Tag: health report

There is no definitive evidence yet that microdosing with psychedelics is either effective or safe.

Psychedelic drugs have been capturing the attention of doctors and patients alike, for their increasingly proven potential to effect long-lasting improvements in the mental health of people who are suffering from conditions such as treatment-resistant depression. Microdosing of psychedelic substances such as LSD or psilocybin involves taking a fraction of a regular dose (a subperceptual dose) that is much lower than one would take if one wanted to “trip” or hallucinate on these substances.

Many people share the idea that microdosing with psychedelics enhances one’s mood, creativity, concentration, productivity, and ability to empathize with others. Or could the benefits be an “expectancy effect”? This means that most people who take a daily pill that they fervently expect will help them feel happier and smarter will feel like they are happier and smarter — just from taking the pill, regardless of what’s in it.

What is microdosing?

There isn’t a single, clearly recognized definition of microdosing for any psychedelic drug, and this complicates attempts to perform consistent research. One definition is approximately 1/5 to 1/20 of a recreational dose. (From anecdotal experience this is accurate, as a medium-strength dose of psilocybin is 2 to 3 grams of dried mushrooms, and a microdose is typically around 0.3 grams.) One obstacle is that the potency of mushrooms can vary greatly, as they are not regulated outside of clinical trials, so this isn’t an exact science. Likewise, LSD is an invisible, tasteless, odorless substance that usually comes either in liquid form or embedded into a piece of paper to be slipped under the tongue.

Given its current illegality and lack of regulation, there is no good way to know what dosage you are taking unless you have an extraordinarily reliable supplier. LSD is an extremely powerful and long-acting drug, and you don’t want to take more of it than intended. Further, psychedelics such as psilocybin and LSD can produce physiological tolerance, which might suggest that, even if microdosing does help, there could be diminishing returns if one stays at the same dosage.

Is microdosing safe?

We don’t know as much about safety as we might have learned if not for the War on Drugs, which curtailed much of the research into psychedelics starting in the late 1960s. This research has been renewed over the last five to 10 years, and many medical centers are conducting research on psychedelics. Psilocybin is generally thought to be safe in low dosages and has been used for centuries by indigenous peoples. However, if one takes too large a dose it can result in a terrifying — even traumatic — experience.

Psilocybin is a compound produced by almost 200 species of fungi (mushrooms), and the mushrooms must come from a trusted source. It is very easy to poison oneself with the wrong type of mushroom, as there are many types of mushrooms in nature that can look quite similar to each other, but some are poisonous and can harm your liver, causing severe illness or even death.

Could psychedelics become safer if legalized?

It is anticipated by experts in the field that some psychedelics may become fully legalized — for medical usage, under supervision — within the next few years, specifically psilocybin and MDMA (ecstasy). Some policy makers and public health experts believe that the safety of these psychedelics would be enhanced if they were decriminalized, and if their cultivation and production were monitored and regulated. At least one state (Oregon), and many cities around the country, have decriminalized psychedelics at the local level.

Some advocates of decriminalization are looking forward to a safer product, and wider access that could include not having to see a medical professional to get a prescription or be under medical supervision when using psychedelics. Skeptics are worried that uncontrolled access to these drugs might affect patients with mental illness, or might even precipitate mental illness such as psychosis in people that are vulnerable.

It is important to mention that the use of all psychedelic drugs should be undertaken with utmost caution — if they should be used at all — in patients with major mental illness such as schizophrenia or bipolar disorder. For safety reasons, these patients are typically excluded from studies involving psychedelic drugs.

Evidence for microdosing of psychedelics is mixed

Does microdosing work? In short, the jury is still out. Some studies indicate a very real and significant benefit from microdosing, whereas others are much less convincing and show little to no benefit. One recent study used a naturalistic, observational design to study 953 psilocybin microdosers compared with 180 nondosing participants for 30 days, and found “small to medium-sized improvements in mood and mental health that were generally consistent across gender, age, and presence of mental health concerns.” This study and others like it appear to confirm many anecdotal reports of people who swear by the benefits they have experienced from microdosing.

