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  • No One Has to Pretend Water Is Exciting

    No One Has to Pretend Water Is Exciting

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    Over the past few decades, what Americans want out of their beverages has swung wildly between two extremes. In the 1990s, sweet drinks were all the rage. Soda sales were on what seemed like a limitless upward trajectory. Quaker bought the then-ascendant Snapple brand for $1.7 billion in cash, a sum that made me actually snort when I read it in the harsh light of 2023. Gimmicky drinks such as Surge, Orbitz, and SoBe “elixirs” crowded grocery-store shelves. As a middle schooler in the late ’90s, my consumption patterns were practically a case study in the era’s marketing magic. I’m not sure a single drop of plain water ever touched my lips outside of soccer practice.

    Toward the end of that decade, the first evidence of the coming reversal was already visible. Skepticism (most of it warranted, though some of it not) toward sugar and artificial sweeteners steadily grew. The soda giants, reading the room, began marketing their own bottled-water brands to compete with the more fashionable likes of Evian and Perrier. Dasani and Aquafina came right on time: As soda sales faltered, bottled-water sales took off. In 2016, the Beverage Marketing Corporation estimated that, for the first time, Americans consumed more bottled water—almost 40 gallons per capita on average—than carbonated beverages. Tap water, too, has found a new home in an ever-increasing number of reusable water bottles. New Stanley cup, anyone?

    Americans, in short, got sold on hydration. As my colleague Katherine J. Wu recently wrote, how much water any particular person needs to drink to maintain a healthy baseline is still the subject of significant disagreement among experts. But in the absence of clear guidance—and with plenty of encouragement from the health-and-wellness industry—many people seem to have simply decided that more is more, and they shoot for as much as a gallon a day.

    That isn’t to say that everyone likes drinking all this water. As the nation has disciplined itself to refill its glasses, Americans have been forced to confront the inconvenient reality that drinking plain water day in and day out can be kind of a chore. To choke it all down, they’ve returned to powders and concentrated syrups designed to make water more palatable, more healthful, or both. Sweet drinks are back again, albeit in a different form. Enter the water enhancer.

    Today, products meant to gussy up your water are everywhere at grocery and convenience stores. They come in little brightly colored squeeze bottles or single-serving packets. The sales pitch is pretty simple: Throw one in your purse or laptop bag, and instead of buying a packaged beverage, you squirt a couple of drops of syrup or mix a tablespoon or two of powder into regular water. Voilà. Now water is better. This is not exactly a new type of product: Powdered mixes from Crystal Light and Gatorade were around in the 1980s. But unlike the water enhancers of yore, today’s mixes are mostly portioned for single servings instead of big batches.

    According to Phil Lempert, a grocery-industry expert and the founder of the website Supermarket Guru, water enhancers split into roughly two categories: low-calorie flavorings, such as Kraft Heinz’s highly concentrated MiO drops, and hydrating sports (or hangover) drinks, such as powdered electrolyte packets from Liquid I.V. Both MiO and Liquid I.V. debuted in the early 2010s. Within a few years, competitors including LMNT, Cure, and Buoy entered the market, along with the new entrants from old brands, Crystal Light and Gatorade among them. Most of these brands boast about their products’ low sugar content; even some of the enhancers flavored to taste like Skittles, Starburst, or other candy rely on artificial or alternative sweeteners and have few calories. Other ingredients have been incorporated into new products: Companies such as Cure now make caffeinated concentrates. Liquid I.V. has a powder that includes melatonin for sleep. Lots of other products now contain additional vitamins, minerals, or electrolytes. Many water enhancers have become, in essence, drinkable supplements.

    Water enhancers’ rise can easily be charted in sales numbers. Darren Seifer, the food-and-beverage-industry analyst at the consumer-data firm Circana, told me that although the products are still a small part of the overall beverage market, they’ve seen consistent growth. In 2022, sales volume of sports-drinks mixes—the category in which the firm places most water enhancers—was up 15 percent over the previous year. According to Seifer, the growth has been much larger for some brands. A spokesperson for Liquid I.V., which was bought by Unilever in 2020, told me that the brand’s sales have nearly doubled in each of the past four years.

