Star Tribune
Depression therapy has magnetic appeal across Minnesota
A magnetic therapy for persistent depression is in such demand in the Twin Cities that Allina Health has doubled its capacity with the opening of a new mental health center in Fridley.
While antidepressant medications and talk therapy are still the first options, Allina psychiatrist Dr. Bennett Poss said alternatives are needed for the growing share of patients who aren’t helped by those treatments alone. Transcranial magnetic stimulation has been an option in the U.S. for 15 years, but it emerged in the post-pandemic era as more people sought depression treatment and more research validated its potential.
“Evidence-wise, it’s one of those things that has actually panned out better or at least as advertised,” said Poss, who provides TMS at Allina’s Abbott Northwestern Hospital in Minneapolis. “There are so many things that look good in clinical trials and then they make it to patient care and they’re not so good.”
TMS involves magnetic coils that are placed on the scalp for around 30 minutes and direct pulses into the brain, usually at a golf-ball-sized target on the front left side that regulates mood. After one to two months of five-day-a-week treatments, about half of patients report some benefit and a third see remission of depressive symptoms, studies have shown.
Poss likened it to lifting weights or running, and he said that it stimulates a part of the brain that is underutilized in people with depression.
“We put it into use more than you would otherwise, and over time it causes some of the same changes you would actually see with exercise” to the body, he said.
More than 23% of Minnesota adults reported in 2022 that they had depression at some point, an increase from 15% in 2011, according to survey data from the Centers for Disease Control and Prevention. Minnesota in that timespan went from below the national average to at or slightly above it.
TMS is only recommended for a fraction of those patients who have been diagnosed with major depressive disorder, which is marked by severe and prolonged sadness and hopelessness. But clinicians said that is being diagnosed more as well.
“The cool thing about (TMS) is once people have received the treatment, and if they respond to it, they don’t have to continue it, necessarily. So it’s distinct in some ways from medication,” said Dr. Sophia Albott, who heads the University of Minnesota’s division of adult mental health.
The treatment has roots at the U, where Dr. Ziad Nahas was involved in clinical trials that persuaded the U.S. Food and Drug Administration to approve it in 2008 as a treatment for major depression in adults.
Albott said the magnetic therapy was originally limited to patients who had tried therapy and had no success, or had severe side effects, with at least four antidepressant drugs. The federal Medicare program recently expanded its coverage so that patients only had to try two drugs before being eligible for TMS, which partly explains the recent growth in Minnesota.
Coverage in Minnesota varies by insurance plan and employer. HealthPartners generally uses prior authorization in its plans to make sure patients have tried other treatments first, but Medica does not use that restriction.
Albott said she hopes it becomes more of a first-line therapy, though its time commitment will remain a barrier along with the roughly $10,000 cost shared between patients and insurers. Recent U research has tried to predict which patients respond best to TMS, whether it substantially increases interest in daily life and reduces suicidal impulses, and whether it can be expanded for use by adolescents and for neurological conditions such as stroke.
The treatment already has been approved for smoking and obsessive compulsive disorder, and some researchers believe it can treat the ear-ringing condition known as tinnitus, which also reportedly increased during the COVID-19 pandemic.
Becky Steffens, 39, of Coon Rapids, didn’t believe it would work, not after 15 years of dealing with depressive symptoms. Success at the U’s clinic for treatment-resistant depression came when her doctors switched sides and directed magnetic pulses into the right side of her brain. Research has found that some patients need stimulation on that side to regulate a different portion of the brain that fuels negative thoughts.
Treatment wasn’t easy because it disrupted work, was noisy and uncomfortable, she said. “It’s like a little bird is pecking on the same spot on your head over and over for like 50 minutes.”
It also wasn’t one-and-done success, as she needed two rounds and once-a-week maintenance treatments along with other depression therapies. But TMS gave Steffens several months of complete remission and reduced symptoms the rest of the time that allowed her to discover joys in life such as painting and volunteering.
“I’m able to have a baseline where I’m not necessarily, like, happy and joyful and everything is great,” she said, “but I’m not sad and stuck. I feel like it’s kind of a place where I’m able to have emotions, feel them and then come back to a baseline … and not get stuck in those negative sticky thoughts.”
