>> rose: welcome to the program. we begin this evening with j.d. vance the best selling author talking about his book hillbilly elegy which has a lot to say about the 2016 election. >> i started writing it when i was a third year student at yale law school and i was sort of troubled by this question of why there weren't more people like me at yale law school. i was the only white working class person i knew or at least was open about it. and it seemed to me not just that i was relatively low income looking at my peers but i had this sort of cultural outsider attitude that was very very unique. not just lower income but i actually felt like a cultural outsider. that was the first time i ever felt like that in my life. >> rose: we finch issue this evening talking about front page. we talked to the director jack o'brien and two of the stars

nathan lane and john goodman. >> it's a great american play that could only have been written here at that particular time when things were popping all over the place. and it covers a wide range of topics, but it does so with the human characters. i've never, i haven't done a style like this since i was in college doing a restoration piece. it's different from anything i've ever done and i'm so glad i was asked on board because it's a challenge, it's a challenge night nightly. >> we concluded with alexandra lebenthal and dr. michael kaplitt for a new treatment for

tremor. >> i was many able to tell people like this how often in one's life does somebody have the ability to change other people's lives. i'm so grateful and honored to have that opportunity. >> rose: hillbilly elegy, the front page and a new medical treatment when we continue. >> rose: funding for "charlie rose" has been provided by the following: >> and by bloomberg, a provider of multimedia news and information services worldwide. captioning sponsored by rose communications from our studios in new york city, this is charlie rose. >> rose:j.d. vance was here raised in the appalachian town of jackson, kentucky. after high school he joined the marine, graduated from yale law

school. he went on to success in the financial community. his new book tells the story of his remarkable trajectory. it offers an examination of white working class america. it's called hillbilly elegy, a memoir of a family and culture in crises. david brooks calls it essential reading for this moment in history. i'm pleased to have j.d. vance at this table for the first time. welcome. >> thank you. >> rose: you should have been here earlier so thank god we've got you here. tell me what drove you to write this. >> so i started writing it as a third year student in law school and why there was no more people like me at yale law school. i was the only working white class person i knew or at least was open about it and it seemed to me not just that i was relatively low income relative to my peers but that i had this sort of cultural outsider attitude that was very very unique. that i was not just lower income but i actually felt like a

cultural outsider. that was is first time i ever felt like that in my life so i started to wonder what was it that made me different. and i decided to start writing to answer this question of why there weren't more kids like me, more kids who lived a charmed life. >> rose: did you feel like you were living in a world where people looked down at you or something because you were qualified to be where you were at every stage. >> absolutely. i never felt people were looking down at me at yale law school. i felt there was a general sense of disdain from the community i came from. some folks would call it redneck but i never felt it was personally directed at me. >> rose: so you decided to write the book. you said you started to think about where you came from it's called a memoir of a family and culture in crises. what culture's in crises. >> well i think the culture is white working class americans, specifically white working class americans with connections to appalachian. what i started to research and realize is a lot of problems that existed in my families existed in the broader community at large in a very

disproportionate way. >> rose: what were those problems. >> increasing rates of family break down and support. opioid addiction. pessimism and sinnism about the future that is very real a learned helplessness about people's future prospect. >> rose: did you have a feeling of being a victim. >> it's partially a failure of being a victim. it's not an individual failure i think it comes down to the communities and neighborhoods we were raised in and the attitudes we acquired. >> rose: you acquired them from the neighborhood. what is it you acquired from the neighborhood. >> i think one of the things you acquire is a sense that your choices don't necessarily matter. and so what's happened obviously is that the industrial economy's been very tough on these areas. so i don't think we should allay that. but in combination with that really tough economic circumstances, people start to give up and start to think no matter what they do, they get ahead and i think that's pretty destructive attitude. >> rose: this is what david brooks wrote on june 28. anyone who spends time in working class of america and one

presumes brittens notice contagious of drugs and suicide, pessimistal and resentment part arises from deindustrialization. good jobs are hard to find but hardship is not exactly new to these places. like in coal valley made it hardship to say i may not have made a lot of money but people can count on me i'm a good person, loyal, tough and part of a could good community. we know what that working class honor code was but if you want a refresher read j.d. vance's new book. history. that's the point i want to come to, this moment in history. do you think in this book, we understand some of the feelings that are driving this presidential election? >> yes. i think that's definitely true.