    Like so many cultural phenomena, water enhancers also have become the subject of a viral trend. WaterTok, a subset of TikTok where users mix and match different powders and syrups into recipes inside giant insulated water bottles, flooded the internet earlier this year with tips on how to make tap water taste like, among other things, birthday cake. (Like most TikTok trends, it’s a little extreme, and it doesn’t seem to be especially indicative of how regular people end up using the products. TikTok Franken-water sounds sort of terrifying, and some health experts have expressed concern over its potential misuse as a weight-loss aid.)

    The whole concept of water enhancement can be pretty easy to mock: Why, exactly, can some people not find it within themselves to drink regular water? Why do they need it to taste like Skittles? Why do some people think a random wellness company might actually be able to improve on water, of all things? Once you’ve got the water in your glass, just stop there! Drink that! And yes, drinking Jolly Rancher aspartame water does strike me as more ludicrous than just having a Diet Coke. But if you let go of your immediate revulsion at the occasional licensed candy branding and consider water enhancers as a concept on its merits, you’ll find that even the worst of the bunch isn’t functionally much different than a sugar-free sports drink or low-calorie lemonade. In most cases, they’re arguably better if your goal is to stay hydrated, have a little treat, and have some say in how much sugar or sweetener you consume in the process.

    There’s little reason to believe that the people who use water enhancers are doing so at the expense of the plain water that they’d be drinking otherwise. Americans’ consumption of plain water remains, by all indications, robust. It’s mostly sales of soda and juice that are generally sluggish, which at least hints that, for a lot of the people who like those types of drinks, the trade-off that’s actually being made is between water enhancers and some kind of heavily sweetened beverage. In a lot of cases, that trade-off seems positive, on balance, especially because the enhancers allow people to control how much sweetness actually goes into a drink. This does not guarantee that people consume lower concentrations of flavorings, but it at least allows them to do so if they want.

    To fully understand why people are suddenly so enthusiastic about water enhancers, you also have to look outside of the beverage market and to the kinds of vessels that are so often used to consume them: reusable water bottles and high-capacity insulated cups. According to Circana’s data, the Hydro Flasks and Yetis and Stanleys of the world are still selling like hotcakes, and they present a significant shift in the physical reality of how a lot of Americans get their daily fluids—and, potentially, how much of those fluids they intend to be drinking. If you’ve already got 30 or 40 ounces of water on your desk at work, buying a Gatorade or coconut water or other premixed beverage to lug around with it makes less sense than it otherwise would, and having a couple of packets of sweetened electrolyte powder in your laptop bag is comparatively easy.

    At the core of all of this is a fundamental anxiety. Americans want to do what they can for their health, but for so many people, the most meaningful changes—easier, more affordable access to nutritious foods; taking time for exercise; less stress—are difficult to achieve or outside of their control. Swapping out sugary drinks for plausibly healthier options might not be life-altering, but at least it feels like something. “It’s a low-hanging fruit, in terms of healthy behaviors,” Caleb Bryant, a food-and-beverage analyst at the consumer-data firm Mintel, told me. The same anxiety exists for people who buy bottled water regularly, which Circana’s Seifer points out is still a huge group whose numbers have not yet shown any decline. If you’re selling water enhancers, you don’t need to convert bottled-water drinkers away from a product they already like, as you would with a bottled drink—you just have to convince them that they might occasionally like adding something to it.

    The enhancers have their limits. The freedom they confer can easily mislead consumers about how much better self-mixed drinks actually are: The experts I spoke with all agreed that at least some people seem to assume that no matter how much or what kind of water enhancer they use, their beverage will end up inherently healthier than something prepackaged, just because they get to see the water first before they add anything to it. In that way, the brands behind water enhancers are still very much profiting off of the confusing hydration hype that’s been separating people from their money in dubiously healthful ways for years.

