Annie Lowrey
Appearances
Fresh Air
Why Do We Itch?
And so the biggest advance that has been made recently are these kind of immune modulating drugs that block certain cytokines, which are proteins in the body that help that inflammatory process.
Fresh Air
Why Do We Itch?
Yeah. So they increase the inflammatory response and they turn out to make the body more sensitive to itch. And scientists found some drugs that block two of them. And this drug... works really, really well with a kind of interesting panoply of conditions with asthma, with psoriasis, with issues that you might have with like your nasal passages even.
Fresh Air
Why Do We Itch?
They're finding that possibly it could help with kind of chronic heart and lung problems also when there's inflammation. And it just smothers itch really, really well in people with certain forms of eczema.
Fresh Air
Why Do We Itch?
There's now a bunch of these sort of similar types of drugs, and scientists are finding more and more of these drugs that are affecting cytokines and these cytokine pathways in the body and are turning down these itch dials.
Fresh Air
Why Do We Itch?
One of the big ones, the first one that came out is a drug called dupixent, which is used commonly to treat asthma and atopic dermatitis, which is a form of eczema. It's a really common condition and can be absolutely miserable for folks. And it was really hard to treat the itching in that condition for a lot of people. And it turns out that dupixent works great.
Fresh Air
Why Do We Itch?
And there's now a number of similar drugs. They often, if you look at the name, they end in U-M-A-B, right? Like dupixent is dupilumab, and these are the umabs. And these are biologic drugs that are helping modulate the body's immune response and affecting these cytokines. And there's a number of them. But research scientists...
Fresh Air
Why Do We Itch?
are noting that now they know so much more about the circuits that are involved in chronic itch that there's a lot of drugs in the pipeline, a lot of studies that they're trying to do that are affecting other parts of these circuits and might really help people in the coming years. And so Gil Yasupovich, I was corresponding with him after the article came out,
Fresh Air
Why Do We Itch?
And he indicated that there might be drugs for liver-relating itch in a few years, whereas right now there's really not a lot to offer people with that kind of itching.
Fresh Air
Why Do We Itch?
I am so engaged that I'm less itchy than when I was nervous and just walked in the door to the studio. So I appreciate that. I really do. And there's all of these other things that modulate, right? Like anxiety increases itch. Sweating increases itch. It really is a complicated, complicated phenomenon to experience. Yeah.
Fresh Air
Why Do We Itch?
turn the itching dial down. So the two big ones being steroids and antihistamines. And it just became all encompassing. I would spend hours in cold baths. I would walk to try to get rid of the itch. It was most intense. I've been pregnant twice. I have two kids. And at the end of one pregnancy, I asked my my surgeons, I was like, if this doesn't stop, I don't want these limbs on my body anymore.
Fresh Air
Why Do We Itch?
Absolutely. Why do we feel anything? Right. I think that there is this sense that the body is kind of like a computer or, you know, a machine which is taking inputs and then creating outputs. And you can have some some problems within, you know, the machine like system that is processing from input to output.
Fresh Air
Why Do We Itch?
But the truth is that all of our sensory experiences are coming from an enormous interplay of external stimuli going through this impossibly complicated computer that is hallucinating reality in every moment before us, right? We don't actually see anything. We don't actually feel anything. This is all coming through this system that is generating the hallucination of experience.
Fresh Air
Why Do We Itch?
And I get that that sounds kind of moony and out there, but it's actually really, really true. I didn't include it in the piece, but one thing I talk to a lot of doctors about is, you know, how you can have itching and pain in limbs that don't exist anymore, right? If you've had an amputation of a foot or a hand, you can still feel things in it.
Fresh Air
Why Do We Itch?
Exactly. It's real. It's just not true. Right. And that's the brain. That's just the brain doing its job, perhaps not in a perfect way. But, you know, the only way that we sense anything is through our brain.
Fresh Air
Why Do We Itch?
Yeah, there's these interesting studies that show that meditating on pain reduces the sensation of pain for some people, at least. So I know for people who are experiencing childbirth, they'll have you... repeat these mantras, right? Like I'm in pain, but that's my body doing its job. I'm in pain, but that's my body trying to keep me safe and I'm safe. I'm in pain, but it's all right.
Fresh Air
Why Do We Itch?
And I'm not always going to be in pain. And that can actually really reduce the sensation of pain, sitting in pain and accepting it. And I don't want to say that that's universal. And I don't know what it feels like to be in anybody else's body, but my own. If you meditate on itch, It just makes it worse. It makes it so much worse.
Fresh Air
Why Do We Itch?
And I've had people be like, well, can you be kind of Zen about it? And I'm like, no, you need to ignore it. You need to say that it's not happening. You need to like attack and override. You need to use all of these other different strategies. Screaming, maybe screaming would help. I don't know that the Zen path works very well with itching.
Fresh Air
Why Do We Itch?
I remember once I, when I was in my phase of trying to figure out anything that might stop it, I went to acupuncture. Because for some forms of itching, acupuncture has been shown to really help. And I was just curled up on my side with all of these like little tiny needles in my ear and on my spine trying to alleviate this itch. And it was making me so itchy to not move.
Fresh Air
Why Do We Itch?
And I ended up like breaking a bunch of them. I was like, oh, God, am I going to stab myself? And it ended up being fine. But yeah, itching, I, you know, movement helps. Ice helps. Ignoring it really helps not thinking about it precisely because thinking about being itchy or scratching makes you itchy and makes you want to scratch.
Fresh Air
Why Do We Itch?
When scientists said that itching is a disease in and of itself, what they meant was that chronic itching changes the body's own circuitry in a way that begets more chronic itching, that implies that itching is not just a side effect, it's a body process in and of itself.
Fresh Air
Why Do We Itch?