i mean one of the thing that's really driving attraction to donald trump is not any special quality of donald trump himself, but of the fact that folks feel very resentful at the media establishment, the political establishment, the financial establishment and so forth. one of the things i really started to recognize as a teen ager is that folks are very cynical, pessimistic and sort of alienated from the broader community that's one of the things i wrote about. i didn't quite think it would be taken but i'm not surprised. >> rose: you felt alienated because what. >> it's a combination of the fact that their communities themselves aren't going especially well. we talk about the addiction crises, family break down andal all of these indicators that don't look very good breafdz frustration and yourself and perceive that people don't care about your problems. you feel you're not dugas specially well and the elite do not care, not that they don't care but they condescend, they look down at people like you because of the way you live your

life. >> rose: why. >> i think it actually did affect me in a lot of ways; based on my grades and drugs i would not have had a success 2368 life. part of the story is the exploration for what changed in that life. >> rose: what changed. >> the first thing is i started to spend a lot more time, in fact i started to live full time with my grandma and my grand mauve was a very classic hard working self reliable woman who recognized life was unfair but need sure i didn't think the deck was stacked against me even if i recognize some structural inequalities. >> rose: how did she do that. >> one, she preached a very tough message, right. so i remember when i was a kid, she bought me a really nice graphing calculator for one of my advanced math classes. but she said if i'm going to

work hard and buy this for you, that meant i had to work hard and study at school. she preached a very tough message. she made sure i took my studies seriously and knew the culture around me had a sort of message that maybe my choices didn't matter and she fought against that. >> rose: you went from high school to the marines. >> that's right. i joined the marine right out of high school and this is right after we invaded iraq. >> rose: did you do that out of patriotism or other reasons. >> i was very patriotic like other kids in high neighborhood but it was recognition i wasn't ready for life after high school. i remember puzzling through the financial aids form after i had gotten into ohio state where i eventually went. i didn't know what to do and i was sort of scared by it and i thought the marine corps gave me four years to shape up. >> rose: did it. >> it definitely did. the great thing about the marine corps is that they really force you to shape up. i like to describe it as a four year character education because they teach you not just you know

how to iron a uniform but they ach you about financial management, they teach you how to make your bed, they teach you a lot of the skill sets you need to be a successful adult. >> rose: part of the conventional wisdom about that, in terms of commentary that leads pele to be so excited about your book is you're giving them a key to understanding. and everybody wants it because it is a dramatic political component in the presidential election of 2016. and they're saying to people, where is the dialogue between politicians, where is the dialogue between the establishment and the people we're talking about. because, because everybody gets, when there's a comment like hillary clinton made about desperates, that offends people. >> sure. >> rose: when donald trump says something it seems to have contempt for people, it offends

them. i wonder how much dialogue is there really taking place in trying to in a sense listen and communicate. and not just use for political needs. >> yeah. so i think there is precious little dialogue between these two big cultural segments of america. sort of middle america fly over country whatever you want to call it. donald trump has become their sort of representative and they're very proud. >> rose: and the trouble in pennsylvania in 2008. >> sure for saying folks cling to their guns and religion which i think was a well-intentioned comments. he mentioned folks were struggling economically and that was his explanation but layered with a certain amount of called sention. awe sults don't cling to things you might have said it a much different way and i don't think the comment would have had nearly the effect it did if he had said it in a much more compassionate way. >> rose: how do we change this. >> that's a really tough

question. i continue to think one of the big problems, one of the big sources of this cultural divide is fact people aren't spending much time together. when my wife of indian descent was born in san diego i was horrified my family were elitists. the truth is they love each other and that's a small example. when people spend time with each other, there's contact theory when people from different groups spend time with each other they empathize with each other at a much greater extent. it's the consequence we have too much geographic segregation between the elites and the rest of the country. at the end of the day if you're a policy maker in washington d.c., you know very little about the people in middle town ohio not because you're a bad person but because you don't spend much time with them. >> rose: one thing people resonates is donald trump says he's the leader of is opposition to quote, globalization. an opposition to trade.