    On balance, though, water enhancers do seem to offer something desirable to people who want their water to be a little bit more palatable and the companies who want to sell to them. They are, on some level, a rare win-win: Water enhancers’ smaller, lighter proportions have significant upsides for the companies marketing them, according to Supermarket Guru’s Lempert. The beverage business as a whole is already a more profitable, less cost-intensive category in which to operate than many other sectors of the grocery industry, he told me, which likely helps account for all the upstarts flocking to the water-enhancer category—they’re inexpensive to produce and don’t spoil quickly. When you take away the necessity of buying plastic bottles and packing, shipping, and stocking heavy liquids, the beverage math gets even better. Consumers find some advantages in those differences too: They create less plastic waste (as long as you’re not always buying bottled water to use with them), take up less room in the pantry, and are sometimes less expensive per serving than a bottled alternative.

    Ultimately, the biggest driver behind water enhancers’ popularity is probably just the nature of water itself. It’s great, but drinking a ton of it every day can become drudgery. These additive products play to a tendency to tinker with water in pursuit of health, stimulation, or pleasure that humans have had for thousands of years. Teas, coffee, beer, wine, and sweetened, fruity drinks such as aguas frescas were all developed because, on some level, water—humble and utilitarian as it is—just wasn’t satisfying all of the needs and desires that our forebears had. Now that lots of people believe they need to be downing liters of water every day for their health, they’ve rediscovered an age-old problem. Yes, water is great. But maybe it could be better, or at least more fun?

    You do need to drink water; any downsides of erring on the side of overhydration don’t really kick in until the volume gets extreme. But forgoing a little fun or flavor in pursuit of perfect physical health is something that humans have never been particularly good at doing. One medieval religious text even cited drinking nothing but plain water as a just punishment for swearing against God. With that in mind, it might have been foolish to expect that in the 21st century, with so many alternatives available, copious amounts of plain water would be the widespread drink of choice for long.

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    Amanda Mull

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  • How Xbox Research accomplished worldwide virtual playtesting with Parsec

    How Xbox Research accomplished worldwide virtual playtesting with Parsec

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    They needed a solution that had the high performance and high fidelity required to remotely demonstrate the truest gameplay experience. They tried many alternatives, but none were able to mimic local gameplay, which was essential to both delivering the greatest control and receiving the most accurate feedback.

    “Parsec was a total lifesaver – it gave us a completely new way to test our games outside the confines of our physical labs to deliver the high-quality, local gameplay feel required for our research,” said Daniel Gunn, Director of User Research for Xbox Research. “We wouldn’t have been able to continue remote playtesting at the same level of quality without it.”

    The solution:

    After successfully leveraging Parsec to playtest Halo Infinite, Xbox Research deployed Parsec to start playtesting with the next Age of Empires release. The initial round of tests proved that Parsec’s seamless gameplay experience produced meaningful user research.

    Xbox Research didn’t see any evidence of reduced testing quality or quantity after using Parsec for remote playtesting for a year. Their reports looked as if those studies had been running in person as usual. And now that Parsec has enabled them to once again test with gamers around the world, Xbox Research can focus on scaling virtual game testing. Without the limits imposed by on-prem hardware, they’ve been able to conduct tests with up to 60 concurrent gamers on Microsoft Azure Virtual Machines (VMs).

    Using Parsec has taken us beyond where we ever thought we could go with playtesting and usability,” said Brian Walker, Principal Research Operations Lead for Xbox Research. “We’re leading the game industry with our ability to do this level of remote testing at scale, and it’s all enabled by Parsec.” 

    By the numbers:

    • Xbox Research was established in 2000
    • Number of workstations running Parsec concurrently: 120
    • Number of playtests (of different games) running concurrently: 20+
    • Number of testing participants per month: 150+

    How Xbox Research accomplished virtual playtesting with Parsec

    Scaling to meet demand: In-person playtesting on dedicated hardware has firm limits in time, space, and numbers. Only so many people can fit in one test space at a time, and budgets can limit access to machine hardware. Virtual playtesting enables Xbox Research to reach gamers regardless of geography so the team can run as many consecutive tests as they need to at a lower cost. During their initial effort using Parsec for Teams Enterprise and Microsoft Azure to create VMs for playtesting, Xbox Research was able to keep methodological control over their testing and meet the demand of the game studios.