It was really debilitating. And I'm not like that all the time. And in fact, the itching has never been quite as severe as it was in my pregnancies. Now the itching is much calmer, although it is persistent, but it comes and goes. At its worst, it's really, you know, just like pain is debilitating, itch is debilitating.
Fresh Air
Why Do We Itch?
And so instead of just being a symptom, instead of being something where if you fix the underlying issue, you might fix the itch, itch itself can kind of rewire the body and can be treated as a condition unto itself. And a lot of dermatologists see itch that way. It's often a symptom, often a side effect, but sometimes it's really its own thing in the body.
Fresh Air
Why Do We Itch?
We're going to start trialing different drugs to see if they affect my itching. And that's in part because doctors have been trying to figure out the appropriate set of drugs to treat my underlying disease. So I turn out to not respond very well to that one drug that has really changed the course of PBC treatment.
Fresh Air
Why Do We Itch?
So they have me on second-line drugs that seem to be working well, and they will monitor me very closely in the same way that they do monitor all PPC patients. Because they know that the disease tends to be fairly slowly progressing, but that doesn't tell you anything about whether your disease will progress slowly.
Fresh Air
Why Do We Itch?
And so they want to watch that in me because I was diagnosed relatively early in life with it. And the other thing is that I, like a lot of folks with issues with autoimmune diseases, ended up with a second autoimmune disease. So as an adult, I developed type 1 diabetes. And they're kind of watching and seeing if I develop other autoimmune conditions.
Fresh Air
Why Do We Itch?
So I'm very, very, very likely at some point to develop something called Sjogren's, which affects, among other things, the tear ducts in your eyes. And so they've been watching. They're like, OK, are you diagnosable with other things? Do we think that the autoimmune process within your body has kind of slowed down and stopped?
Fresh Air
Why Do We Itch?
And I had some frustrating conversations with my doctors where they'd kind of be like, OK, let's keep on doing more blood work. Let's do biopsies. Let's do tests. Let's talk about, you know, like improvements that we can see in these hard and fast numbers. And I would say, OK, but can we talk about my symptoms? Like I'm not sleeping very well and the itching isn't as bad now as it has been.
Fresh Air
Why Do We Itch?
And one of the sort of spooky things about it, and I'm very grateful for this, but I will be not itchy at all for long periods and then it'll just come back out of nowhere. And I don't really understand why. the trigger or what happens. In the spring, this was true for about six weeks. It's been true on and off since I published this piece, I think just because I'm thinking about itching so much.
Fresh Air
Why Do We Itch?
So finally, one of my doctors was like, yeah, okay, let's focus on the itching. And there's a bunch of different treatment options that they have, and none of them work that well, and none of them work for everybody. So you have all these PBC patients who are kind of doing this grab bag approach to, OK, like, let's try this. Let's try that.
Fresh Air
Why Do We Itch?
And even the drugs they're suggesting are just like kind of wildly different things. So one of the things that they will trial is analog of a drug that's used to reverse heroin overdoses. It's a medication that blocks opiates in the body. Another is an SSRI, which are commonly used. used to treat depression. There's a antibiotic that seems to work for some people's itching.
Fresh Air
Why Do We Itch?
I don't understand why that is. And I think that this kind of scattershot ragtag approach reflects the fact that they just don't really understand what's happening in terms of itching with people with my condition. So they're kind of guessing at what might interrupt it. And some things happen to interrupt it and other things don't.
Fresh Air
Why Do We Itch?
But maybe as they understand it better, they'll come up with better treatment options.
Fresh Air
Why Do We Itch?
In some sense, I was thrilled to get an answer for something that had been going on for so long. So I never got a diagnosis after my first pregnancy. One of my doctors had suggested that the itching was psychologic in nature and that I was just really stressed out. And I'd never had problems with itching before.
Fresh Air
Why Do We Itch?
I'd occasionally gotten itchy when I had bug bites or something, but I wasn't a person who was an itchy person. I didn't have, you know, childhood eczema or any of those conditions. So I was thrilled to finally get a diagnosis. And they trialed this drug, Ursadiol, which has really changed PBC treatment in me.
Fresh Air
Why Do We Itch?
The amount that you might itch and the place that you might itch has to do with the network of nerves inside your body and the messages that those nerves are receiving from chemical irritants from outside your body or the chemical messengers within your body.
Fresh Air
Why Do We Itch?
And it was only a year or 18 months later that they kind of said, look, like, you know, your organs don't seem to be responding in the way that we would love for them to respond that we're seeing in your blood work. So we're going to try additional medications.
Fresh Air
Why Do We Itch?
And that was actually the moment that I got a little bit spooked because they didn't quite say to me, look, there's only one treatment and the treatment doesn't work on you. It was kind of, you know, oh, well, we'll try other things. We'll try other things. We don't know the course of your disease.
Fresh Air
Why Do We Itch?
And I think that it was meaningful for me personally to find out that I was sick while I was having my kids. And certainly I don't think you need to have children to feel part of the tremendous fabric of humanity at all. But at least for me, it did really remind me of that. Certainly reminded me of my own mortality experience.
Fresh Air
Why Do We Itch?
And I also think that I was in a place where I was really accepting of the fact that I was getting older and moving into a different phase of life. And all of us, if we have the good luck to live for a long time, are going to have our bodies fail us. And maybe it's actually nice for me to know the way in which my body seems to be sensitive.
Fresh Air
Why Do We Itch?
And I try not to be dire about it because I continue to be really healthy. The itching is annoying. The chronic fatigue is annoying. The type 1 diabetes is deeply annoying, but it is very manageable. But I'm still enjoying really good health a lot of the time and science is advancing. And I try to remember that.
Fresh Air
Why Do We Itch?