how they see that as sort of friends of the establishment, whichever strained them by taking the manufacturing out of their small town and sending it overseas and they're left there with the same life they had, with no of course and trying to figure out a way to live a good life. >> right. yes, that's absolutely right. and work isn't just about a wage, right. it's not just about of course, it's about building something that's belonging to a community of workers. grandpa, to the pay he died en made with steel from thead steel mill he worked at. we built that car. that pride started to disappear because the cars started to disappear. >> rose: do the people you write about feel like they are victims. >> i think in a lot of way they feel like they're victims, victimized by the political class, they see the jobs going overseas and they want to blame somebody right. and often times the only person

it makes sense to point their finger at is the local representative or congressman or attracted to donald trump is whether you are pessimistic or optimistic about the future. >> that's right. >> rose: if you're pessimistic about the future you'll vote for donald trump. >> that's right. one of the biggest drivers of trump's support is expressing cynicism about the future. >> rose: his voice is to every time he makes a campaign stop. >> absolutely. >> rose: cynicism is appropriate. >> absolutely. >> rose: for those people don't care. >> you think about the slogan make america great again. the implication is america isn't great right now and if you're very unhappy about your life that's going to resonate. >> rose: do you think this is a large number of people? do you think this is enough people to elect donald trump? >> no, i don't think it's a large enough people to elect donald trump. obviously the democrats for the country has changed a lot and the working class community is a big part of the electorate and will not let donald trump alone. my fear is i don't think donald

trump is not the right candidate for this group of voters. >> rose: who would have been. >> well, i don't know that there was a single candidate who really appealed to these voters in a way that one inspired them, and two, actually had a set of policies that would have been good for them either on the democratic or the republican side. part of the problem with this election is in fact i think the problems that are unique to some of these working class communities don't get a lot of attention and maybe hopefully the book will raise people's awareness a little bit. >> rose: they feel strongly about patriotism, they feel strongly about national service. and they feel strongly about the american military. >> sure. >> rose: because they have been the backbone of those people lieu have gone to war. >> when you think of the demographics of the u.s. military more likely to be republicans, likely working middle class not destitute or wealth. that is donald trump's core group of supports right there.

>> rose: politicians have speculated about this. to unite the poor with a broad brush with the latino poor because of race and culture differences and other things. because that's a powerful coalition. you saw with bernie sanders certainly reaching out to those people who thought they wanted something different. >> sure. >> rose: and had a special appeal to melennials. >> right. you know, i mean i don't know if the problem is so much that it's actually really hard to unite these different groups into a coalition of voters. i think it's probably, i think it's a winning coalition and it's possible i just don't think many people have actually tried. if you think of the republican party rhetoric, it is almost designed to turn off black voters. >> rose: in fact, that's what happened in the south. >> exactly. >> rose: the politicians used, in a sense used race to

prevent. >> yes. and it's unfortunate that we don't have the counter factuals right. i wish we had tried to do something differently and we might be sitting right here saying isn't it great we have a fantastic american political party appealing to the concerns of both white and black poor. unfortunately we don't. we have a party that's primarily white working class and very little else these days and we have a party that is the black poor and the latino poor and sort of the cosmopolitan middle and upper classes of all races. >> rose: and pervaded wisdom is their bitter. >> if you look at the polls that's probably true. >> rose: what impact do you think this election's having on this country other than a sense of disdain for the tenor of it. >> i think that this election is really having a negative effect especially on the white working class. because i think a lot of these grievances are legitimate but what it's doing is giving people an excuse to point the finger a someone else. point the finger at mexican

immigrants or chinese trade or the democratic elites or whatever else. sometimes these villains are legitimate. i think it's totally fair to say the policy elites of the democratic party haven't been totally concerned about the white working class but at the same time fundamentally what's going on and what donald trump has done is change the focus of the white working class from a sort of engaged and constructive politics to a politics of pointing the finger. >> rose: someone on this program jeff green field said hillary clinton, he worked with bobby kennedy, john lindsay and others said that what hillary clinton should do now is she should go to these working class communities and perhaps she is. but go to them and say i may not get your vote but i won't you to know i'm listening and i want you to know that if i win and even don't get your vote i'm coming back. to give them some sense to be

able to believe that somebody heading for washington if she is indeed heading for washington is taking enough time to try to hear what the problems are. >> sure. i think it would be an extraordinarily constructive addition to our politics because at the end of the day if people only focus on those who they think are going to vote for them we'll have an increasing polarized electorate. i think there could be a national constituency in the white working class. they voted for bill clinton in overwhelming numbers. so it's not to me, it's not so much an ideological opposition to either the democratic or the republican elite. it's a sense that people just don't care about those like you. >> rose: exactly right, they don't care. >> exactly. and that feeling unfortunately if you think about the political dialogue that we're already starting to have, both on the left and the right, there's a movement to sort of gloat over the fact that the elites were right about donald trump, right. i'm a never trump guy, i never liked him but i noticed this