Other studies on microdosing are far less impressive. In one example the researchers conducted a randomized controlled study, which represents the strongest type of evidence because it weeds out the placebo effect. The researchers took 34 patients and randomized half of them to receive psilocybin and half to placebo. While there were some intriguing subjective effects (people felt happier and more creative), and even some changes in brain waves recorded on an EEG machine, they concluded that low-dose psilocybin mushrooms did not show objective evidence of improvements in creativity, well-being, and cognitive function. Studies such as this one support the hypothesis that the effect people receive from psychedelics at these subperceptual doses is mostly an expectancy effect, and that one needs to consume a higher dosage to receive a therapeutic benefit.

To microdose or not to microdose?

While any medical or lifestyle decision is an individual’s choice (assuming that they aren’t harming others), I would highly recommend that you speak with your doctor to explore your decision to take psychedelics, and see if there are any medical reasons why you should be cautious or avoid these drugs. It is critical to pay attention to the legality and the quality of your product — you likely can’t afford to get into legal jeopardy, and certainly can’t afford to poison yourself.

Finally, it is important to understand that there isn’t yet definitive proof that microdosing is at all helpful, or even that it is safe in the long term. With these points in mind, it is fair to say that psychedelic drugs are becoming better understood, and are undergoing a resurgence of research and a more widely accepted use.

The wait is finally over: after 40 weeks of medical appointments, nursery planning, and anticipation, your baby has finally arrived. She is perfect in your eyes, healthy and adorable. Yet over the next few weeks, your initial joy is replaced by all-consuming worries: Is she feeding enough? Why is she crying so often? Is something medically wrong with her? These worries are constant during the day and keep you up at night. You feel tense and irritable, your heart races, and you feel panicky. Your family members start to express their concern —not just about the baby, but about you. You wonder whether your anxiety is normal.

Baby blues, postpartum depression, or postpartum anxiety?

Chances are, you have heard about the baby blues or postpartum depression. You may have even filled out questionnaires about your mood during your postpartum doctor’s visit. The baby blues are a very common reaction to decreasing hormone levels after delivery, and may leave you feeling sad, weepy, and overwhelmed. However, these symptoms are mild and only last for a couple of weeks. When the symptoms persist and become debilitating, something else could be going on.

Many symptoms overlap between postpartum depression and postpartum anxiety (such as poor sleep, trouble relaxing, and irritability). Mothers experiencing postpartum depression commonly experience symptoms of anxiety, although not all mothers suffering from anxiety are depressed. Establishing the correct diagnosis is important, as women with postpartum anxiety may not respond as well to certain treatments for depression, such as interpersonal psychotherapy or medications such as bupropion (Wellbutrin).

Similar to postpartum depression, postpartum anxiety may spike due to hormonal changes in the postpartum period. It may also increase as a response to real stressors — whether it’s the health of the baby, finances, or in response to navigating new roles in your relationships. A history of pregnancy loss (miscarriage or stillbirth) also increases your risk for developing postpartum anxiety. If you have a history of anxiety before or during pregnancy, postpartum anxiety symptoms may also return after delivery. Anxiety and sadness may also appear after weaning from breastfeeding due to hormonal changes.

Some women experience panic attacks or symptoms of obsessive-compulsive disorder (OCD) in the postpartum period. Panic attacks are distinct episodes of intense anxiety accompanied by physical symptoms including a rapidly beating heart, feelings of doom, shortness of breath, and dizziness. Obsessions are intrusive, unwanted thoughts and may be accompanied by compulsions, or purposeful behaviors to relieve distress. These symptoms may be frightening to a new mother, especially when these thoughts involve harming the baby. Fortunately, when obsessions are due to an anxiety disorder, mothers are extremely unlikely to harm their babies.

What are the treatments for postpartum anxiety?

In general, postpartum anxiety is less studied than its cousin postpartum depression; however, it is estimated that at least one in five women has postpartum anxiety. We do know that therapies such as cognitive behavioral therapy (CBT) are excellent treatments for anxiety disorders, including OCD. For some women, medications can be helpful and are more effective when combined with therapy. Selective serotonin reuptake inhibitors (SSRIs) are generally the first-line medications (and the best studied medication class) for anxiety disorders, whereas benzodiazepines are rapidly acting anti-anxiety medications that are often used while waiting for an SSRI to take effect.

Should you take medications when breastfeeding?