And in the piece, part of the story was talking about the struggle of just coming to terms with the fact that you might be uncomfortable for a really long time. You are in a body and hopefully you will live long enough for it to fail you. And I talked to two folks who are a lot older than I was just about like, how do you deal with it?
Fresh Air
Why Do We Itch?
How do you deal with the fact that you might itch and never stop itching? Because I was really revving myself up about it and didn't feel good about it and didn't feel like I had a psychologically satisfying answer. And both of them were kind of like, you put up with it. Stop worrying about it and get on with your life. And they said it in a much nicer way than that.
Fresh Air
Why Do We Itch?
Both of them were people of faith and they were like, I praise God and I move on and I keep on focusing on the good things in my life. I think they were totally correct. It was such a nice jolt of an answer just not to get stuck. It's interesting. keeps you trapped in these loops. And I think I was mentally trapped in this loop. And sometimes it's like, okay, just get out of it for right now.
Fresh Air
Why Do We Itch?
And my understanding, and I'll just note that I am not a scientist, I am not a doctor, I am a layperson who knows a lot about this, unfortunately, from experience, is that when you have a lot of basically itchy receptors, nerve fibers that accept itch, and you have a lot of
Fresh Air
Why Do We Itch?
It's a great question, and I think that the answer is multilayered. So one is that doctors didn't understand itch, even just that basic histaminergic itch, very well until recently. There's not a lot of drugs to treat itch, and there didn't seem to be a lot of money in treating itch. there's a lot of money in treating pain, right?
Fresh Air
Why Do We Itch?
An upsetting amount of money that has led to a tremendous social crisis due to our treatment of pain. But it is also true that, you know, there's a lot of chronic pain and we have a lot of ways to treat it. And, you know, I think there's now a lot more emphasis on non-opiate medications to treat pain while also acknowledging that a appropriately, opiate medications to treat pain.
Fresh Air
Why Do We Itch?
So there just wasn't a lot of optionality for treating itch. It wasn't the sort of thing that medical centers were going to make a lot of money by treating people with chronic itch because they didn't have options to give them. I also think that there's a social aspect Pain is so awful. And I would never say that there's something ennobling about pain.
Fresh Air
Why Do We Itch?
But I think that there's a certain amount of social respect to people who are going through it. And itching, you kind of sound like a Muppet, right? I do think that like itching, it's just a little bit like disrespected. You look like a dog with fleas. It's like embarrassing to scratch yourself in public. It's inappropriate to scratch yourself in public.
Fresh Air
Why Do We Itch?
I think people just kind of don't take it very seriously. I'd also thought a lot about how like, you know, if you had a chronic itching support group, Everybody would come into it and then just start scratching themselves and then make everybody else itchier by being in the simple presence of people who were itchy. So I don't know. But it's something that, you know, people suffer through alone.
Fresh Air
Why Do We Itch?
It's kind of embarrassing. And it's been so nice since the piece came out to get I got a lot of emails from people suggesting lotion. And I was like, OK, thank you. Thank you for that. But then I got a lot of emails from people who were like, people don't believe me, but I've been itchy and they don't know what it is and I feel so alone.
Fresh Air
Why Do We Itch?
Or I have this cancer and it makes me itchy and it drives me completely nuts. And so it was really nice to get responses from people who didn't want to be alone and do have some trouble conveying to folks just how hard it can be. And this is not to, you know, there's no misery Olympics here. I'm not saying like pain is awful. Itching is awful. It's just that sometimes I think itch is not respected.
Fresh Air
Why Do We Itch?
chemicals that engender itch like histamine and others in those sites you'll feel itchy and one thing that happens to me and I know happens to other people with chronic illness who get itching is that it actually you'll feel itchy on the inside of your body like you know in your guts right like part of your body that has you know you're not itchy on your skin and you can't get to it so there's no way to scratch it and I remember talking with a number of dermatologists who are like well you don't really have the nerves for itching on the inside of your body and
Fresh Air
Why Do We Itch?
It says, yes, I have tried lotions. So people, when you say that you're itchy, I think they kindly assume it's a dermatologic thing. And they're like, oh, yeah, I was itchy, too. And I tried this lotion and you should try this lotion. And I try not to get short with those people because they are trying to be helpful.
Fresh Air
Why Do We Itch?
But I'm like, I'm not saying I've tried everything, but I've tried a lot of things. Like I'm an expert in my own itch at this point. And if Eucerin fixed it, I can assure you that I wouldn't be experiencing it. But people are trying to be nice. And so I try to be nice back. I don't know that I succeed at that all the time.
Fresh Air
Why Do We Itch?
Yeah, I try not to talk to people when that happens. I guess in some ways it's nice that usually when I'm really itchy, it's at night, like in the middle of the night. Because, you know, during the daytime, it would be pretty unusual for me to be severely itchy now. That was not true when I was pregnant so much. But now it's like the sun starts to go down.
Fresh Air
Why Do We Itch?
I'm leaving the office so I can go hide in my house if I'm itchy. You know, so for the past week that I've been itchy, it's mostly it's been at night. And I just excuse myself because it's just like sometimes I'll subtly try to scratch my head or scratch my feet or something. But it's noticeable. People kind of pick up on it. It's like not a cool thing to do socially.
Fresh Air
Why Do We Itch?
I think it leads to a sense of disquiet in the person that you're talking to. And then they end up scratching themselves. You've just you've allowed your itch to become contagious. Yeah.
Fresh Air
Why Do We Itch?
Which he's not doing intentionally. And it turns out that that is a hormonal thing. So there are a number of your body hormones, including estrogen, that affect your propensity for itch. And so you have a hormonal cycle during the day. And that's why you itch more at night. So sometimes, yeah, I feel like accidentally nudge me or something. We have two dogs. One of our dogs skulks around.
