When You Talk In Your Sleep, Are You Talking To Your Secret Self?

In this week’s episode of the show and podcast Invisibilia, we explore what happens when you discover a part of yourself that is very different than who you think you are.

And Freud was so wrong about our dreams. In NPR’s Shots blog, Jon Hamilton explains that scientists now think that our dreams have nothing to do with repressed desires. Instead, it looks like they help us process memories and gain insight. They can be surprisingly mundane. And funny.

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OB-GYNs Give Women More Say In When They Have Mammograms

Women have gotten conflicting advice from doctors on when to have mammograms.


Amelie Benoist/Science Source
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Amelie Benoist/Science Source

Women in their 40s at average risk for breast cancer should talk to their health care provider about the risks and benefits of mammography before starting regular screening at that age, according to guidelines released Thursday by the American College of Obstetricians and Gynecologists.

The group previously recommended annual mammograms starting at age 40. But the advice has changed to better incorporate input from the woman being screened, says physician Christopher Zahn, vice president of practice activities at ACOG. “A patient’s preferences and values need to be an important part” of the decision, he says.

Now the group says providers should offer the test when a woman enters her 40s, and that after a discussion, she may opt to start screening. If she doesn’t, she should start by age 50, ACOG says. Zahn says the guidance intentionally encompasses advice from other major groups.

The U.S. Preventive Services Task Force says women should start regular mammograms at 50, and that women in their 40s should make an individual decision about whether or not to screen. The American Cancer Society says screening should be offered starting at age 40, and outright recommends it starting at 45. And the National Comprehensive Cancer Network, an alliance of major cancer centers, recommends starting at 40.

The question all these groups have wrestled with is how to balance the benefits and harms of mammography; their different recommendations reflect differences in how they interpreted and weighed the available data. “All three [schedules] are reasonable approaches to take,” says Zahn.

Mammography clearly saves lives for women over 50, and likely does so overall for women in their 40s, says Otis Brawley, chief medical officer at the American Cancer Society. But the benefits in those younger women are smaller, and come at the cost of false alarms, unnecessary biopsies and overdiagnosis, when cancer is detected and treated that never would have threatened a woman’s health had it gone undiscovered. (The ACS says estimates of overdiagnosis vary widely, from 0 percent to 54 percent of breast cancers, in part depending on whether cases of ductal carcinoma in situ – abnormal cells that sometimes turn into cancer — are included.)

Once a woman starts mammography, she can be screened every one or two years, again after a discussion about the pros and cons of the different schedules, ACOG advises. The American Cancer Society recommends annual screening for women through age 54 and every other year for older women, with the option to continue annual tests, while USPSTF says every other year is sufficient and the network of cancer centers recommends annual screening.

A statistical model from the USPSTF finds that if 1,000 women are screened every other year from age 40 to 74, there will be eight fewer breast cancer deaths compare to no screening, 213 unnecessary breast biopsies and 21 overdiagnosed breast tumors. Meantime, if 1,000 women are screened every other year from 50 to 74, there will be seven fewer breast cancer deaths compare to no screening, 146 unnecessary biopsies and 19 overdiagnosed tumors.

Some women may decide that the small additional benefit doesn’t outweigh the increased risk of biopsy or possibly being treated for a cancer that didn’t need attention. There’s as yet no sure way to know which tumors are harmless and can be left alone. Others may choose differently. “There’s more of a respect for the individual person,” says Brawley of the new ACOG guidelines and the 2015 changes by his own organization. “You’re starting to hear, ‘Let the woman decide.'”

“If a woman is told to get a mammogram starting at 40, it’s very reasonable to question that and ask, ‘Why? I’ve read that there are conflicting guidelines,'” says Deanna Attai, assistant clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles.

She says women should know, or ask about, the risk factors for breast cancer so they can have the screening conversation with some understanding of where they fall on the spectrum. And don’t stop the risk-reduction discussion at screening. “Ask what lifestyle or health habits can help reduce risk,” she says. (For example, research suggests exercise can cut breast cancer risk.)

On the question of when to stop routine mammograms, ACOG says screening beyond age 75 should be based on a conversation about a woman’s health status and longevity. The group also recommends against regular breast self-exams, but says women should be aware of the normal feel and appearance of their breasts so they can report any changes.