    Gaming without limits: For remote playtesting to provide statistically viable feedback, gameplay needs to feel the same in a gamer’s living room anywhere around the world as it would in the Redmond lab. Xbox’s rigorous research methodology requires a predictable and consistent gameplay experience across geographic divides with near-zero lag and latency – which Parsec delivered with flying colors. With Parsec for Teams Enterprise, Xbox Research can connect with multiple markets and gamers of all abilities knowing the user experience is virtually identical.

    Secure connections: Keeping intellectual property safe is a primary concern of game developers. Leaks and piracy threaten the success and reputation of billion-dollar franchises. With Parsec for Teams Enterprise, Xbox Research has fine-grained control over what both internal team members and guests on the system can access and when. Additionally, Parsec connections are peer-to-peer and end-to-end encrypted, so game studios can run content securely.

    ”Playtesting is such a complicated beast, given the interactive content and the hardware requirements,” said Walker. “Parsec made remote playtesting efficient, reliable, and more secure.”

    Moving forward: Integrating Parsec more deeply with Microsoft

    Xbox Research’s success is real-world proof of Parsec’s value for real-time 3D applications. So much so that the Microsoft Studios developer ecosystem has continued wider adoption of Parsec for Teams Enterprise, partnering with Microsoft Azure. Through the Azure Marketplace, creative teams can deploy VMs preconfigured with Parsec in five minutes or less.

    Parsec is going to allow us to scale in scenarios we’ve never been able to before,” said Walker.  With Parsec, we can spin up an Azure virtual machine lab anywhere in the world. This is our future.”

    Ready to playtest your games from anywhere? Try Parsec for free.

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  • A Radical Idea to Split Parenting Equally

    A Radical Idea to Split Parenting Equally

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    While her wife was pregnant with their son, Aimee MacDonald took an unusual step of preparing her own body for the baby’s arrival. First she began taking hormones, and then for six weeks straight, she pumped her breasts day and night every two to three hours. This process tricked her body into a pregnant and then postpartum state so she could make breast milk. By the time the couple’s son arrived, she was pumping 27 ounces a day—enough to feed a baby—all without actually getting pregnant or giving birth.

    And so, after a 38-hour labor and emergency C-section, MacDonald’s wife could do what many mothers who just gave birth might desperately want to but cannot: rest, sleep, and recover from surgery. Meanwhile, MacDonald tried nursing their baby. She held him to her breast, and he latched right away. Over the next 15 months, the two mothers co-nursed their son, switching back and forth, trading feedings in the middle of the night. MacDonald had breastfed her older daughter the usual way—as in, by herself—a decade earlier, and she remembered the bone-deep exhaustion. She did not want that for her wife. Inducing lactation meant they could share in the ups and the downs of breastfeeding together.

    MacDonald, who lives in a small town in Nova Scotia, had never met anyone who had tried this before. People she told were routinely shocked to learn that induced lactation—making milk without pregnancy—is biologically possible. They had so many questions: Was it safe? Did she have side effects? How did it even work? But when she described how she and her wife shared nursing duties, many women told her, “I wish I had had that.”

    Induced lactation wasn’t initially developed for co-nursing. Mothers who wanted to breastfeed their adoptive babies were the first to experiment with hormones and pumping. But over time, the few experts who specialize in induced lactation told me, that has given way to more queer couples who want to share or swap nursing duties. Early in her career, Alyssa Schnell, a lactation consultant in St. Louis who herself breastfed her adopted daughter 17 years ago, found that when she suggested to same-sex couples that the non-birthing partner might try nursing, “they would be horrified.” The idea that a woman would nurse a baby she did not give birth to—common in the era of wet nurses—had become strange in our era of off-the-shelf formula. Now parents are coming to her asking to induce lactation, and more of them are interested in co-nursing.

    About a quarter of all babies in the U.S. are breastfed exclusively for six months; more than half are breastfed at least some of the time. The statistics don’t say by whom, but that’s because they don’t need to. We can assume it’s virtually always their birthing mother. Even with the help of formula, the pressure around or preference for breastfeeding means that, in many families, the work of feeding falls disproportionately on one parent. But induced lactation decouples breastfeeding from birth. By manipulating biology, parents who co-nurse are testing the limits of just how equal a relationship can truly be.