Fresh Air
Why Do We Itch?
Patricia likes to get up and sleep on the bed with me, and so she'll do the same thing. She'll wake me up, and I'll wake up, and I'll be itchy, and I'll just be absolutely furious if the itch-crash cycle starts because then it's hard to get back to sleep, and you're taking, like, melatonin or, you know, hydroxyzine or one of these drugs.
Fresh Air
Why Do We Itch?
And so, yeah, touch can be completely unbearable if you're itchy because it just, instead of setting off those receptors for platelets pleasure or warmth or pressure. It just sets, you know, your receptors for itch off.
Fresh Air
Why Do We Itch?
Absolutely. If you saw somebody scratching themselves on the subway, would you go sit next to them? No, of course not. Of course you wouldn't do that. Just instinctively, I think you have that self-preservation mechanism. I've actually noticed it with my kids who are little too, right?
Fresh Air
Why Do We Itch?
And, you know, I would talk to other doctors or patients, people who itched and they'd be like, no, no, no. Like, and I felt this way, too. I was like, no, I swear that I feel it. And I finally found this one neuroscientist who was like, oh, no, no. Some of those fibers exist inside your body. So, yeah, anywhere where you have those, there's probably a little bit of itching possible.
Fresh Air
Why Do We Itch?
Like if they cry, if they get owies, it's this deeply instinctual thing to go run up and like scoop up the body and make sure that it's okay. And I think that you see that even among adults, right? A crying person, they're sort of a magnet, right? Like, are you okay? Do you need a tissue? Do you need a hug? Do I know you well enough to give you a hug? I would love to give you a hug.
Fresh Air
Why Do We Itch?
But you don't feel that way when people are scratching. It's a really deep thing. thing. Don't get scabies. Don't get bedbugs. Don't get ticks on you, whatever is going on with them. And I think it's, again, it's like a deeply elemental thing. I don't think that people are trying to be cruel. I think there's something deeply hardwired in there, right?
Fresh Air
Why Do We Itch?
Like, don't approach the mangy dog that looks like it has fleas all over it. You know, don't approach the human that's compulsively scratching themselves, which, you know, is socially coded in the same way that like chewing with your mouth open is. It's not something that is an attractive thing to do.
Fresh Air
Why Do We Itch?
I often sort of tell it to shut up. I'm often like, I know, I know I'm itchy. You can stop it. I know. I don't need to itch. I don't need to be scratching. I don't know why it's happening, but it could stop and we'd be fine. There's no point to my itching. It's not helping me get something off of my skin. It's just interrupting. Thank you so much. So many people come to better terms with that.
Fresh Air
Why Do We Itch?
And I always want to be careful to note, like, it's, you know, I don't think that illness is any kind of gift. And I don't think that there needs to be upsides to bad things happening to people at all. But I do appreciate the insight that I've had into myself, even if I wish that I never had occasion to have it.
Fresh Air
Why Do We Itch?
I just like you can endure a lot. Your body is going to fail you. You know, it can feel completely crazy making and obsessive and miserable and you can survive it. You can just keep on breathing through it. You can do really amazing, wonderful things. And again, that's not to say I think that it's worth it or that I'm taking the right lesson away from it.
Fresh Air
Why Do We Itch?
I really often just try to be like, not everything needs to be a lesson. You don't need to respond to things that are unfair and difficult in this fashion. But writing the piece led me to a much greater place of acceptance, and I really appreciated that.
Fresh Air
Why Do We Itch?
And I felt very, very good knowing that. But yeah, so I think that your hands, your hands are just enormously sensitive, right? Like so many of these touch receptors and receptors for hot and cool are on your hands. I think your feet and your scalp are also places that are just really, really sensitive in your body.
Fresh Air
Why Do We Itch?
I'm so sorry. Especially the people who are always itchy. I'm really sorry. I hope you turned this off the second you heard it. You're like, nope, not me, not today.
Fresh Air
Why Do We Itch?
I hope so. I hope so. And it is all of us. All of us. It's yeah, it's not as common as chronic pain, but chronic itch is really common and everybody is itchy at some point.
Fresh Air
Why Do We Itch?
Whereas, you know, like, you know, the small of your back or something might be less, less innervated in that way.
Fresh Air
Why Do We Itch?
Absolutely. I've tried to come up with a lot of metaphors for itching, and I feel like we have a lot of metaphors for pain, right? Unfortunately, all of us in human bodies experience pain and often really severe pain. And itching is basically a universal phenomenon also. But itching feels kind of qualitatively different to pain, at least to me in some ways. It can be really hard to tune out.
Fresh Air
Why Do We Itch?
I always describe it as being like a car alarm, right? Like you can't stop thinking about it. It interrupts you somehow. It feels like being trapped inside your own body. And, you know, maybe pain has these qualities for other people. Sometimes I describe it as like a feeling of drowning. It creates in me a sense of fight or flight, but there's nothing to flee from and nothing to fight.
Fresh Air
Why Do We Itch?
I guess you can scratch yourself and you're fighting your own body. It has this kind of hallucinatorially strange quality for me. Sometimes you're feeling things that aren't there. And sometimes I even get that sense. I will feel things on my skin when I'm looking at the skin and there's nothing there. And and It can be spooky in a way. And notably, there's lots of different ways to feel itchy.
Fresh Air
Why Do We Itch?
There's burning itch. There's kind of electric itch. There's sunburn itch. Our brain is amazing at sensing things in unbelievably refined ways. And so, yeah, you know, sometimes it's just a bug bite. And sometimes I'm like, I could write a book trying to describe this.
Fresh Air
Why Do We Itch?