Keep in mind that these recommendations are for average-risk women who are not experiencing symptoms. Many factors can increase risk, including a family history of breast or ovarian cancer and certain genetic mutations. So those women should check with their physician about when, how, and how frequently they should be screened. There’s also not enough evidence to make recommendations on whether women with dense breasts should be screened differently.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She’s on Twitter: @katherinehobson.

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Man Accused Of Making Millions Of Robocalls Faces Biggest-Ever FCC Fine

Telemarketers are prohibited from making prerecorded phone calls to people without prior consent. It’s also illegal to deliberately falsify caller ID with the intent to harm or defraud consumers.

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PeopleImages/Getty Images/iStock

Federal regulators on Thursday said they’ve identified “the perpetrator of one of the largest … illegal robocalling campaigns” they have ever investigated.

The Federal Communications Commission has proposed a $120 million fine for a Miami resident said to be single-handedly responsible for almost 97 million robocalls over just the last three months of 2016.

Officials say Adrian Abramovich auto-dialed hundreds of millions of phone calls to landlines and cellphones in the U.S. and Canada and at one point even overwhelmed an emergency hospital paging service.

Making prerecorded telemarketing phone calls to people without their prior consent is prohibited. So is making telemarketing calls to emergency phone lines and deliberately falsifying caller ID to disguise identity with the intent to harm or defraud consumers.

According to the FCC, the robocalls made by Abramovich through his ambiguously named companies (Marketing Strategy Leaders or Marketing Leaders) would show up “spoofed” as if they came from a phone number with the same area code and the same first three digits of the recipient’s number.

If the recipients answered, they’d get a recording offering an “exclusive” vacation deal from prominent travel companies such as Expedia, Marriott, Hilton or TripAdvisor — instructing them to “Press 1” to learn more. But pressing 1 would instead land people on a line with a call center hawking “discounted” vacation packages and time-shares unaffiliated with any of those brands.

According to FCC documents, TripAdvisor investigated some of the robocalls that purported to offer that company’s deals and found call centers that it said were based in Mexico.

Abramovich now faces the largest penalty ever proposed by the FCC, according to FCC Commissioner Mignon Clyburn. The fine is for Abramovich’s unlawful caller ID spoofing, the FCC says. The agency’s Enforcement Bureau has also issued a citation to Abramovich, and the documents say his “mass robocalling campaigns violate the Communications Act, and his misrepresentations in the prerecorded messages constitute criminal wire fraud.”

Abramovich now has 30 days to respond to the FCC, which is expected to finalize the investigation and penalties in the following months.

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NBA Draft Day – The Impossible Dream To Beat The Golden State Warriors?

Golden State Warriors celebrate their 2017 NBA Championship at The Henry J. Kaiser Convention Center in Oakland, Calif., on June 15.

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Thearon W. Henderson/Getty Images

For those too young to remember the NBA’s Michael Jordan era, you’re living it now. The Golden State Warriors are the new Michael Jordan.

When Jordan ruled the earth’s hardwood, everyone else played for second. That’s where we are today with the super team from the Bay Area that just wrapped up its second title in three years.

So why even play games for the next 3 to 5 years? Just build a permanent trophy case in Oakland’s Oracle Arena, right?

WRONG.

Sports, if anything, represent hope. It’s why they play the games. On any given Sunday. David did beat Goliath.

Which brings us to today’s annual day of NBA hope – the draft. Teams will replenish rosters with fresh faced, college-aged talent; they’ll execute trades to move up in the draft order.

Draft day also begins what’s expected to be a frenzied summer that will see the better teams try to beef up AND bolster their rosters in an effort to challenge you-know-who.

Here’s some of what’s being said about the expected frenzy – an offseason drama that may as well be scored to “Man of La Mancha.”

To dream the impossible dream
To fight the unbeatable foe

“Cleveland is closer than anyone to competing with Golden State, and the only player who realistically gets them closer is [Indiana Pacers star Paul] George.”

That’s from a CBSSPORTS.com article titled “Six trades or free-agent signings that could challenge Warriors’ NBA supremacy.” The article also suggests sending Chicago’s Jimmy Butler and Utah’s Gordon Hayward to Boston, Chris Paul of the L.A. Clippers to San Antonio and sums up with the three-team trade that would “save the world.”