    Breastfeeding is hard work, even when it’s “natural.” Adding induced lactation is harder work still. MacDonald was putting herself on a newborn schedule weeks before her baby was even born. She pumped at home. She pumped at work. She even pumped while her wife was in labor, because skipping sessions can cause milk supply to drop. As Diane Spatz, a lactation expert at the University of Pennsylvania and Children’s Hospital of Philadelphia, puts it, “You have to start pumping like a wild person.”

    MacDonald followed a version of the Newman-Goldfarb protocol, named after a pediatrician and an adoptive mother who documented and shared the process in 2000. In addition to pumping, the protocol includes birth control, which causes a surge of progesterone and estrogen akin to pregnancy hormones, and a drug called domperidone, which boosts the milk hormone prolactin. Together they biochemically prime the body for milk production. It’s unusual, Schnell told me, for a woman inducing lactation to make enough milk to feed a baby all on her own—unless she’s breastfed before, like MacDonald had—but it’s also unusual to make no milk at all.

    In the U.S., getting domperidone can be a challenge. Though the drug is widely available in Canada, Australia, and Europe, the FDA has banned it in the United States, citing the risk of abnormal heart rhythms and even death. But these heart problems have shown up only in the elderly, foreign experts have noted, and Australian scientists concluded in a 2019 review that domperidone is safe for lactation, as long as women are screened for heart conditions. But in the U.S., parents usually aren’t taking it under the supervision of a doctor. They might buy pills with a prescription at a Canadian pharmacy or surreptitiously order the drug online through overseas pharmacies. “There was a brief moment when you could only buy it in Bitcoin,” says Lauren Vallone, whose partner, Robin Berryman, induced lactation so that they could co-nurse their daughter, who was born in 2020.

    Inducing lactation felt like a DIY project to Vallone and Berryman. As a queer couple trying to start a family, though, they were also used to doing things a different way. They eventually reached out to Schnell for guidance, but they also swapped tips in a Facebook support group that had a wealth of anecdotal advice. Not that most doctors would have been helpful. Even the idea that one can breastfeed without having been pregnant isn’t widely known, Spatz told me. “Nurses are surprised about that,” she said. “Physicians don’t know that.”

    Vallone and Berryman planned to divide nursing duties 50/50, but they didn’t know exactly what that would look like. Would they trade off every other feeding? Would one nurse while the other pumped? What about when one parent went back to work? “There’s stories of people who have induced lactation, but then there’s no, like, ‘Well, what does your day look like?’” Vallone told me. They had no script to follow, so they could write their own. They envisioned giving themselves equal roles from the start, much like how many same-sex couples share a more equal division of labor, because they do not come in with the gender baggage of a heterosexual relationship.

    What Vallone and Berryman did not want was to lapse into the roles that they watched their friends fall into, where the birthing parent becomes the breastfeeding parent becomes the default parent. The arrival of a new baby is a delicate time in any relationship—for many reasons, but in no small part because it disrupts whatever division of labor was previously agreed upon. Here is a tiny helpless human, along with a mountain of new tasks necessary to keep them alive. If the baby is breastfed, now a large share of that labor can be done by only one parent. In her case against breastfeeding in The Atlantic in 2009, Hanna Rosin described how that initial inequality persists and festers over the years: “She alone fed the child, so she naturally knows better how to comfort the child, so she is the better judge to pick a school for the child and the better nurse when the child is sick, and so on.” But what if—under very specific circumstances at least—breastfeeding did not fall solely on one parent? What if instead of parenthood starting off on unequal footing, it could be perfectly equal from the very beginning?


    For a while, Vallone and Berryman did trade off feedings, and both continued to pump, because they worried that their milk supplies would drop. They tracked every ounce in a shared spreadsheet. (This careful data logging actually allowed Schnell to write a case study about the couple.) The pumping eventually became too much—they couldn’t sleep if they were pumping!—but they have kept co-nursing for two years now.

