many people, after they watched my Ted Talk, people who went to Dartmouth College and Harvard Law School where I went to school, very intelligent, very educated people said to me, “Wow, I thought these things should be banned. It never occurred to me. It absolutely never occurred to me.” This-

Debra:              We don’t have the full story.

Kate:                We don’t.

Debra:              We don’t have the full story.

Kate:                We absolutely don’t.

Debra:              I didn’t realize a lot of this until I talked to you, either.

Kate:                Yeah.

Debra:              Tell us about the book. When’s the book coming out?

Kate:                Well, I just-

Debra:              Do you have a title yet?

Kate:                I just started it.

Debra:              Okay, cool.

Kate:                I actually just signed with a literary agent in New York in December, so working on a book proposal, and it should go pretty quickly, but-

Debra:              Good, good, good.

Kate:                I’d say it’s in the early stages.

Debra:              Of course, I know that you’ve been an AXS Chat and my program, and we do transcriptions to make sure that they’re accessible, so you should ask for those transcriptions. That might help with the writing.

Kate:                Absolutely. That’s a good idea.

Debra:              As a writer. Yes.

Kate:                Yeah, that’s a very good idea.

Debra:              Kate, how can people follow you? How can they learn about your work? Do you have a website? What do you [crosstalk 00:34:31]-

Kate:                I do. Thank you. It’s just my name. It’s www.katemnicholson.com because I wasn’t very quick on getting my own domain, had to add the middle initial. I’m starting to be active on social media as well. Historically, I’m a little bit of a Luddite, so this is new for me. You, obviously, have mastered it in terms of getting the message out on AXS Chat and in this program, which is so important.

Debra:              Yeah, sure is.

Kate:                I mean, as you know, digital media is a phenomenal area for accessibility for people with disabilities. I mean, I remember one of my last cases at DOJ was making sure that sort of Kindles and things like that were accessible because they were being used in educational environments, so it’s critical, and so people can follow me there. I respond to everyone who emails me, so-

Debra:              Okay, good.

Kate:                If you have questions, I’m happy to respond and happy to engage people.

Debra:              Yeah, and you let us know more about how we can help, but what we’ll do is I’ll make sure that your website is out on the show links so people can find you. When your book comes out, come back and tell us so that we can make sure the audience knows about it. We just wish you so much luck, Kate.

Kate:                Thank you.

Debra:              We really appreciate that you’re the voice out here educating those of us that … We mean well. We just don’t understand the ramifications of this entire story, and so that’s why it’s a blessing, all the advocacy that you’ve done for your entire life, and I think this next chapter is really critical, so-

Kate:                Thank you. Thank you.

Debra:              Thank you so much for joining us today, Kate, and look-

Kate:                I also want to add … Oh, I’m sorry. Go ahead.

Debra:              No, no. Go ahead.

Kate:                No, I also want to add, I guess, that people can also see my Ted Talk, which is called What We Lose When We Undertreat Pain, which sort of tells my story and goes through some of the more general attacks on doctors in numbers.

Debra:              Okay, good. Of course, we’re doing this on Facebook Live, and I tagged you, so what I’d like you to do, Kate, is respond and put your Ted Talk out there and your website out there.

Kate:                Okay, okay.

Debra:              Then we’ll also make sure that when we take the audio out and turn this into podcast and the radio show that we also will add that information there, so you send me that by email. We want to make sure that anybody that’s interested in this topic knows how to get to you. If you want to support Kate with her writing her book or anything you want to do to make sure that her voice is heard … I think it’s obvious why I had to have her on the show, because her voice is very critical, and she’s speaking for hundreds of millions of people, so let’s make sure that she has the volume turned up. Kate, thank you for your work. Thank you so much.

Kate:                Thank you for having me and being willing to really engage on this very important issue. I so appreciate it.

Debra:              Yep, yep. Thank you so much. Talk to everybody again. Bye-bye.

Kate:    Okay, bye.

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You’ve been listening to Human Potential at Work with Debra Ruh. To learn more about Debra and how she can help your organization visit RuhGlobal.com. If you’ve enjoyed today’s episode and you want to make sure that you don’t miss any future epsiodes, go to itunes and subscribe to Human Potential at Work. Thanks so much for listening and we’ll be back next week with a new episode.