I think everybody who listens to this is going to do that. We can talk about why that is. Why is that? Tell me why that is. So just to go back to one thing that you said, and then I'll answer that question. But yeah, scratching, it engenders pain in the skin, which interrupts the sensation of itch. And it gives you the sense of relief that actually feels really good.
Fresh Air
Why Do We Itch?
It's really pleasurable to scratch. And then when you stop scratching, the itch comes back. And the problem is that when you scratch or you damage your skin in order to stop the itch, to interrupt the itch, you actually damage the skin in a way that then makes the skin more itchy because you end up with histamine in the skin. And histamine is one of the hormones that
Fresh Air
Why Do We Itch?
generates itch within the body. But to go back to what you were saying, there's actual studies that show that itching is contagious. So watching somebody scratch will make a person scratch. There's this interesting question, are people scratching empathetically in the way that we will mirror the movements of people around us? in the way that yawning is contagious or crying can be contagious.
Fresh Air
Why Do We Itch?
But it turns out that, no, it's probably a self-protective thing. If you see somebody scratching, there's some ancient part of your body that says, that person might have scabies. That person might, you know, have some other infestation. I'm going to start scratching to get this off of myself. Because scratching is in part a self-protective mechanism, right?
Fresh Air
Why Do We Itch?
We want to get irritants off of the body, and that's in part why we scratch.
Fresh Air
Why Do We Itch?
Yes. So histamine is an amazing chemical that does many, many, many things in our body. And it's part of our immune response. It leads to swelling so the body can come in to heal. And the scratching is meant to get, you know, whatever irritant was there off. And the itch-scratch cycle ends when the body heals.
Fresh Air
Why Do We Itch?
So I think that that's all part of a natural and proper cycle that's part of our body being amazing at sensing what's around it and then healing it. But we have some itch that's caused by substances other than histamine. We've only started to understand that kind of itch recently. Similarly, we didn't really understand, science did not understand chronic itch very well until recently.
Fresh Air
Why Do We Itch?
And we're in a period, I'd say in the last 20 years, of just tremendous scientific advancement in our understanding of itch.
Fresh Air
Why Do We Itch?
I think the patients that he often sees, and he does a lot of things. He, you know, studies itch as a doctor who does medical research, and I believe that he also sees patients. I've talked to other dermatologists who've told me not to itch, who've, you know, tried to hand me cold packs and try to get my hands off of my body.
Fresh Air
Why Do We Itch?
and explained the itch scratch cycle and sort of said, OK, we might not be able to treat your underlying itch, but at least we can break the itch scratch cycle and stop that kind of secondary itch that's coming on top of it. And when I talked to him, he sees people that are so miserable and they know they know that scratching is not going to help them. But at some point it's reflexive.
Fresh Air
Why Do We Itch?
And I think that he felt like it was cruel to tell people to stop doing this thing that is so deeply irresistible and often the only source of relief that you might be getting, even if it's leading to a problem down the road.
Fresh Air
Why Do We Itch?
So short of having like a nice ice cold bath for somebody to sit in, telling somebody with no other answers at that moment to stop scratching themselves might feel a little bit rude. But I would say that all of the dermatologists I've ever seen have been very, very sympathetic and Itch is something that they deal with on a daily basis. It's enormously common, and they mean well.
Fresh Air
Why Do We Itch?
Absolutely. So I have a poorly understood degenerative disease called primary biliary cholangitis. It's autoimmune in nature. It seems to be partially genetically, you know, you perhaps have a genetic predisposition, but then perhaps environmentally triggered. They don't really know why people get it. Right now, I believe that it's roughly 80,000 people in the United States total who have it.
Fresh Air
Why Do We Itch?
About 9 in 10 of those people are women. And the disease is most common in adult women, somewhat 40 and older. And it is a disease in which the body mistakenly attacks some of the cells in your bile ducts, in the lining of your bile ducts. It causes them to inflame. It hurts your liver's ability to secrete bile into your digestive system, into your body.
Fresh Air
Why Do We Itch?
It is. I have been itchy for about four days now. So we're talking during the daytime, so I'm not terribly itchy. But my feet are itchy, my scalp is itchy, and my hands are itchy. But it's a two out of ten. It's manageable.
Fresh Air
Why Do We Itch?
And ultimately, if the disease is allowed to progress, will slowly progress towards cirrhosis. Disease used to be considered or was often considered fatal. They found a drug, an actually really old drug that dissolves gallstones, works really well to slow its progression. And so, yeah, so that's the condition that I had.
Fresh Air
Why Do We Itch?
I was diagnosed with it during my second pregnancy, though I clearly had it in my first pregnancy. And I was young, although not unheard of, young to get it. And my OBGYNs had never had a patient with it. It took a while to get to a hepatologist who recognized it.
Fresh Air
Why Do We Itch?
But it, like a lot of liver and kidney conditions, for reasons that are not understood at all, causes really, really bad itching that does not respond to antihistamines and does not respond to steroids.
Fresh Air
Why Do We Itch?
We know a lot more, and we have a pretty clear map of itching that is a allergic response, a histamine response. So the kind of itching that probably comes from trying a new laundry detergent that doesn't agree with you or getting a bug bite, something like that, sometimes called histaminergic itch.
Fresh Air
Why Do We Itch?
And it's basically that histamine is firing up these nerve circuits, goes to the brain, brain senses itch, and then you scratch. That's a very, very probably oversimplified explanation. Scientists did not know until recently what was happening with itch that didn't involve histamine.
Fresh Air
Why Do We Itch?
They understood that you could itch completely independent of histamine, but what chemicals and what nerves were involved in that? It's really only like 20 years ago that they began to get a good sense of it. And that was about the same time that they really began to see that Itching was a sensation distinct of pain in the sense that there are nerve circuits that only work with itch in the skin.