Poss said there will be need for other treatments, including more extreme but highly effective electroconvulsive therapy that causes patients to go into seizures and “resets” their brains without depressive symptoms. But he said he is particularly optimistic about TMS now that it is gaining interest and access is expanding at Allina’s Mercy Hospital Campus in Fridley.
Hundreds of Minneapolis park workers went on strike on Thursday — the first strike by workers in the park system’s 140-year history.
After seven months of contract negotiations, about 100 union workers and supporters rallied and marched Thursday in northeast Minneapolis, kicking off what could be a week-long strike.
The Minneapolis Park and Recreation Board gave its “last, best and final offer” Monday before the workers’ contract expired Tuesday.
The Laborers’ International Union of North America (LIUNA) Local 363 said they haven’t reached tentative agreements on a single one of their proposals, including improvements to health care, safety procedures and pay raises.
“These are not unreasonable demands. These are basic rights that every working person deserves,” said AJ Lange, an arborist who is now the business manager of Local 363, which represents more than 200 employees and more than 100 seasonal workers.
The last offer from the Park Board was a 10.25% wage increase over three years, plus two market adjustments for 13 positions.
“That would barely get us caught up,” Lange said, adding that workers’ pay has slipped by 10% in the last three years due to rising inflation. “We’re not asking to be rich. We’re just trying to get by. We’re asking for a fair share in the work we do so we can afford to live in the city we take care of.”
He added that the Park Board had proposed concessions, like overtime restrictions, that would harm workers.
In a statement, Park Board spokeswoman Robin Smothers said Park Board leaders believe their proposals were reasonable and comparable to eight other Park Board employee union contracts. The Park Board “leadership believes it is vitally important that employee wages and benefits are fair and competitive throughout the organization,” she added.
The Park Board has previously said that its funding is limited, especially with decreasing property tax collections. If employees choose not to report to work during the strike, they must remain on strike for the duration of the strike, until the agreement is ratified, Smothers said.
She added that the Park Board has plans to adjust maintenance services to minimize the strike’s impacts on park visitors. No park closures are anticipated.
The union plans to picket at parks each day through Wednesday and during the July 4th long holiday weekend — one of the busiest times of the year for park visitors.
“We are the heart of our parks,” said Anthony Smith, an arborist. “We are struggling … we are on strike because we deserve better.”
U.S. Rep. Ilhan Omar, a Democrat who represents Minneapolis, joined city and legislative leaders at Thursday’s rally to show their support.
“We know they magically do not become No. 1,” Omar said of Minneapolis parks often topping national lists. “There is a lot of effort, there is a lot of maintenance and work, sweat and tears that goes into it. And you all are the reason for that.”
Star Tribune
Minnesota says tobacco companies owe $58 million in underpayments from landmark settlement
Minnesota is seeking $58 million from tobacco companies Philip Morris and R.J. Reynolds Tobacco Co., alleging that they underpaid what they owe the state in a landmark 1998 lawsuit settlement over the costs and dangers of tobacco use.
Attorney General Keith Ellison filed a motion this week in Ramsey County District Court to enforce the settlement agreement, alleging that when the federal corporate tax rate changed in 2018, the companies recalculated their 1997 profits using the new and lower tax rate, leading the manufacturers to underpay Minnesota by nearly $10 million a year.
“After lying to the American people about the dangers of their products, it is unfortunately not surprising that the largest tobacco manufacturers have also tried to avoid the commitments they made when settling with Minnesota,” Ellison said in a statement.
His office is asking Ramsey County District Judge Mark Ireland to order the tobacco companies to pay the state $58 million plus interest and legal fees. A hearing is scheduled for Aug. 8.
Messages with Philip Morris USA’s parent company, Altria Group, Inc., and R.J. Reynolds Tobacco Company weren’t immediately returned Wednesday.
According to court documents, the tobacco manufacturers have argued that they get to re-calculate their 1997 profits with modern tax rates. Ellison’s office argued in court filings that the settlement specifically required using 1997 tax rates when calculating 1997 after-tax profits.
In 1994, Minnesota was one of the first states in the nation to sue tobacco companies. Attorney General Hubert Humphrey III sued tobacco companies and advertisers for violating antitrust and consumer protection statutes, arguing they misrepresented or concealed the dangers of tobacco.
In the settlement agreement with the state and Blue Cross Blue Shield of Minnesota, manufacturers agreed to make annual payments to the state in perpetuity, with the amounts tied in part to their tobacco sales. It was considered payment to the state for what the government spent or would spend on the health repercussions of tobacco on smokers, such as increased Medicaid payments.