    From the early days, they saw that nursing not only nourished their baby but also soothed her when she cried, made her sleepy when she was tired but fussy. So the work of not just feeding but all-round caregiving fell on them more equally. In the morning, they could alternate one person waking up early with the baby, the other sleeping in. At night, one parent could go out with friends without racing home for bedtime or pumping a bottle of breast milk for the other to feed. Because they could each provide everything their baby wanted, they were also each freer. Breastfeeding simultaneously deepened their relationships with their baby and allowed them a life outside of that. “You really get a sense of how radical it is to have caretaking split so evenly,” Vallone said. The couple is now trying for their second child, which Berryman plans to carry. They plan to co-nurse again.

    Vallone and Berryman did, however, run into an unexpected obstacle to their co-nursing: their baby. She at one point refused to nurse on Vallone, the birthing parent, and wanted to nurse only on Berryman. Any parent is probably familiar with how babies can develop seemingly arbitrary preferences: breast over bottle, left breast over right breast, even. As they get older, toddlers, too, go through periods of wanting only one parent or another to feed, clothe, bathe, or comfort them. In this case—as in many cases—Vallone and Berryman had to be deliberate about returning to a more even state. At its most intense, Berryman would sleep away from the baby in another room; it got better over time, but it also sometimes got worse. Equality did not come easily even with two nursing parents, which perhaps isn’t surprising. The advent of formula did not magically render all marriages equal. Vallone and Berryman still had to work toward keeping their co-nursing relationship as balanced as possible. Dividing work is also, well, work.

    Not all couples who induce lactation end up splitting breastfeeding evenly. Some are not able to, and some don’t even want to. For example, one parent might choose to carry the baby while the other takes on breastfeeding. Some of the women I spoke with were primarily motivated to induce lactation to pass along their antibodies in breast milk, or to physically bond with a baby they did not carry. Even for those who never made more than a few of the roughly 25 ounces a baby typically needs every day, being able to comfort nurse—when a baby sucks more for soothing than for nourishment—was meaningful. They could nurse their baby to sleep or calm them when upset. It brought the parents closer together too: Although inducing lactation is not equivalent to pregnancy, both parents felt like their bodies were preparing for a baby together. And later, they could troubleshoot a bad latch or clogged duct together. Breastfeeding can be an isolating experience when one parent is attached to a baby eight times a day and the other looks on a bit helplessly; co-nursing made it less so.

    Because induced lactation has flown under the radar of mainstream science for so long, a lot remains unknown. A couple of small studies suggest that the protein and sugar content of induced breast milk is in the normal range, but detailed experiments into, for example, the mix of antibodies have never been done. And why are some women inducing lactation able to produce more than others? Schnell has noticed that those who have struggled with infertility or hormonal balances usually make less milk. She has worked with trans women, too, who are able to make milk, though usually not in large amounts. Men, theoretically, could lactate as well; early studies into domperidone actually noted this as a side effect. There are anecdotal reports of men breastfeeding infants, but there’s virtually no research into the phenomenon.

    One mother I interviewed, Morgan Lage, told me that her experience inducing lactation to breastfeed her daughter inspired her to train as a lactation consultant, and she hopes now to fill in some of the many unknowns. The Newman-Goldfarb protocol is widely used as the template for anyone attempting induced lactation, but no one has rigorously studied the optimal time to initiate pumping or birth control. Lage started pumping earlier than the protocol suggested, and she wonders if that’s why she was able to have a full milk supply despite never having breastfed before. She loved nursing her daughter. She loved feeling “just as important and needed” in the fleeting, precious period of infancy.

    I know what Lage means about feeling needed, though perhaps because I breastfed solo—as most mothers do—I did not always love it. Still, I remember staring at my baby’s eyelashes and toes, marveling at how nearly every molecule in her body came from mine. We did supplement with formula, too, in part because we wanted my husband to be involved in her feeding. Although the bottle satisfied her hunger, it did not always satisfy some primal need for comfort. During her most inconsolable nights, my husband would spend hours trying to soothe her with every trick in the book, only for her to fall quiet and asleep the minute I nursed her. This frustrated us both. To be needed this way was a burden and a joy. I was sorry, for both of us, that we could not share it.