Fresh Air
Why Do We Itch?
That said, and I'm going to caveat this because every scientist I talked to caveated it too, that, you know, these pathways within our body, it's not like a car traveling route. from destination B to destination A on a road, right? It is like trying to describe a city full of traffic. There are many, many pathways. They're enormously complicated.
Fresh Air
Why Do We Itch?
They interrupt or intensify or turn down one another. And so pain and itch are still pretty tightly linked in the body. And lots of painful things will ping itch receptors. Itch receptors will ping pain receptors. So we don't want to cleanly say that these are two different things. But there are itch circuits that are just for itch. And we found those. We sort of nearly found them in the late 90s.
Fresh Air
Why Do We Itch?
We really found them in the aughts is the sense that I got from scientists.
Fresh Air
Why Do We Itch?
At its worst, it was like having poison ivy in the acute phase of poison ivy, although my skin didn't show anything. There was no rash or anything like that. And it was completely maddening. It was impossible to do anything other than focus on scratching or trying to find relief from the itching. And the type of itching that I have is not sensitive to the medications that we have that normally...
Fresh Air
Why Do We Itch?
So if we understand what is happening in the body with these forms of itch, we can then go in and find ways to disrupt it. All different spots along those routes that we understand are being caught in that traffic snarl. It gives scientists a way to try to develop drugs or treatments that interrupt it.
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Can I microdose veganism?
I didn't see any turkeys thrown out of planes, but I'm talking to a ton of people. And then towards the end of this conversation, I was talking to this guy who was involved, and he was like, oh, you know, there were turkeys that were thrown out of planes. I was like, what are you talking about? I was there the entire time.
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Can I microdose veganism?
And he was like, oh, well, they weren't thrown out of planes, but they threw them like off of a truck. Like they had gone to someplace high and thrown them out of a truck. And again, I was like, I did not see that. I was not there. And he was like, well, I wasn't there either, but I heard about it. And so I managed to get daisy chained to this guy.
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Can I microdose veganism?
And he was like, yeah, we decided to have like a little festival within the festival to do some turkey throwing. And like, you know, nobody got hurt. It was wonderful. Everybody loved it. And that was the kind of end of the piece.
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Can I microdose veganism?
Yeah, totally. I felt nothing for the turkeys whose legs were for sale at the Yelville turkey drop, and nothing for the birds in the surrounding hills. Even when I knew they were sitting, crowded by their neighbors, legs broken and beak cut, awaiting the electric bath and the scalding tank and the dinner table. Felt nothing for the turkey toms threshed to death as soon as they were born.
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Can I microdose veganism?
Something for the birds chucked out of the plane, flapping wildly to stay upright. I felt something for the birds panting and panicking when caught by children below, pinned down with their heavy breasts and thick thighs and thin bones. I felt perhaps too much for George, that fabulous ham of a turkey that had rushed out to greet me but was too shy to take some tomato out of my hand.
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Can I microdose veganism?
To think this way and to feel this way is, of course, to be human. To paraphrase Joseph Stalin, one turkey thrown out of a plane is a tragicomedy. 46 million turkeys killed in a slaughterhouse is Thanksgiving dinner. You can hold the suffering of one being in your head and your heart, but the suffering of many becomes static.
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Can I microdose veganism?
I get it. When I was earlier in my veganism, I had this rule for myself, which was that if I was maintaining a vegan diet and avoiding things like buying leather or fur or products that I knew were tested on animals, that I didn't have to go look at vegan propaganda or really just go look at what the food system was actually doing.
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Can I microdose veganism?
But if I wanted to eat meat and dairy and buy leather goods and all of that, that I should really understand what I was doing and what I was purchasing, and I had to go look at it. And the information is out there.
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Can I microdose veganism?
And I actually think that I, in that sense, was similar to everybody, which is that people don't want animals to suffer at all. Your average person is an animal lover, and I think is really sincere about that. You can look at how people treat their dogs and their cats, and they don't want animals to live lives of pain and fear and then have this really horrible end either.
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Can I microdose veganism?
But they also don't want to think about it. They want somebody else to think about it. They want to trust that there is a system that is protecting animals.
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Can I microdose veganism?
In the fall, I was contacted by the head of a farmed animal advocacy group called Farm Forward. And a guy named Andrew, he used to be involved with the organization that checks the welfare and sort of sets the welfare standard for the meat that you see in Whole Foods.
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Can I microdose veganism?
And he said that he had gotten information from a number of whistleblowers, both people who had worked on these farms and worked with the farm.
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Can I microdose veganism?
This wasn't like a big factory farm company. This was a farm that is almost kind of famous and considered really best of class in terms of dairy production. That interested me about it, in part because I was skeptical, right? I was like, you're telling me that this farm that's really notable for having high animal welfare standards is abusing animals.
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Can I microdose veganism?
So I was looking through all of these photographs and videos and I was just like, well, how do I know what's going on here?
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Can I microdose veganism?
Yes. So dairy cows are kind of beef cows with a job to do first.
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Can I microdose veganism?
Beef cows, they're both male and female. And most beef cows in the United States are kept on range. They're kept outside in big herds. And they're not really messed with, right, until they are brought to a feedlot to fatten up and then they're sent to slaughter. That's the life cycle of your average beef cow in the U.S., Dairy cows are inseminated or bred, the calves are taken away.
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Can I microdose veganism?
The male calves are generally not worth very much because they can't become dairy cows and they don't make great meats. You're not going to spend a lot of money raising them and fattening them up. So the male calves often are slaughtered quite quickly and they become something like dog food. The dairy cows then are milked for a couple of years, somewhere between usually two and six years.
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Can I microdose veganism?