Breastfeeding provides many benefits to the baby: it’s the perfect nutrition, it helps build a baby’s immune system, it may help prevent adulthood obesity, and it provides comfort and security. Breastfeeding also provides benefits for the mother: it releases prolactin and oxytocin (the love and cuddle hormones), which help a mother bond with her baby and provide a sense of relaxation. When considering whether to start a medication, it is important to be aware that all psychiatric medications are excreted into the breast milk. Your doctor can help you think through the risks and benefits of medications based on the severity of your illness, medication preference, and previous response, as well as factors unique to your baby, such as medical illness or prematurity.

What non-medication strategies are helpful in decreasing postpartum anxiety?

• Cuddle your baby (a lot). This releases oxytocin, which can lower anxiety levels.
• Try to maximize sleep. Although the baby may wake you every three hours (or 45 minutes) to feed, your partner should not. Sleeping in separate rooms or taking shifts caring for the baby may be necessary during the first few months. Aim for at least one uninterrupted four-hour stretch of sleep, and be mindful about caffeine intake.
• Spend time with other mothers. Although you may feel like you don’t have the time, connecting with other mothers (even online) can do wonders in lowering your fears and validating your emotions. Chances are you are not the only one worrying up a storm.
• Increase your physical activity. In spite of the physical toll that pregnancy, delivery, and milk production take on your body, physical activity is one of the most powerful anti-anxiety strategies. Activities that incorporate breathing exercises, such as yoga, may be particularly helpful.
• Wean gradually. If you are breastfeeding and make the decision to wean, try to do so gently (when possible) to minimize sudden hormonal changes.
• Ask for help. Caring for a baby often requires a village. If you are feeding the baby, ask someone else to help with household chores. There is an old saying “sleep when the baby sleeps.” You may prefer “do laundry when the baby does laundry.”

And finally, give yourself a break — after all, you just had a baby. Postpartum anxiety is common, and in many cases, it will pass with time.

I admit it: I’m not a fan of drug ads. I think the information provided is often confusing and rarely well-balanced. Plus, there are just so many ads. They show up on TV and streaming programs, on social media, on billboards and the sides of busses, on tote bags, and in public bathrooms. Yes, there’s no refuge — even there — from the billions spent on direct-to-consumer ads in the US.

I’ve often wondered how highly-promoted, expensive new drugs stack up against other available treatments. Now a new study in JAMA Network Open considers exactly that.

Many advertised drugs are no better than older drugs

The study assessed 73 of the most heavily advertised drugs in the US between 2015 and 2021. Each drug had been rated by at least one independent health agency. Researchers tallied how many of these drugs received a high therapeutic value rating, indicating that a drug had at least a moderate advantage compared with previously available treatments.

The results? Only about one in four of these heavily advertised drugs had high therapeutic value. During the six years of the study, pharmaceutical companies spent an estimated $15.9 billion promoting drugs on TV that showed no major advantage over less costly drugs!

Why drug ads are not popular

Only the US and New Zealand allow direct-to-consumer medication marketing. The American Medical Association recommended a ban in 2015. While I’ve often written about reasons to be skeptical, let’s focus here on three potential harms to your wallet and your health.

Drug ads may

• raise already astronomical health care costs by increasing requests for unnecessary treatment and promoting much costlier medicines than older or generic drugs.
• create diseases to be treated. Everyday experiences, such as fatigue or occasional dryness in the eyes, may be framed in drug ads as medical conditions warranting immediate treatment. Yet often, such symptoms are minor, temporary experiences. Another example is “low T” (referring to low blood testosterone). While it’s not a recognized illness on its own, ads for it have likely contributed to increased prescriptions for testosterone-containing medicines.
• promote new drugs before enough is known about long-term safety. The pain reliever rofecoxib (Vioxx) is one example. This anti-inflammatory medicine was supposed to be safer than older medicines. It was withdrawn from the market when evidence emerged that it might increase the risk of heart attack and stroke.

Four questions to ask your doctor if you’re curious about a drug ad

Wondering whether you should be taking an advertised drug? Ask your doctor:

• Do I have a condition for which this drug is recommended?
• Is there any reason to expect this drug will be more helpful than what I’m already taking?
• Is this drug more expensive than my current treatment?
• Do my health conditions or the medications I already take make the drug in the ad a poor choice for me?