willingness from people who think a lot like i do that look we told you so. to all these white working class voters we told you so, we told you that trouble was going to be a terrible candidate. we told you were an idiot if you voted for him. the problem is if you take that attitude as sort of gloating over trump's defeat then you're playing into the very thing that gave rise to trump in the first place which is a feeling that the elites think they are smarter than you and just think you're a bunch of idiots. >> rose: what impact has writing this book had on you other than the fact that it made you think deeply about where you came from and what impact and understanding of your own community might make. >> yeah. well for the first time it exposed me to the wild world of internet trolls who criticize everything that you do. absolutely. it's very interesting. the internet is a deny den of

vipers. it sort of forced me to confront the fact i sort of exist uneasily in the world of elites and i exist in the world of non-elites back home. i will always feel more comfortable back in middle town, ohio but i realize the media has sort of asked me to be this spokesman for the white working class voter voting for trump, right. but as somebody who doesn't like trump myself, i understand where trump's voters come from but i don't like trump himself and that made me realize i'm not quite part of either world totally. >> rose: hillbilly elegy is a book of memoir, family and culture in crises. j.d. vance said he has by david brooks and others, a lot others have come to sort of be the person that they think that readers think and that people who write criticisms of books talk to him and look to him as someone who really does understand. because that's where he came

from. where i came from. and therefore listening to him, hillbilly elegy. back in a moment. stay with us. the. >> rose: in 1928, former journalist turned playwrights ben heck and charles mick arthur wrote the acclaimed page the front page. a comedy follows a group of crime reports in the press room of the chicago criminal courts building. tennessee williams wrote that the play accosted the american theatre with earthy two-fisted vitality. the front page has been revived on stage and adapted to film numerous times since 1928 debut including the hit 1940 comedy his girl friday. the latest revival play is currently in previews at the broadhurts theater. i'm very pleased to have the director of the revival, jack o'brien and two members of the all star cast, john goodman and nathan lane. what is it about the front page we have revivals.

>> it's huge, it's 27 people. so you can't afford to do that play anymore unless you get somebody like an institutional theatre to do it. but there's oddly enough, i think, i don't think there's ever been anything before like it and there's never been anything after like it. >> rose: it meaning what. >> it's this curious combination of reality. these guys listened, they base the play on a lot of people they knew, this is -- incidences they lived through and there were lawsuits about it when it was originally done. but it just, it's the structure of it, the comedy, the veracity of it, the politics of it. it's a grab bag of everything

that we've ever been to each other, know about and still have not gotten over. >> rose: what would you say, john. >> it's a great american play. it could have only been written here at that particular time when the the things were popping all over the place and it covers a wide range of topics, but it does so with the human characters. i've never, i haven't done a style like this since i was in a college doing a restoration piece. it's different from anything i'd ever done and i'm so glad i was asked on board because it's a challenge, it's a challenge for me but it's so much fun. >> rose: nathan. those people associate this with his girl friday which was a great idea by howard hawks to

make hillary johnson a woman and they created a sort of screw ball comedy. but the play is not screw ball comedy, it's dark comedy mixed with mel owe drama that somehow by the third act spins into the edge of farce. it was put together by jed harris and gave it to george kaufmann one of the great men of the theatre, director and writer and said fix this. and so it has a very authentic feel because they came from that world. and it also has the hand of george kaufmann, it was a three act play structure and it's very much in the tradition of his plays, which the first act is set up, the second act is complications and things start getting really funny and the third act is hilarious and everything you've seen pays off in a delightful and satisfying way. but it's interesting for an audience today who, you know are

the best thing you can tell someone about a play is that it's 90 minutes with no intermission and they're thrilled. they don't care what it's about. do you mean i'm in and out and i can tell people i saw it; you know. and this is asking people to have a little patience. and it's worth it by the end because these guys knew what they were doing. and it is as john said, it is the most fun i've had in a long time but it is technically a hard play to do. it's demanding. >> rose: what does it say about people who are attracted to journalism and this kind of reporting. >> well i'm sure like to kill a mockingbird led people into the law. this led a lot of people -- >> rose: led people into journalism. >> this led a lot of people wanting to become a journalist because it was sort of, i mean it was the first play that, it was profane and people considered it vulgar in 1928 to