And the auction is, you know, this isn't Sotheby's. It is like a small kind of rickety roadside operation. This is in the far north of California. It's like four or five hours north of San Francisco. So it's sort of in the middle of nowhere. It's a public auction. You can go sit on like these plywood bleachers and cows come in and the auctioneer sort of mumble chants and the cows get a price.
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Can I microdose veganism?
Exactly. That's what's happening. That is precisely what's happening. There's cowboy hats involved. And a lot of the cows are going for like a couple dollars per pound, $2 per pound maybe. And then some other cows go for really, really cheap, like $0.05 a pound, $0.10 a pound.
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Can I microdose veganism?
And after the auction was over, later that night, all of the animals that were sold are kept in these pens back behind the auction house. And so we went with one of the buyers of some of the cows to look at them and got a copy of the auction affidavit, which is a legal document kind of showing the chain of title of who's owned a cow. And you can look at the cow's ear tag and see who owned it.
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Can I microdose veganism?
Yes. So this is in the back of the auction, and that was when I saw more closely just how kind of little and skinny cow 13039 was. Aw, little baby. Hi.
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Can I microdose veganism?
Just explain what you just did for me. So she's still producing milk, so this cow has been recently milked.
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Can I microdose veganism?
This is A2A2 milk. And one of her eyes was, like, cloudy and roomy, and then the other one was covered with a denim eye patch.
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Can I microdose veganism?
Which was notable. She was the only cow there with a denim eye patch. So I kind of helped to sort of work up the denim patch's edge. And the patch was glued directly onto her orbital rim. And I'm kind of like very, very gently like using my finger, right, like to sort of get it. And at some point, one of the folks who was there just pulls it off. And her eye... kind of half falls out.
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Can I microdose veganism?
It swells out of the socket. Wow. And it's still attached to her skull by sinew and, you know, some of the tissue internal to the eye. And there's, you know, musculature there.
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Can I microdose veganism?
Yeah. It was bloody and pussy. It smelled really bad. And I asked, when the rancher's there, I was like, what has happened here? And all of the folks there who work in the dairy or the cattle industry were like, well, that's cancer eye. It was so surprising to me. We didn't know that there were going to be any cows from this farm when we went there.
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Can I microdose veganism?
And we did not know that there was going to be a cow that so clearly should have been euthanized probably some time ago. A cow this sick shouldn't have been transported, should have received medical care a long time ago, shouldn't have been sent to auction.
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Can I microdose veganism?
This was a cow that, you know, if you were facing the question of do you send this cow to auction or do you euthanize on site, I don't know why you wouldn't have euthanized on site.
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Can I microdose veganism?
What is criminal is... socially constructed, right? And in the case of animals, we might think that we have a standard for how we want to treat animals in our care in this country.
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Can I microdose veganism?
And we kind of set that standard that they should have medical care, that they should have adequate food and water, that they shouldn't have painful things done to their bodies without anesthesia, that they should be euthanized quickly if they're in pain and they can't be treated. But what I think has happened is kind of the opposite.
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Can I microdose veganism?
We've understood what it takes to produce food inexpensively and reliably at mass scale. And whatever that requires of animals is what is legal.
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Can I microdose veganism?
The farm is just impossibly beautiful in this kind of, you know, there's like wild elk roaming around and flocks of wild birds. And the cows are really out there on pasture. They really, really are. This is Northern California, so it's really mild, wet weather. And they're kept out in these kind of like beautiful fields all by the ocean. Lots of space.
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Can I microdose veganism?
I would rather be a beef cow than a dairy cow, but this is, it is physically beautiful, and I think that there's a lot of things about the farm where they're doing it well.
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Can I microdose veganism?
Yeah, I'm really grateful that they sat down with me and answered all of my questions. And it was awkward and it was tense. But I appreciated getting their perspective. And I also came away from my meeting with them thinking that I'm not sure that... I'm not sure, especially with dairy specifically, I don't know how much better you could do than how they're doing. Wait, really?
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Can I microdose veganism?
I think that one thing that I took away was that— They were just so big. There were so many cows. The whole operation was so enormous. And so it did have that kind of element of industrialization. Second thing is that the organic prohibition on the use of antibiotics, it just creates terrible incentives and results in a lot of animal cruelty.
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Can I microdose veganism?
Yes. My name is Annie Lowry, and I am a staff writer at The Atlantic.
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Can I microdose veganism?
The United States has an extraordinarily rigid rule in its organic program that any animal who's given an antibiotic at any point in its life is no longer organic. So if you had an organic dairy cow who was given a course of antibiotics for, like, you know, pneumonia at week seven of its life, it's a conventional cow for the rest of time. Five years later, it still can't be an organic cow.
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Can I microdose veganism?
But this is problematic because it incentivizes farmers not to give organic cows antibiotics even when they really need them.
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Can I microdose veganism?
Totally. And it means that if a cow is not going to die from an infection, the math suggests that you should withhold the antibiotic. There's a rule also in the organic program that you cannot withhold antibiotics in order to maintain a cow's organic status. But talking to folks in the industry, it happens all the time.
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Can I microdose veganism?
I haven't for a long time. I was like a slippery slope vegetarian, so I ate meat for most of my life. And then at some point was like, okay, I'm going to try to stop eating the low welfare stuff. So I was like, okay, I'm going to try to eat animals that have lived a pretty good life, high welfare.
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Can I microdose veganism?
They had instituted a policy, and they actually showed me it, that they had written out in English and Spanish for all of the farmhands just about what to look for canceri. They said they didn't get a lot of canceri because it's pretty cloudy there and UV exposure is one of the things that seems to be a factor in the development of canceri.
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Can I microdose veganism?
But they admitted, they were like, yeah, that cow should have been sold to auction or euthanized way sooner. That shouldn't have happened.
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Can I microdose veganism?
