Research shows only a tiny percentage of physicians integrating PACEs science

Three relatively recent studies from different parts of the U.S. show that only a tiny percentage of physicians, medical school faculty and other healthcare providers are integrating practices and policies based on the science of positive and adverse childhood experiences (PACEs).

Why it matters: For people in the PACEs community, the following is news that’s 20 years old: Adverse childhood experiences are common, preventable and linked to six out of the top ten leading causes of death in the United States.

As one of the studies noted: “Positive and negative experiences in childhood shape our trajectory of health or illness for our entire lives, and this impact can be attributed to the brain-body physiology that results from our experiences during childhood.”

The science is well established. Thousands of research papers have been published about the long- and short-term health effects. Every U.S. state has done an ACE survey, many more than one. Legislation addressing childhood trauma and PACEs science has been passed in 39 states. Dozens of books have been written about the topic, including two bestsellers; one of those—Bessel van der Kolk’s The Body Keeps the Score—has been on the New York Times paperback bestseller list for 178 weeks. Physicians who have been early adopters for more than a decade say they would never go back to not integrating it into their practices.

In 2016, only eight out of 192 medical schools included content about childhood trauma, and that could be just a single lecture. Early adopters in the medical community know that if PACEs science isn’t integrated into medical schools, benefits of its knowledge will never get to patients. And people WANT their doctors to know about this. Donna Jackson Nakazawa, author of Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal, posted this article on ACEsTooHigh.com: Childhood trauma leads to lifelong chronic illness—so why isn’t the medical community helping patients? It’s had more than two million page views and hundreds of comments.

Who did the studies and why? In Muskegon County, MI, Resilience Muskegon, a community organization created by mental health agency HealthWest, did a survey of county residents that showed a huge disconnect between the healthcare system, which is highly rated, and the health of people in the county. A local ACE survey showed that 31.4 percent of adults have experienced 4 or more ACEs, nearly three times the number in the original CDC-Kaiser Permanente Adverse Childhood Experiences Study, which showed 12.5 percent had an ACE score of 4 or higher. This prompted researchers to recruit 226 physicians from Mercy Health, a hospital and healthcare system that serves 85% of the county, to participate. They asked if they knew about ACEs science, if they used it in their practice, and if they had a personal history of ACEs.

In Texas, researchers from the University of Texas and the University at Albany, NY, recruited 85 healthcare providers from Central Texas that included physicians, nurses, social workers and other staff who were at least 18 years old and providing care in a medical setting to women or children in Central Texas. Going into the study they thought that most healthcare workers would know about ACEs. They thought that most screened for traditional ACEs such as substance use or mental health issues, more often than ACEs such as bullying or community violence, and they thought that most patients would self-disclose common ACEs. They also thought that healthcare providers familiar with ACEs would implement ACE-informed strategies for patients, such as providing resources for patients or creating an ACE-informed culture in their practice. They were remarkably off target.

In Illinois, a team comprising three medical students and four medical school faculty noticed that “very, very few of our colleagues knew anything about childhood trauma,” says Dr. Audrey Stillerman, one of the authors who is clinical assistant professor in the Department of Family and Community Medicine at the University of Illinois at Chicago. They were also interested in why this science that has existed for decades hasn’t been integrated into medical education so that it could become a part of clinical practice. What’s the rub? they wondered. Why isn’t medical education just different now? The team developed a survey to explore these questions; 81 faculty members from the University of Illinois College of Medicine and Rush Medical College in Illinois responded.

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How Vladimir Putin’s childhood is affecting us all

Examine Vladimir Putin’s childhood and you will see an eerie parallel to the atrocities playing out in Ukraine today. His life is a stark example of how childhood adversity is the root cause of most social, economic and mental health issues, as well as violence and chronic disease, as the science of positive and adverse childhood experiences demonstrates.

And while we can’t change the Russian president, we can encourage and educate people not to create more Putins by recognizing how childhood adversity impacts us throughout our lives and by integrating solutions into our healthcare, education, justice and economic systems.

Born in 1952 Leningrad, Putin was a street kid in a city devastated by a horrific, three-year siege by the Nazis during WWII, a genocide described as the world’s most destructive siege of a city. Most of the population of three million people died, one million starving to death. Putin’s father was badly injured in the war, his mother nearly died of starvation. Living in a rat-infested apartment with two other families, the family had no hot water, no bathtub, a broken-down toilet, little or no heat. His father worked in a factory; his mother did odd jobs she could find. A small child, whose two older siblings are believed to have been lost to war and disease, Putin was left to fend for himself, severely bullied by other children.

From his parents he inherited their wartime trauma personified by Nazi forces threatening their existence, ravaging their city and killing their friends and family. With his parents struggling to survive, they were absent or too traumatized to be attentive to their son. There’s no mention of other family members: no grandparents, aunts, uncles, cousins. Kindness and affection didn’t seem to have been part of the child Putin’s world.

While the experiences of childhood adversity piled up, two positive experiences changed his trajectory: After years of being labeled a troublemaker in school, a sixth-grade teacher helped him realize his potential. He excelled in high school, learned judo to defend himself, got a law degree and was selected to join the KGB. But the damage that led to his current behavior was done. It produced a machismo man, distrustful and unpredictable, and who cultivates disinformation to advance his own agenda at any cost. 

In her essay, The Ignorance or How We Produce the Evil,” psychologist Alice Miller wrote: “Children who are given love, respect, understanding, kindness and warmth will naturally develop different characteristics from those who experience neglect, contempt, violence or abuse and never have anyone they can turn to for kindness and affection. Such absence of trust and love is a common denominator….All the childhood histories of serial killers and dictators I have examined showed them without exception to have been the victims of extreme cruelty, although they themselves steadfastly denied this.”

Research shows that early abuse and neglect damages an infant’s developing brain. If a child suffers abuse and neglect for years without intervention, the consequences can be dire. As Dr. Bruce Perry, co-author with Oprah Winfrey of What Happened to You? Conversations on Trauma, Resilience and Healing, says, the more healthy relationships a child has, the more likely they will be to recover from trauma and thrive. Relationships are the agents of change and the most powerful therapy is human love.” 

But without that love in their childhoods, abused people in power can do serious damage. Hitler, Stalin and Mao Zedung all suffered years of merciless beatings and other unconscionable abuse in childhood and went on to be responsible for the deaths of millions of people. In Mao’s case, 35 million people. Of course, dictators can’t become dictators absent an environment that supports their ability to accumulate power. In The Real War, Richard Nixon pointed out that the “Darwinian forces of the Soviet system produce not only ruthless leaders, but clever ones.” Stalin killed nearly a million people each year he was in power; in 1938 he sent Khrushchev to Ukraine where he proved his ruthless ways by eliminating 163 out of 166 members of that country’s Central Committee. Of course, not everyone who has an abusive childhood grows up to abuse others; but it’s safe to say that all abusive dictators and autocrats had a childhood filled with abuse and/or neglect, and not enough love. 

So, Putin’s statements on and after Feb. 23, are chilling and revealing: “The purpose of this operation is to protect people who, for eight years now, have been facing humiliation and genocide perpetrated by

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