have a woman walk on stage and asieve been looking for you, was unbelieve been, it was shocking. >> rose: you and scott got together and said let's find the perfect cast. >> no,. >> that's a nice idea. >> like most of these. no, scott and nathan were flirting with each other. nathan had done this sensational revival. >> let me explain that. no, we're old friends and colleagues. scott had along with brooklyn academy of music presented iceman cometh and we were talking about what else we could do and he suggested a couple thing and i suggested the front page and he bravely said yes, let's do that. >> bravely indeed. >> rose: bravely indeed because of all the cast members. >> it hadn't been a commercial production since 19 -69d. the last production was in 86 in lincoln center. it's very brave to do this play commercially because it is so

huge. and yet now he seems very smart because it seems to be doing very well. >> rose: scott likes challenges been doesn't he. >> he sure does. that's part of the fun for him. >> rose: then he called you and said. >> nathan and i had a couple shows just recruitmently. we had done it's only a play. we done -- we did one night only of guy's and doll's at carnegie hall. so we had a little run going and we built on that. like most of us we know a lot of people now but at this time in our careers we picked up the phone and called a few people up and said do you want to be in the play. they all said yeah, we sort of do. >> rose: who did you have in by the time you were calling them up. >> i got nathan. >> rose: you called and got john. >> we got john. >> john was receptive. scheduling was always an issue with all of these people. >> yeah.

it was a no brainer for me but i'm going to stop it there. there are other factors involved but yeah, i was very keen on the idea because i thought i knew the play. which i didn't. >> didn't we all. >> yeah. it's one thing when you read it on the page. it's a hard read because there's overlapping dialogue and so many characters but you think oh, this will be fun. and then when you have to bring it to life, it is, it is, it's a whole other animal. >> it is a dialogue almost on to itself. there are so many elements. >> no, stalkered and shapes peer are almost walks in the park compared to this piece because you have to keep all these plates in the air and all of these stories are not supporting, they are all vitally energy going into this moving

thing that's going forward. i think it's powered in my estimation by two or three different farce mechanism. two or three different stories that are in competition with each other to keep the thing moving forward. and that's why it takes that many people to do but it's the densest piece and most rewarding. >> rose: you said directing him, it's not directing, it's a creative partnership. >> yes, that's true. >> rose: is the same thing true with john or simply because you and nathan done so much together. >> these are people at the very top of their craft. when you start out you sort of feel your way. but like anybody, you know, you get to work with really good people. you suddenly twist them out and see what they do. and then basically what you are is their first audience. you listen to them, you try to edit, you try to reflect but you don't give them anything because they're pouring at you all the

time. >> rose: who is sheriff hartman. >> that's periment b. hartman who was in realty peter b. hoffman who threatened legal action when the play opened. he was sheriff of cook county under the administration of william hail, big bill thompson whose sole contribution was the phrase keep king george out of chicago. he's a back slapping chicago version of a good old boy. not quite the brightest ball but a dressing room mirror. and i wanted to see how stupid i could make him and still breathe. which is not a good approach.

>> rose: you're stuck with it. >> but yeah, he's in peril. >> rose: and walter burns who comes in the fact half. >> walter burns, it's such a tremendous character. and sort of the that's the relationship in the play. that's this bromance and hillary johnson the star report. it's the same with howie the reporter in chicago. it's the same with mick arthur who gave him his watch and arrested him for stealing it. he was an scared convict in chicago they sort of based this loosely on. but he was famous for telling men not to get so involved with women because it would distract them from the story getting their work done. he also apparently the legend

goes he got drunk one night and fell on what they called a copy spike and popped out his eye. so he had a glass eye and glenn beck used to say you can tell which one was the glass eye, it was the warmer one. he was a tough character. they say he dressed very well. he looked like a very successful local merchant, and had a sort of purring voice. >> rose: who was hillary. >> these are all real people. hilly is a composite of macarthur himself. they put themselves on stage there's no question about it. and they used literally every piece of gossip, every terrible story, every snide remark that ever happened. >> rose: a lot of it not politically correct. >> almost all of it not

politically correct. oddly enough it's still shocking. the play still sometimes makes the audience gasp. and also, the audiences are stunned because surely we made some of this up for today's production. we didn't. we had the benefit of the great polisher over here who suddenly can sort of get you right through a joke if you need to. no stone is unturned there and he's done some brilliant work. >> rose: did you -- >> a handful, a handful of things he did. i know, you're part of the plot is an anarchist who is to be publicly executed for shooting a black policeman. and the mayor and the sheriff are courting the black votes in chicago so they are moving up their election, the hanging to