The bottom line

The AMA recommended banning drug ads nearly a decade ago. But a drug ad ban seems unlikely, given strong lobbying by the pharmaceutical companies and concerns about violating their freedom of speech.

Still, cigarette commercials were banned in 1971, so it’s not an impossible dream. Meanwhile, my advice is to be skeptical about information in drug ads, and rely on more reliable sources of medical information, including your doctor. Consider contacting the Federal Communications Commission if you have complaints about these ads — a step few Americans seem to take. And try this: mute the TV, fast-forward your podcast, and close pop-ups as soon as drug ads appear.

How well are you protecting yourself against heart disease, the nation’s leading cause of death? A check of five important numbers can give you a good idea: blood pressure, blood sugar, LDL cholesterol and triglyceride levels, and waist circumference. Those values provide a picture of a person’s overall health and, more specifically, what factors they may need to address to lower their chance of a heart attack or stroke.

Below are the ideal values for each measurement, along with why they’re important and targeted advice for improving them. Universal suggestions for improving all five measurements appear at the very end.

How do your heart health numbers stack up?

While the ideal values are good goals for most people, your doctor may recommend different targets based on your age or other health conditions.

Blood pressure

Less than 120/80 mm Hg

Blood pressure readings tell you the force of blood pushing against your arteries when your heart contracts (systolic blood pressure, the first number) and relaxes (diastolic blood pressure, the second number). Your blood pressure reflects how hard your heart is working (when you’re resting or exercising, for example) and the condition of your blood vessels. Narrowed, inflexible arteries cause blood pressure to rise.

Why it matters to heart health: High blood pressure accelerates damage to blood vessels, encouraging a buildup of fatty plaque (atherosclerosis). This sets the stage for a heart attack. High blood pressure forces the heart’s main pumping chamber to enlarge, which can lead to heart failure. Finally, high blood pressure raises the risk of strokes due to a blocked or burst blood vessel in the brain.

What helps: A diet rich in potassium (found in many vegetables, fruits, and beans) and low in sodium (found in excess in many processed and restaurant foods); minimizing alcohol.

LDL cholesterol

Less than 70 mg/dL

A cholesterol test (or lipid profile) shows many numbers. Doctors are usually most concerned about low-density lipoprotein (LDL) cholesterol, particles that makes up about two-thirds of the cholesterol in the blood.

Why it matters to heart health: Excess LDL particles lodge inside artery walls. Once there, they are engulfed by white blood cells, forming fat-laden foam cells that make up atherosclerosis.

What helps: Limiting saturated fat (found in meat, dairy, and eggs) and replacing those lost calories with unsaturated fat (found in nuts, seeds, and vegetable oils).

Triglycerides

Less than 150 mg/dL

Perhaps less well-known than cholesterol, triglycerides are the most common form of fat in the bloodstream. Derived from food, these molecules provide energy for your body. But excess calories, alcohol, and sugar the body can’t use are turned into triglycerides and stored in fat cells.

Why it matters to heart health: Like high LDL cholesterol, elevated triglyceride values have been linked to a higher risk of heart attack and stroke.

What helps: Limiting foods that are high in unhealthy fats, sugar, or both; eating foods rich in omega-3 fatty acids (such as fish); avoiding alcohol.

Blood sugar

Less than 100 mg/dL (fasting)

High blood sugar defines the diagnosis of diabetes. Type 2 diabetes is most common. It occurs when the body develops insulin resistance (insulin enables cells to take in sugar) and does not produce enough insulin to overcome the resistance.

Why it matters to heart health: High blood sugar levels damage blood vessel walls and cause sugar (glucose) to attach to LDL. This makes LDL more likely to oxidize — another factor that promotes atherosclerosis. Excess sugar in the blood also makes cell fragments called platelets stickier so they’re more likely to form clots, which can trigger a heart attack or stroke.

What helps: Avoiding sugary beverages and foods high in sugar; eating whole, unprocessed grains instead of foods made with refined grains (white flour, white rice).