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    Sarah Zhang

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  • Hiccups Have a Curious Connection to Cancer

    Hiccups Have a Curious Connection to Cancer

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    Colleen Kennedy, a retired medical assistant, was prepared for the annihilation of chemotherapy and radiation treatment for stage-three lung cancer. She hadn’t expected the hiccup fits that started about halfway through her first treatment round. They left her gasping for air and sent pain ricocheting through her already tender body.  At times, they triggered her gag reflex and made her throw up. After they subsided, she felt tired, sore, breathless—as if she’d just finished a tough workout. They were, Kennedy, now 54, told me, “nothing compared to what we would consider normal hiccups at all.” They lasted for nearly a year.

    Hiccups are one of the most common bodily experiences that humans (and, rats, squirrels, rabbits, cats, dogs, and horses) have; even fetuses get them. When we hiccup, the diaphragm involuntarily contracts and the vocal cords snap closed, producing the eponymous “hic” sound. These spasms usually disappear within a few minutes. Compared with cancer’s existential threat and the brutal reality of treating it, hiccups are innocuous, banal, and unserious. But these two experiences are, peculiarly, connected. As many as 40 percent of cancer patients deal with bouts of hiccups during their illness. For a smaller subset—about one in 10—those spells last for more than 48 hours.

    Chronic hiccups interrupt almost every aspect of life. They disrupt concentration and conversations. They shake a person awake. Eating, drinking, and swallowing can feel like choking. Often, chest aches linger long after a hiccupping fit subsides.

    And they are difficult to treat. Doctors have some off-label prescriptions at their disposal, but none has been rigorously tested—none has been proved to work any better than home remedies. Kennedy tried to eradicate her hiccups with deep, forceful inhales and by drinking water from the far rim of a glass; she also trained herself to exhale before drinking or eating to limit the amount of air she swallowed. “Sometimes it worked, but most times it didn’t,” she said. Many try chiropractice or acupuncture. Others recruit household items: sugar, lemons, vinegar, a pencil, a cold spoon. Only one hiccup drug has ever been approved by the Food and Drug Administration.

    Hiccups, one of the most basic physiological features of human life, remain deeply mysterious and surprisingly understudied—partly because their fleeting nature makes them hard to examine, partly because they just seem so harmless. But when they’re not, hiccups confront us with how helpless we can be against our own body’s whims.

    In popular culture, hiccups are a joke: In a Looney Tunes bit from 1942, Daffy Duck’s hiccups send his hat bouncing. In a 2005 episode of Foster’s Home For Imaginary Friends, Bloo tries everything to cure his hiccups—he pours a box of sugar into his mouth, breathes into a brown paper bag, drinks hot sauce, eats peanut butter, gets scared, takes small sips and big gulps, stands on his head, brushes his teeth while singing, swallows a lemon. Nothing works. In 1937’s Snow White and the Seven Dwarfs, Dopey accidentally swallows a bar of soap and starts hiccuping bubbles. In 1970’s Aristocats, Uncle Waldo gets hiccups from drinking too much. In 1975’s Monty Python and the Holy Grail, a hiccuping guard is commanded by the king to get a drink to rid him of his ailment. In a 1992 episode of The Simpsons, a man who’s been hiccupping for 45 years gives this four-second interview to the local Springfield TV news: “Hic—kill me—hic—kill me—hic—kill me.”

    In medicine, hiccups are a conundrum. “There’s really no benefit to a hiccup, as far as anyone knows,” Aminah Jatoi, a Mayo Clinic oncologist who studies hiccups, told me. A transient symptom that appears and disappears randomly, hiccups are nearly impossible to study with rigor. Experiments on treatments are, accordingly, a nightmare to orchestrate. To date, only a handful of randomized, controlled trials have studied pharmacological treatments for hiccups; none recruited more than 40 patients. Most studies rely on storytelling: single-patient case reports, limited case series, and analyses of databases of doctor’s notes.

    What we do know: A sudden temperature shift can bring hiccups on, as can drinking alcohol, eating spicy food, and getting excited or stressed. High blood sugar can be to blame. So can low sodium or electrolytes. Many drugs—including steroids, chemotherapy agents, benzodiazepines, opioids, nicotine, antibiotics, anesthesia, and anti-nausea and blood-pressure medicines—are linked with hiccups. Some drugs used to treat intractable hiccups can cause hiccups. In one case study, a patient’s hiccups were incited by a hair brushing against the eardrum; in another, from 1988, the culprit was an ant crawling around the eardrum.