coincide with their election. and it's amazing how relevant some of this is. >> and how true. that's the other thing about this is how outrageous some of this has become and we've explored how far we go witness. there's the edge of reality about it that's grounded everybody in the play. >> there has to be. >> absolutely. >> rose: meaning it has ideas that still resonate. >> yes. also no matter how funny, it's really funny and how absurd it becomes and it's really absurd. we, all of us keep our feet on the ground. and sort of have to make it real because it never floats away to become just he walks for the kitties. it's about something very serious. and of course great comedy is always about something very serious. >> rose: is that true, great comedy's always about something serious. >> well, yes. i would agree with that but

there's, it has to be played that way. and certainly, i mean it's got to be played. and usually -- >> rose: what, john? >> you can take comedy as seriously. >> yes, it's life and death situations and that's what this is certainly. and yet this play, you really have to, there's no being relaxed about this play. it's the music, and the music is very difficult. it's overlapping dialogue. it demands a kind of precision and accuracy and vocal stamina and what needs to be heard and what doesn't need to be heard. and it never, it's relentless. there's only a couple places where the play relaxes just for a minute or two. and then it's a speeding train. i mean yeah, it's unusual in that way. >> finding the places where one can breathe and relax to set up

what's coming. >> rose: you couldn't mount a play like this today. >> we just did. >> rose: you just did because you had the reputation. >> well, we had the people to write -- >> rose: the reputation brought the people and the people brought the audience. >> it's thrilling. >> rose: i assume somebody could write something fantastic and you know it and say yes i want in on this. but you have all the thing, how difficult it is to get these actors and put them on broadway in a commercial project. >> the great thing for me is watching this group of men and women watching each other act. >> it's such, that is such a joy and pleasure. and i get to it nightly. i don't want to single everybody out but jefferson --

>> hilarious and brilliant. and that's the joy of it. it's like putting together very quickly a repertoire company and people reveling in. it's not about who has the biggest part it's getting to watch all these people work and interact with them. and the joy of doing that in a play like this. >> we don't have a national theatre. we've never been allowed to have one because we don't support that that arts here. other nations do. so every once in a while a clarion call goes out on a piece of material where people think gee i'd like to have a little of that. i've had a couple those in my career. >> rose: don't both of you say this is why i got into this life because there's things like this and all the satisfaction i can feel. >> i took the amtrak from st. louis in 1975 to this is beyond my wildest dreams. we don't have a bad penny in the

bunch. to watch and listen to these men and women every night is just buehl. beautiful. >> rose: talk about walter's ability as a master manipulator. >> well, he's, you know, he's many things. he's a bully, he's a misogamists. wait a minute, is this donald trump? no. he's a master manipulator. he has no life, he has no relationship he has three marriages. i was in love once with my third wife. he's groomed him and become a greater report and the only one he really trusts which is why he refuses to let him go.

>> rose: he wants to go with his fiance. >> he's going to get married and live in new york and have a real job in advertising and make 150 bucks a week and he's going to get away from this sordid world of journalism. >> rose: that break his heart. and walter just will not accept that. so he does, i mean he has, i guess you would call it tough love. you hear him on the phone in the beginning of the play a few times talking to walter and you hear me on the other side of it. there's something that happened with the sheriff and the convict who shot the doctor and it's ridiculous and he's gotten this story and he's telling me about it and we're both loving and enjoying it and revel in how we're going to tell this story.

later his fiance comes in and says what are you doing. he's giving away their marriage money and says let me tell you. she's speaking another language and he's like i don't care, we're getting married. she's not interested in the story. only hilly and walter are interested in this story and we're going to get this story. and that's the center of the play. is he going to go off and lead a so-called normal life or will he wind up staying with walter burns. >> i think most can sympathize with this and have something legit must to do we would have done it. but none of us can stand to leave this journalistic idiot.