In 2023, the three remaining tobacco companies in the settlement — Philip Morris, R.J. Reynolds and ITG Brands, LLC — paid Minnesota about $160 million, according to court documents.
Tobacco manufacturers owe more if their post-tax profits are higher than they were in 1997 despite lower tobacco product sales. When the federal corporate tax rate was cut in 2019 from 35% to 21%, Philip Morris had its payment administrator PricewaterhouseCoopers recalculate its 1997 post-tax profits with the 2018 tax rate, which Ellison’s office said misrepresented the settlement, according to the court documents.
The state of Mississippi sought similar legal action to Minnesota’s recent filing in 2019 over tobacco companies not paying fully, and a court agreed with the state in 2022 that tobacco companies owed what was agreed upon in the original settlement. The manufacturers have appealed that case. Then, in 2023, Texas took action against manufacturers over the same tax rate issue and a Texas court sided with the state.
Minnesota sued R.J. Reynolds and ITG Brands in 2018 to recoup payments that hadn’t been made since 2015. The companies agreed in 2021 to make $81 million in back payments to the state.
When a “WolfQuest” player takes control of a young wolf and roams the hills of Yellowstone National Park, it’s easy to see why the Minnesota-made educational video game has stayed relevant 17 years after its initial release.
Later this year, a new version of the wolf-simulator game will be released with an aim of keeping it relevant for new players into the future. The game’s producer, who said the original has been downloaded about 5 million times, is adding improved graphics and game play for players who assume the role of a wolf, raising families of pups and chasing down prey in the wild.
“I just thought, ‘This is the most successful project I’ve ever done, it would be crazy just to let it fade away,'” producer Dave Schaller said in an interview Monday from his home in St. Paul.
Schaller and his wife Susan Nagel’s educational video game company Eduweb released the original “WolfQuest” in 2007 along with the Minnesota Zoo, which partnered with the game company and assisted with its creation. Players control a 2-year-old wolf as it learns to hunt, find and court a mate, and raise a pack of pups that must be defended from predators including coyotes, cougars and rival wolves.
Eduweb programmed the game, but Minnesota Zoo assisted by providing wolf experts who informed Schaller’s team on how the animals would act in real life. The goal was to accurately depict the animals of Yellowstone and teach kids about wolves in a fun way outside of a classroom setting or a zoo. This meant adding all aspects of wolf behavior, including how parents will sometimes regurgitate prey for their pups’ consumption.
“We would have meetings where it was like, ‘OK. Hunting elk. How does it really work? And how is this going to work when we distill it down into a game?'” Schaller said.
The game was initially free, thanks to a $500,000 grant from the National Science Foundation, and the original version is still available for purchase online along with a free demo. When the partnership with the zoo ended roughly a decade ago, Eduweb kept updating the game, and began developing “WolfQuest: Anniversary Edition” in 2017.
An early version of the anniversary edition was released in 2019 and is available for purchase through the online game distribution platform Steam for $20, but the complete updated game is not expected to be released until later this year. Unlike the original, the anniversary edition allows players to continue growing their wolf pack past the one-year mark. The new game also increases the size of the environments and gives players 7- by 7-kilometer sections of Yellowstone to explore.
Though the game was intended for middle schoolers, many adults have become devoted fans. Fan videos posted on YouTube, often just footage of the game being played, have racked up hundreds of thousands of views. Some players add backstories for the wolves and narrate the animals’ lives in dubbed-over audio, making up their own lore as they go.
A collaborator on the original game was Grant Spickelmier, the former assistant educational director for Minnesota Zoo. Now the executive director of the International Wolf Center in Minnesota, Spickelmier helped write the initial grant for the first game. The game’s release in 2007 coincided with a rise in popularity around online forums where young players could bond over fascination with wolves and wildlife.
“We discovered there was a huge demand for people who wanted to live their lives as animals and who were interested in them,” Spickelmier said.
With the early version of the game already out and the full edition on the way, Schaller said he’s hopeful the game can continue to attract new players and teach kids about wolves and how they act.
“The biggest idea of the game was [combating] the misconceptions about wolves as these ferocious, dangerous animals,” Schaller said. “It’s like, ‘No, they’re family animals, mate for life depending on how things go, and they care about their kids.'”