Waist circumference

Whichever number is lower:

Less than half your height in inches

OR

Women: Less than 35 inches

Men: Less than 40 inches

Measure your waist around your bare abdomen just above your navel (belly button). A big belly — what doctors call abdominal or visceral obesity — usually means fat surrounding internal organs.

Why it matters to heart health: Visceral fat secretes hormones and other factors that encourage inflammation, which triggers the release of white blood cells involved in atherosclerosis.

What helps: Consuming fewer calories, especially those from highly processed foods full of sugar, salt, and unhealthy types of fat.

Universal advice to improve all five measures of heart health

If one or more of your numbers is above ideal levels, you’re far from alone. Most Americans are overweight or obese and have bigger-than-healthy bellies. Excess weight and waist circumference affect blood pressure, LDL cholesterol, triglycerides, and blood sugar. Eating a healthy, plant-based diet can help. Regular exercise also helps: aim for at least 30 minutes of moderate-intensity exercise like brisk walking most days. Other lifestyle habits that can lower your heart disease risk include getting seven to eight hours of sleep nightly and managing your stress level.

Want your child to grow up healthy, happy, smart, capable, and resilient? Play with them. Infants and toddlers thrive on playful games that change as they grow.

Why does play matter during the first few years of life?

More than a million new nerve connections are made in the brain in the first few years of life. And pruning of these neural connections makes them more efficient. These processes literally build the brain and help guide how it functions for the rest of that child’s life. While biology — particularly genetics — affects this, so does a child’s environment and experiences.

Babies and children thrive with responsive caregiving. Serve and return, a term used by the Harvard Center on the Developing Child, describes this well: back-and-forth interactions, in which the child and caregiver react to and interact with each other in a loving, nurturing way, are the building blocks of a healthy brain and a happy child, who will have a better chance of growing into a healthy, happy, competent, and successful adult.

Play is one of the best ways to do responsive caregiving. To maximize the benefits of play:

• Bring your full attention. Put the phone down, don’t multitask.
• Be reciprocal. That’s the “serve and return” part. Even little babies can interact with their caregivers, and that’s what you want to encourage. It doesn’t have to be reciprocal in an equal way — you might be talking in sentences while your baby is just smiling or cooing — but the idea is to build responsiveness into the play.
• Be attuned to developmental stages. That way your child can fully engage — and you can encourage their development as well.

Great games to play with infants: 6 to 9 months

The Center for the Developing Child has some great ideas and handouts for parents about specific games to play with their children at different ages.

6-month-olds and 9-month-olds are learning imitation and other building blocks of language. They are also starting to learn movement and explore the world around them.

Here are some play ideas for this age group:

• Play peek-a-boo or patty-cake.
• Play games of hiding toys under a blanket or another toy, and then “find” them, or let the baby find them.
• Have back-and-forth conversations. The baby’s contribution might just be a “ma” or “ba” sound. You can make the same sound back, or pretend that your baby is saying something (“You don’t say! Really? Tell me more!”).
• Play imitation games: if your baby sticks out their tongue, you do it too, for example. Older babies will start to be able to imitate things like clapping or banging, and love when grownups do that with them.
• Sing songs that involve movement, like “Itsy Bitsy Spider” or “Trot, Trot to Boston” with words and motions.
• Play simple games with objects, like putting toys into a bucket and taking them out, or dropping them and saying “boom!”

Great games to play with toddlers

Between 12 months and 18 months, young toddlers are gaining more language and movement skills, and love to imitate. You can:

• Play with blocks, building simple things and knocking them down together.
• Do imaginative play with dolls or stuffed animals, or pretend phone calls.
• Use pillows and blankets to build little forts and places to climb and play.
• Play some rudimentary hide-and-seek, like hiding yourself under a blanket next to the baby.
• Continue singing songs that involve movement and interaction, like “If You’re Happy And You Know It.”
• Go on outings and explore the world together. Even just going to the grocery store can be an adventure for a baby. Narrate everything. Don’t worry about using words your baby doesn’t understand; eventually they will, and hearing lots of different words is good for them.

Older toddlers, who are 2 or 3 years old, are able to do more complicated versions of these games. They can do matching, sorting, and counting games, as well as imitation and movement games like “follow the leader” (you can get quite creative and silly with that one).

As much as you can, give yourself over to play and have fun. Work and chores can wait, or you can actually involve young children in chores, making that more fun for both of you. Checking social media can definitely wait.