To try when your arms are too weary
To reach the unreachable star

If the quest to topple Golden State begins with tonight’s draft, it’s not as easy as taking one of the projected stars, such as Washington’s Markelle Fultz, UCLA’s Lonzo Ball OR Josh Jackson of Kansas. Teams have to get the right players that fit, then develop them into stars, says Neil Paine from fivethirtyeight.com. “To beat the Warriors,” Paine writes, “you have to do what the Warriors did.” That included drafting Draymond Green 35th in 2012. The Warriors did pick Stephen Curry and Klay Thompson in the first round of the 2009 and 2011 drafts respectively. But Curry wasn’t an NBA all-star until 2014 and Thompson, in 2015.

The Warriors, as it turns out, do not have any picks in tonight’s draft. That doesn’t mean they won’t be active – at the right moment. Golden State still could buy a draft pick, which it did last year, or getting the Warriors UNLV’s Patrick McCaw. He got regular playing time in his first year, giving him the confidence to play effectively even in critical moments. He played 11 minutes in this month’s title-clinching game and scored 6 points.

Everything Golden State touches, it seems, turns to gold.

OK, almost everything. The Warriors drafted Ekpe Udoh with the 6th pick in the 2010 draft. He’s now playing in Turkey.

Still, Golden State mostly has made the right moves and made itself into a great team that was able to lure Kevin Durant last offseason – a super free-agent signing that turned the Warriors into a super team.

Tonight, the Philadelphia 76ers have the first draft pick – the first official counter move in this new NBA era of “Golden State vs. the World.”

Philly, you’re on the clock.

And so are 28 other NBA teams that will do what they can – draft, trade, buy, sell – to pull closer to the Warriors. Ever closer.

And the world will be better for this
That one man scorned and covered with scars
Still strove with his last ounce of courage
To fight the unbeatable foe, to reach the unreachable star

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A Wounded Union Soldier In A House Of Southern Women: 'The Beguiled'

L to R: Elle Fanning as Alicia (Elle Fanning), Miss Martha (Nicole Kidman), Edwina (Kirsten Dunst), Jane (Angourie Rice), Amy (Oona Laurence), Emily (Emma Howard), and Marie (Addison Riecke) in The Beguiled

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Ben Rothstein /Focus Features

While Clint Eastwood was busy playing a wounded Union soldier held at the pleasure of a bevy of Southern belles in Don Siegel’s 1971 Civil War drama The Beguiled, the actor also found time to direct his first film, Play Misty for Me, in which he also starred as a disc jockey stalked by an unhinged female fan. Both films were visceral articulations of male paranoia about the sinister potential of repressed or oversexed women.

Imagine such fighting talk in the hands of a woman filmmaker whose aesthetic draws heavily on the world of fashion. Best known for lushly visual meditations like The Virgin Suicides, Lost in Translation, and Marie Antoinette, this year Sofia Coppola became only the second woman since 1961 to win Best Director at the Cannes Film Festival for her take on The Beguiled. Though Coppola adapted her screenplay from the original novel by Thomas Cullinan, her interpretation also streams a sly subterranean dialogue with Siegel’s nakedly badass reading. Coppola’s The Beguiled doesn’t so much negate the festering male paranoia as reclaim the point of view for the women it targets. Then she bats the premise around like a graceful cat with an addled mouse in its paws.

The Beguiled opens with an archetypal fairytale sequence of a little girl in braids wandering into a forest, pausing to collect mushrooms in a basket. The meaty veggies will be back later in a crucial supporting role. For now they provide innocent ambiance as the girl ventures deeper into the woods, where she stumbles on a wounded Union soldier who is either a wolf in lamb’s clothing or the other way about.

Both are viable possible outcomes given that Corporal John McBurney is played by Colin Farrell, who could charm the Spanish moss off the mist-covered trees, with an edge of sinister. Back at the gated ladies’ seminary where teachers and girls strive to maintain a chastely Christian life even as the war dwindles their reserves, McBurney turns his Irish magic on every girl or woman who visits his room to nurse him back to health. Which, in short order, is every voluminously skirted female in the house, whatever her age and with or without permission.