>> this is like trying to explain some things to my wife. >> that kind of excitement, the thrill that you get. >> rose: what is the thrill. >> the thrill. >> rose: one out of every four outings. >> i've been very very luckiest specially in the theatre whether it's the iceman cometh or doing. what's better than doing the front page with a company like this, an old trend on broadway and people laughing their heads off and getting. do you know why i wanted to do the play was to say one of the curtain line of all times. i wanted to say i wanted the sn

of a bitch stole my watch. black out. what's better than that. that's what life is all about. to have those moments. you know. the. >> stuff the "new york times" into the cracks in the wall. the crack goes to sleep but we live for the next thrill. >> rose: it is currently in previews at the broad hurts theatre and will run until january 29th. thank you for coming. >> loved being here. >> rose: thank you, john. >> always a pleasure. thank you charlie. >> rose: back in a moment. stay with us. >> rose: alexandra lebenthal is well-known in the financial

community and is ceo of length null and company. she was diagnosed with something called essential tremor at the age of three. a nerve disorder which causes involuntary shaking and affects an estimated 10 minute people. a new treatment was recently approved by the food and drug administration. it is called high intensity ultrasound uses 1,000 ultrasound waves directed at the affected area. on august 22, she became the second person in new york to undergo the procedure. here with her to discuss her treatment and what it means for the future of neuroscience is her dr., michael kaplitt. he is from new york presbyterian, i'm please to do have both of them here at this table for the first time. i must say alexandra is a good friend of mine so welcome. >> thank you very much. >> rose: tell me about you first. >> you know, as you mentioned, i've had this since i was three and it has not only been a major frustration but certainly been an issue in my career, as you said. i'm in the financial services world and need to have people

trust me and feel can dealt about me in terms of doing business. and having this hand tremor which was very very visible really caused problems for me. inside me and affected my confidence. >> rose: so what did you do. you lived it for a long time. >> i did. i lived with it for a long time. i tried various medications that either didn't work or there was one that actually lowers your blood pressure and i have low blood pressure to begin with. so i just went along trying to handle daily tasks that are second nature for everyone else, picking up a cup of coffee, eating shi with chop sticks. but it was a great embarrassmet for me. i never wanted to talk about it before. >> rose: what causes it. >> we don't know. simple tremor simply means a tremple when you move what we

call an action tremor. you go to pick up a glass, you shake and spill it all over yourself. >> >> rose: how is it different from parkinson. >> parkinson is a disease we don't know what causes it. it leads to various symptoms. but in parkinson's disease you have multiple symptoms and the tremor's different. parkinson tremor is a so-called rest tremor where you're just sitting there tremoring away. you have stiffness, difficulty moving and a whole holes of other problems. essential tremor is really an isolated movement tremor that make it difficult to perform normal activities but otherwise you're fairly normal. >> rose: and the treatment that she took and that you administered so to speak, was developed where. >> it was developed in israel actually. it's based on an operation we've been doing for several decades where you would make a small hole in the skull and go into the middle of a circuit that regulates coordination which is where the problem is. and we with a normally put a little electrode in there that's

attached to a battery and that's effective. what they found in israel was that they could generate this device, where ultra sound waves which do go through the skull but are very low energy. they could create this helmet that has a thousand sources as you mentioned earlier that all converge on the one spot. so all of the beams of ultrasound energy are relatively safe as they go through the brain but they add up their energy at the spot so you can actually essentially burn or take out that abnormally functioning not and free up the rest of the brain to function normally. >> rose: any risks. >> well there are some risks with any procedure. it is a new procedure even though it is fda approved. any time you do anything inside the brain,n't non-invasively there's a slight risk of bleeding or something. but so far it's been relatively safe. >> rose: so far. >> so far. it is a new procedure. we also don't know whether it will last as long as the traditional procedures because it's only been around for a

short time. there's some evidence that it can, that the effects can last at least for one year but it's so new that i can't say about ten years even though we're hopeful. so these are some of the issue that we're addressing. and then there's some uniquenesses to each patient based on how their head is shaped, based on the thickness of their skull and the complicated figures. >> rose: are you going back for more treatments. >> they have to do one side at a time. i would love to do both sides >> rose: one affects your left side. >> this is great for showing purposes because this is my tremor and this is my hand now. >> rose: what's it done for your spirit and your confidence and your sense that no long will i have to live with this. >> it has been amazing. and as i said before, there are things that are second nature to everyone else that each time i do it for the first time or the

second or third time, i am just amazed. i kind of chuckle inside. i'm lifting a glass by myself. i'm drinking my coffee my myself. but for business that's great for me as well. i never wanted to talk about it, i was always embarrassed. to be able to talk to people about this. how often in one's life does somebody have the ability to potentially change other people's lives. i'm so grateful and honored to have this opportunity. >> rose: we have the tremor before the surgery. i'm going to show that. >> holding my cups with two hands. even sometimes holding a wine glass by the stem and by the glass itself which obviously looked quite odd. people would wonder. >> rose: let's take a look at the next clip. this is you going high intensity