It was interesting. I had been bracing to get a lot of angry emails from farmers and organic farmers about, you know, did an isolated incident really mean a pattern of abuse? And I actually got a ton of notes from farmers, both organic and non-organic, saying that they thought that the substance of the piece was a little bit shocking and that it shouldn't have happened.
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Can I microdose veganism?
And a lot of them saying basically, yeah, like with a farm that big, I don't know how you would have really high standards for that many cows. I also got notes from some farmers who I think are really committed to doing it right. This was two dairy farmers in the Northeast.
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Can I microdose veganism?
And they said that they don't like the system as it exists either because there's some really high quality animal welfare certifiers, nonprofits, but there's some that are just industry fronts. If you can just like slap, you know, ethically sourced or certified as humane by so-and-so on any product, that means that it's not fair in an even playing field for all of the farmers either, right?
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Can I microdose veganism?
I was a vegetarian for a long time, and I can talk about why I think that that's not really a useful moral category. I think you're better off eating beef and, like, oysters than you are eating eggs and dairy.
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Can I microdose veganism?
Absolutely. So my answer to this is always, you can just eat less. You can just reduce your meat, dairy, and egg consumption by cutting it down. You don't have to go all the way. You could do it like once or twice a week, like one meal per day. That's great. That's like a wonderful, wonderful, wonderful start. Sometimes I hear people and they're like, my consumption doesn't matter.
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Can I microdose veganism?
There's this massive machinery of agricultural production in the United States. What does it matter if I'm not eating it or if I am eating it? I'm such a tiny, tiny part of demand. But there's actual studies that really do show kind of like two things. So one is that supply is responsive to demand. Absolutely.
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Can I microdose veganism?
So if you stop eating animal products entirely, there's like a measurable number of animals that won't die and won't be part of the food system for that. And the second thing is that there is a kind of subtle social contagion effect that people do kind of tend to do what the people around them do.
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Can I microdose veganism?
So if you're like, yeah, I'm trying to eat higher quality meat or I'm trying to eat less of it, I do think that that matters.
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Can I microdose veganism?
Yeah. I wrote a whole piece about this. You can't persuade people. It's so fascinating to me. We have had 50 years of animal rights and vegan activism that has not increased the share of vegetarians in the United States at all. None. None.
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Can I microdose veganism?
Completely and totally unsuccessful social movement. You can get people to kind of maybe go vegan-ish or vegetarian a little bit on the margin. It never sticks.
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Can I microdose veganism?
It's a really hard cause. People don't want to be told that they are participating in something evil. They don't want to feel bad about themselves in that way. And it's just a really hard sell. Like, oh, all those meals that your grandmother made you, those were cruel and immoral. That's an awful message to deliver to somebody. Like, oh, you want ice cream because your boyfriend broke up with you?
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Can I microdose veganism?
Why don't you think about the animal, right? Nobody likes it.
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Can I microdose veganism?
Yeah, Yellowville, Arkansas. It's beautiful. It's in the Ozarks and a really tiny town. And it happens to be in a part of the United States that has a lot of turkey processing. So they grow a lot of turkeys and they process a lot of turkeys there. And they've had this tradition for like 70 years. It's at this kind of fall festival that they have called the Turkey Trot.
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Can I microdose veganism?
Turkeys don't really fly. They can kind of catch the wind sometimes. So the turkeys you probably eat, like a butterball turkey at Thanksgiving, that turkey is not going to be able to fly at all. They are so big. They are so heavy. They might like flap a little bit, but it's, you know, it'd be like sticking two tiny wings on like a dishwasher, right? Like it's just not going to be able to fly at
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Can I microdose veganism?
Yes. And they're using generally sort of the heritage turkeys, so the dark feathered ones. If you're buying like a really nice Thanksgiving turkey, it might be one of these. And those turkeys are better flyers. And I would also note, because I always get commentary about this, wild turkeys can kind of fly, but they're not good flyers. They're not going to fly long distances, right?
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Can I microdose veganism?
Like they can get up into trees and things like that. I'm not saying that they can't fly, but they're not good.
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Can I microdose veganism?
Oh, God. These people, they're like, I've seen them. And I'm like, Trust me, they're bad flyers. These are not hawks. These are not eagles. They're not sparrows. They're not pigeons. And, yeah, that was exactly it. So, anyway, in Yellville, so they throw the turkeys out of this, like, low-flying aircraft. They do this for literally decades. And some of the birds die immediately.
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Can I microdose veganism?
Some of the birds die of shock or stress. They have, like, heart attacks, basically, because they're so upset by this. A lot of them are injured. Some of them survive.
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Can I microdose veganism?
They have this, like, really amazingly overwritten story. And then at some point PETA hears about it. I see. And PETA gets involved. And PETA is just great at whipping folks up. They're like, this is terrible. There's this whole campaign to shut it down.
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Can I microdose veganism?
The town cops weren't going to do anything about the turkeys. Like, these are people from this community. Why would they stop it? and be like, okay, let's get that plane's tag number and go and try and find it. People had tried to get the FAA involved because they were like— They wanted the FAA to regulate. Exactly. They were like, can you throw turkeys out of planes?
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Can I microdose veganism?
This doesn't seem like a great idea. And the FAA is basically like, yeah, we're not getting involved in this.
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Can I microdose veganism?
So I went to Yelville to talk to people about this, in part because there was just so much— there's such strong partisans on either side. And a lot of folks in Yelville, many of whom work in turkey processing, are like, you have national media attention over 10 birds, not all of whom die, some of whom survived. At the same time that we are like an agriculturally dependent community where—
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Can I microdose veganism?
You know, every fall we eat 45 million turkeys that live life in warehouses and get slaughtered when they're like a few months old. Isn't there some irony here?