The first hour of The Beguiled is as slow and atmospheric as you’d expect from Coppola, some of whose exquisitely mounted films, it must be said, are paced like beautifully crafted wall hangings. Posed like tableauxvivants in artfully coordinated pale pastels, the assembled women more closely resemble a period-perfect Vogue cover than a besieged community on the losing side of a brutal war.

There is cunning method, though, in the suffocating formality of the well-mannered civilities that pass at first between the ladies and their patient. Underground energies are released and libido rises as three of our most intelligent actresses — Nicole Kidman as the tightly wound principal, a wonderful Kirsten Dunst as an earnest teacher ripe for all kinds of flight, and Elle Fanning in fine form as a trainee strumpet — gear up for a covert but accelerating rivalry for their objet de lust. Here the pace quickens nicely into a whispery bedroom farce with modest bodice-ripping attached. McBurney, it turns out, has radically underestimated his hosts, and his practiced efforts to divide, conquer, and score bring about a sharp left turn into Southern Gothic, delivered with Coppola’s signature, coolly amused gaze. Civilization goes out the window, and suffice it to say that a teacher’s injunction to “brung meh thah anatomy textbook” is not a last call to biology class.

Is Coppola’s The Beguiled a “women’s movie?” As always the director has stacked her cast and crew with female talent, and certainly the film is all about women taking charge of their emerging animal natures. Some feminists have pursed their lips over Coppola’s recent admission that she’s never heard of the Bechdel test, which calls for films in which women talk to each other about anything other than men. The Beguiled‘s women do little else, but though I suspect Coppola would wince at the word empowerment — ideology and art don’t mix well in her movies — they move on to carry the conversation, shall we say, to their distinct advantage.

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Documentary Scours Our Noisy Globe 'In Search Of Silence'

Tea ceremony participants in Kyoto, Japan from In Pursuit of Silence.

Cinema Guild

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Cinema Guild

The premiere of John Cage’s famous/notorious composition “4’33″” in Woodstock, New York in 1952 stirred some measure of the outrage that greeted Stravinsky’s “The Rite of Spring,” only here the audience was upset by the notes they didn’t hear, instead of the ones they did. The first of three movements started with the pianist opening the keyboard lid and ended with him closing it; that same pattern was repeated for the next two. After four minutes and 33 seconds, the composition was over and the fury began: “Good people of Woodstock,” one audience member declared, “I think we should run these people out of town.”

The good people of Woodstock felt cheated because they came to a music concert and heard no music. Cage’s piece implies that the deliberate, conscious silence heightens awareness of the fact that music is everywhere—in the natural sounds bleeding through from the outside, in the shifting of seats, in the whispers of “isn’t this pretentious twaddle?” wafting down from the balcony. In the decades since, Cage has won the argument: “4’33″” remains his most widely discussed and celebrated work, and it’s been performed by underworked orchestras in venues as exalted as Carnegie Hall. It seems the noisier the world gets, the more essential Cage’s work as an aural palate-cleanser.

Patrick Shen’s documentary In Pursuit of Silence include Cage’s work in a spectrum of other sounds, from the quiet of a Kyoto tea ceremony to the decibel-bursting street noise of Mumbai during its three-month festival season. Its central purpose is the same as Cage’s: To make the viewer aware of the sounds they accept without thinking and the ones they’re not attuned to hearing at all. Shen makes his case through a globetrotting survey of different soundscapes and interviews with doctors, theologians, scientists, and others who proselytize about the virtues of quiet and solitude.

As much a visual treat as an aural one, the film divides its time between using the tools of cinema to isolate and enhance the beauty of sounds and silence and exploring different schools of thought on the subject. Shen follows Greg Hindy, a young hiker who decided to trek from Nashua, New Hampshire to Los Angeles, California without speaking a word, looking to confirm his intuition that his vow of silence would open him up to other inputs. He visits Okutama Forest in Japan, where an environmental research has established therapeutic retreats under the conviction that quiet can help relieve stress and prevent disease. He interviews a student and teacher at a New York public school where noise from the passing train disrupts 15% of instruction, debilitating the learning process.