treatment. >> right now she's in the mri machine and what you see there is you can see the bottom half r head is being held in place because the focused ultrasound has to be so precise that you really don't want the head to move at all. so the head is fixed in place there. what you saw in a minute ago was the helmut that has host el tra sound beams and working to deliver the ultrasound. >> rose: you said it's not invasive. >> that's correct. >> rose: the essential tests before and after treatment. >> this is before the procedure. you try to draw a spiral or at any rate line so you can see it. this is her writing upside down. most of us might not do well so she's drawing a circle upside down and a straight line upside down. you can see the degree of improvement. >> rose: you think it's a platform for the future. >> i do. i think that what we can do now is take all of the skills and knowledge that we've learned as

surgeons over decades and apply that to much less invasive technologies and that's what people want. the idea we can take out a certain part of the brain might be good for essential tremor, for things like epilepsy, an abnormal part of the brain. what we've been experimenting is use this in a slightly different way to actually open up the blood vessels and do things like gene therapy which we've worked on for several decades. in this way we can expand the diseases like alzheimer's disease, depression etcetera if we use this to deliver advanced therapy rather than just take out part of the brain. >> rose: any down side here. >> not really. at the beginning for the first pupal weeks, i had two wishes. one i was wobbly and unbalanced. and that's since subsided entirely. the other was i had in a way had

to relearn how to reuse my hand because i was so used to trying to control. i compare it to a batter swinging three bats in practice and then using one bat. my hand would jerk as i would try to reach for something six inches away and it would go a foot away. but that's subsided as well. other than that no. >> rose: you would recommend it to anybody. >> absolutely. >> rose: that had essential tremor. we don't know what causes it. it's heredity. >> there's research into that but we know the area of the brain that's responsible for it we just don't know where it's abnormal. >> rose: same part of the brain that's responsible for parkinson's. >> no, it's different area. the brain is composed of a variety of circuits, all right. and there are circuits that control movement that interact with one another but the particular circuit that's responsible for essential tremor is slightly different than the circuitry that's mostly responsible for parkinson's. don't forget there are many circuits affecting parkinson's

depending on what symptoms there are. this is a much more specific thing. >> rose: what do you think the might be applicable to. >> well, i think that the way we're using it now would be applicable to essential tremor. i think it would be applicable to things like epilepsy as i mentioned earlier. if we can use this to open the so-called blood brain barrier. the blood vessels have a way of preventing things in our blood stream from getting into our brain to protect the brain. you don't want every virus to get into your brain but it prevents us from getting drugs, therapies, anti-bodies. they don't get into the blood treatment well. we now have the ability with this and we've proven this in our laboratories to be able to open up this barrier and allow these things to get from the blood into specific brain targets. so now you have the opportunity to deliver new chemotherapies to brain tumors potentially. we have the opportunity to potentially deliver things as i said for other diseases like alzheimer's disease and we're

working on that and others. >> rose: what else might cause tremors. >> well so tremor is a very big diagnosis, right. there's essential tremor which basically means it's an isolated tremor. there's parkinson's disease which is a very specific resting tremor. there are obviously tremors that are the result of certain types of degenerative diseases in the brain. for example, there's a disease called hydrocephalus which is just build up of spinal fluid in the brain. and that is something that we can treat surgically to relieve that fluid build up. that can cause tremors and be confused with this and parkinson's disease. people with liver problems can get tremorsf >> rose: enthusiastic for

joining us. see you next time. >> rose: thank you for joining us. see you next time. captioning sponsored by rose communications captioned by media access group at wgbh access.wgbh.org

>> rose: funding for "charlie rose" has been provided by: >> and by bloomberg, a provider of multimedia news and information services worldwide. >> you're watching pbs.

♪> you're watching pbs. this is "nightly bu" with t. inside intel. the dow component beat expect, but its revenue guid disappoints. more for less are investors bett off buying index funds that track the market or picking stocks. sales sizzle. domino pizza brings in more orde for smartphones than from walk-i or phone orders. the company's big bet on tech pays off. > those stories and more " for tuesday, october. good evening, everyone, i'm tylemathis. sue has the evening off. earnin