Playing with your child is an investment in your child’s future — and a great way to build your relationship and make both of you happy.

Chronic pain often fluctuates during the day and for some it worsens at night — but why?

As many as one in five adults in the US — 50.2 million — experience chronic pain, according to a recent survey. These people usually encounter fluctuations in pain during the day: sometimes it’s better in the morning and worse in the afternoon, or the opposite.

But what happens when the sun sets? Some research — supported by many chronic pain sufferers — suggests chronic pain worsens at night.

“The end of the day doesn’t mean people necessarily get a break from flare-ups,” says Ellen Slawsby, director of pain services at Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. “In some cases, nighttime is when pain is the worst and can drastically interfere with sleep.”

What is chronic pain?

Chronic pain is defined as pain that lasts at least two to three months, often long after a person has recovered from the original injury or illness. The pain may even become a permanent issue. It can strike individual joints or muscles, or affect only certain areas of the body like the back and neck. Persistent pain may be more diffuse from conditions such as arthritis or fibromyalgia.

Symptoms and severity of chronic pain vary and can include a dull ache; shooting, burning, stabbing, or electric shock–like pain; and sensations of tingling and numbness.

Why might chronic pain increase at night?

There are several reasons why pain might worsen at night. Hormones could be a major factor, says Slawsby. “Nighttime is when the production of the anti-inflammatory hormone cortisol is at its lowest.”

New research also has suggested that pain may follow a circadian rhythm like the body’s internal 24-clock that regulates our sleep-wake cycle. “This helps explain why some people regularly have higher pain levels at certain times, such as during the night,” says Slawsby.

While there is no good time for chronic pain, nighttime is especially problematic, as it disrupts sleep. Insufficient sleep affects our ability to manage pain. And sleep problems are common among people with chronic pain. At least 50% of people with insomnia (the most commonly diagnosed sleep disorder) suffer from chronic pain.

“Insomnia can lead to sleep deprivation, which increases the release of proteins called cytokines that are involved in the body’s inflammatory response and makes people even more sensitive to pain,” says Slawsby.

Ways to get the rest you need if pain at night is a problem

If pain at night has been keeping you awake, trying these strategies may help you sleep better.

• Do a pre-bedtime relaxation routine. A soothing transition from a hectic day can help prepare your body and mind for sleep. “Spend at least 20 minutes before bedtime focused on relaxation, which helps slow the heart and breathing rate, decrease cortisol levels, and lower the chance of flare-ups occurring,” says Slawsby. For example:
  • take a warm or cool shower
  • perform a series of gentle stretches or yoga poses
  • do several minutes of deep breathing exercises.
• Create a healthy sleep environment. Make your bedroom as dark as possible and keep it cool (the ideal temperature is 65º Fahrenheit). Consider a sound machine that plays relaxing white noise or nature sounds. “Also, use comfortable pillows and supports for areas that have pain, like under your knees if you have back pain,” says Slawsby. Consistent routines and tools like cognitive behavioral therapy for insomnia can also help improve your sleep.
• Reframe your thoughts. People with chronic pain often worry about when their pain will occur, which can further increase stress and anxiety. “If you fear not falling asleep because of your pain, remind yourself that you’ve slept well in the past and can do so again,” says Slawsby. “If chronic pain does strike at night, remind yourself that it will go away soon, just as before. It’s difficult to change this mindset, but engaging in more positive thinking is important in mitigating pain.”

If pain wakes you up, allow your body time to recover so you can fall back to sleep. Listen to soft music or read, though preferably not on blue light–emitting electronic devices (computers, tablets, and smartphones) that affect sleep cycles. Another option is to count your breaths. Close your eyes and do a simple breathing exercise where you inhale while mentally counting to one, exhale while counting to two, and continue this pattern until you reach 10. Repeat as necessary. This can move your focus away from the pain and help relax the body. “Most of the time, you will fall back to sleep after a short while,” says Slawsby.

While studies sometimes reach faulty conclusions, researchers can help correct the record.

When it comes to clinical research, the most powerful type of study is a randomized, double-blind, placebo-controlled trial.