    The medical conditions associated with hiccups range the body’s entire upper half: stroke, brain injury, meningitis, multiple sclerosis, ear infection, rhinitis, goiters, sore throat, pneumonia, bronchitis, asthma, tuberculosis, fluid in the lungs or heart, bloating, gas, pregnancy, hernias, ulcers, liver disease, kidney disease. And cancer.

    Experts offer two main explanations for the cancer-hiccup connection. In one, cancers that invade the chest, throat, or head (that is, anything along the route of a hiccup) provoke them. In the other, medications prescribed to cancer patients— including chemotherapy drugs, steroids, and opioids—set them off. Regardless of whether cancer itself is to blame or whether they’re a side effect of treatment, hiccups add another layer of misery to the experience.

    One study published in 2022 showed that hiccups were a major detriment to the quality of life of about one in 20 of the cancer patients surveyed. Among those with hiccups, almost one in three said they struggled to relax or recreate; a smaller portion said they couldn’t enjoy meals. In another study of 320 cancer patients, hiccups sent one in 10 to the hospital for help. Other research suggests that upwards of three-quarters of hiccup-struck patients deal with the spasms without medical intervention. In a survey of 90 cancer-health-care providers with experience with hiccups, 40 percent rated their patients’ hiccup severity as worse than their nausea and vomiting.

    Even so, experts say, hiccups remain an aside for both patients and practitioners.

    Given the rapidity of physician visits—on average about 23 minutes, by one measure, for patients with cancer—hiccups may simply fall too low on a list of preoccupations to warrant mention, but “I think part of what happens is patients feel a little embarrassed bringing it up,” Jatoi said. Or “the patient may want to be a ‘good’ patient and not complain,” says Thomas Smith, an oncologist and palliative-medicine specialist at Johns Hopkins—perhaps because they fear their doctors will modify their treatment course if they speak up about any negative side effects.

    Oncologists, for their part, don’t consistently or directly ask about hiccups in the way that they screen for pain, nausea, and trouble breathing. “I don’t know of a single symptom-assessment scale in use that has a line for hiccups,” Smith told me. Some brush off patients who do complain of the spasms. “My doctors just shook their heads like I was joking when I told them I got the hiccups all the time,” one patient wrote to Mayo Clinic hiccup researchers.

    And so hiccups are relegated to the category of “orphan” symptoms—prevalent, distressing, characteristically unaddressed. Other such symptoms include muscle cramps, itchiness, muscle twitching, restless legs syndrome, loss or distortion of taste, dry mouth, and sweating. The success of palliative care depends on alleviating orphan symptoms: Every hiccup or itch or tingling foot, every flush of sweat or bout of constipation tethers patients to a raw state of awareness. “It’s a common reminder that you have chemotherapy, which is a constant reminder you have cancer, which is a constant reminder you’re facing your mortality,” Smith said. Treating hiccups offers medical relief in the form of escape. “It may make it possible for patients to have a few hours where they don’t think about cancer.”

    Jatoi said she often warns patients who are about to start a potentially hiccup-inducing regimen. “That helps patients speak up,”  she said, which is a step toward finding relief.   Oncologists can try prescribing a muscle-spasm treatment, for example, an off-label use that seems to help some patients. They might tweak the chemotherapy regimen to swap in drugs less likely to cause hiccups. The one treatment for hiccups that the FDA has approved—chlorpromazine, an antipsychotic first synthesized 72 years ago—can come with serious side effects, which research has shown to include low blood pressure and delirium.

    In the absence of clinically proven solutions, most hiccup sufferers are shepherded toward home remedies—breath-holding; drinking through hard-to-suck straws; swallowing spoonfuls of sugar, peanut butter, or vinegar.  “None of them have been tested to see how effective they are,”  Smith said. But without solid alternatives, he added, they’re worth trying. After all, unlike the hiccups themselves, “they’re completely harmless.”

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    Marion Renault

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