In Pursuit of Silence aims for a comprehensive study of its subject, from the impact of sound pollution to the cacophony of urban centers and technology to the scientific and religious belief that silence brings us closer to our natural, primal, selves. To some extent, the film is fundamentally at odds with itself: There’s no easy way to reconcile the push-and-pull between conventional documentary interviews where experts share their thoughts and the wordless rapture of sequences where Shen illustrates the point through sound and image. Shen wants to be informative and demonstrative, and he struggles to have it both ways.

Not surprisingly, the film works best as pure cinema. It’s one thing to talk about noise and solitude, but much more powerful for Shen to cut from the “soul-crushing din” of cable-news arguments to the tea ceremony in Kyoto, where no voices compete against each other for attention. In another sequence, Shen isolates various sounds — rain on a rooftop, a child crying, radio static, a marching band, the ambience of Sixth Avenue — into a kind of sensory test, calling on us to assess their specific value. Fitting for a documentary about the value of quiet, In Pursuit of Silence is better when it shows than tells.

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Who Wins, Who Loses With Senate Health Care Bill

Senate Majority leader Mitch McConnell eaves the chamber after announcing the release of the Republicans’ health care bill on Thursday.

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J. Scott Applewhite/AP

Republicans in the Senate on Thursday unveiled their plan to repeal and replace the Affordable Care Act — also known as Obamacare. The long-awaited plan marks a big step towards achieving one of the Republican party’s major goals.

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The Senate proposal is broadly similar to the bill passed by House Republicans last month, with a few notable differences. Senate Majority Leader Mitch McConnell, who has been criticized for drafting the bill in secret with just a dozen Republican Senate colleagues, says the proposal — which he calls a discussion draft — will stabilize insurance markets, strengthen Medicaid and cut costs to consumers.

“We agreed on the need to free Americans from Obamacare’s mandates. And policies contained in the discussion draft will repeal the individual mandates so Americans are no longer forced to buy insurance they don’t need or can’t afford,” McConnell said.

The plan gets rid of those mandates. Instead, it entices people to voluntarily buy a policy by offering them tax credits based on age and income to help pay premiums.

This bill is better designed than the House version, according to Avik Roy, founder of the Foundation for Research on Equal Opportunity, because it offers more help to older people who can’t afford insurance while making coverage cheaper for young healthy people.

“The bill will encourage a lot more of those individuals to buy health insurance,’ Roy says. “That in turn will make the risk pool much healthier, which will also lower premiums. And the tax credits in the bill will also be better designed.”

But Caroline Pearson, a senior vice president at the consulting firm Avalere Health, says the bill bases its tax credits on lower-quality insurance.”If you’re paying a similar percentage of income, you’re getting a less generous product under this new plan,” she says.

The plan keeps some popular parts of Obamacare. It allows parents keep their kids on their policies until they turn 26, and requires insurers to cover people with preexisting conditions.

But it then allows states to opt out of that requirement.

“The protections around preexisting conditions are still in place in the Senate bill, but the waiver authority gives states options that could include limiting coverage for people with preexisting conditions,” says Pearson.

Those waivers would allow state to drop benefits required by Obamacare like maternity coverage, mental health care and prescription drug coverage.

Both bills would eliminate most of the taxes imposed by the Affordable Care Act.

And they would bar people from using tax credits to buy policies that pay for abortion, and also block Planned Parenthood from getting any money from Medicaid for a year.

Perhaps the most sweeping change, however, is that the Senate plan follows the House lead in completely changing how the government pays for health care for the poor and disabled, and goes even further.

Today, Medicaid pays for all the care people need, and state and federal governments share the cost.

But Medicaid has been eating up an ever-larger share of federal spending. The Senate Republicans’ plan puts a lid on that by rolling back the Obama-era expansion of the program and then granting states a set amount of money for each person enrolled. They also want to start to change the way the federal government calculates payments to the states starting in 2025, which will reduce the federal government’s contribution to the states.

“The Medicaid cuts are even more Draconian that the House bill was, though they take effect more gradually than the House bill did,” Pearson says. “So we’re going to see very significant reductions in coverage in Medicaid and big cuts in federal funding that will result in significant budget gaps for states.”

Several Republican senators have already said they oppose the bill, at least as of now. Senate leaders are aiming for a vote before July 4.

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