But even a well-designed trial can arrive at questionable conclusions. Recent follow-up on a 2019 cardiovascular study dubbed REDUCE-IT is one example that offers a great lesson. While innovative treatments are the focus of many clinical trials like this one, the choice of placebo is critical as well.

What made this a powerful study?

In this type of study, subjects are randomly assigned to two groups: one group receives the treatment being evaluated (such as a new drug) while the other group gets a fake treatment called a placebo.

Neither study subjects nor researchers know who is receiving active treatment and who is receiving placebo. That is, they are both blind to group assignment — that’s why it’s called double-blind. Treatment assignment is coded and kept secret until the end of the study, or decoded at earlier, planned intervals to monitor effectiveness or safety.

This reduces the chance that expectations of the researchers or participants will bias study outcomes. That means any differences in health or side effects can reasonably be attributed to the treatment — or lack of it.

What to know about placebo treatment

Ideally, study participants and researchers cannot tell who is getting an active treatment and who is getting a placebo. But sometimes, participants might be able to tell what they received. For example, the active treatment might have a bitter taste, or a noticeable side effect such as diarrhea.

If that happens, the study is no longer double-blind. This means expectations could affect outcomes. Studies can assess this by asking participants during or after the trial whether they thought they were taking an active treatment or a placebo. If the answers seem random or the subjects answer “I don’t know,” blinding was successful.

While a placebo treatment should have no effect, that’s not always true:

• The well-known placebo effect is a positive effect related to an expectation of benefit: if you tell someone a pill can relieve pain, some people will experience pain relief, even if that pill was a placebo.
• A negative side effect due to a placebo is called the nocebo effect: if you tell someone they might develop diarrhea from the placebo pill they’re taking, the expectation may cause some people to experience this. (The very same placebo used in another study may trigger headaches, if that’s the side effect the study subject is warned about.)

Finally, a placebo should not have any direct, biological impact on the person taking it. And that seems to be where REDUCE-IT went wrong.

REDUCE-IT demonstrates the importance of choosing a placebo carefully

The full name of REDUCE-IT is the Reduction of Cardiovascular Events With Icosapent Ethyl–Intervention Trial). It was designed to determine whether the drug icosapent ethyl could lower triglyceride levels as a way to reduce cardiovascular disease, such as heart attack or stroke.

Triglycerides are a type of fat in the blood. High levels may increase cardiovascular risk, but experts aren’t sure whether treatments to lower triglyceride levels result in fewer heart attacks or strokes.

Among participants who received the active drug, triglyceride levels fell. Rates of cardiovascular problems, including heart attack or stroke, were a whopping 25% lower compared with rates in those assigned to take a placebo. There was even a 20% reduction in cardiovascular deaths in the treatment group.

Based on these findings, the FDA approved a drug label claiming that icosapent ethyl benefitted certain people at high risk for cardiovascular disease.

But questions arose soon after the study was published in 2019. True, the treatment group fared better than the placebo group. Yet a careful reading of the results suggested that this may have been because those in the placebo group had more heart attacks and strokes over time, not because the treatment group had fewer.

A follow-up study shows a different result

Responding to these questions, the study’s authors performed additional analyses. This time they looked at substances in the blood called biomarkers associated with cardiovascular risk. They found little change in the biomarker results among participants receiving the active drug. But biomarkers worsened in the placebo group, suggesting that the apparent benefit conferred by the drug may have been due to the negative effects of the placebo!

How can a placebo worsen cardiovascular risk? One possibility is that the mineral oil placebo used in this trial may have reduced absorption of statin drugs participants were taking to lower their cholesterol, which also affect heart and blood vessel health. Regardless, this new analysis suggests that the skepticism about the dramatic results of the original study was appropriate, and additional study is warranted.

The bottom line

For me, this story has three take-home points:

• There are many ways for research to come to faulty conclusions; an unfortunate placebo choice is an unusual one, but appears to be true here.
• For medical research to be trusted, researchers must be willing to accept criticism, re-assess findings, and perform additional analyses if necessary.
• It appears that in the case of REDUCE-IT, this self-correction process worked.

After the initial study in 2019, enthusiasm was high for the drug icosapent ethyl. In the wake of this latest analysis, however, that excitement is likely to wane. But one thing should be clear: this is not science being unable to make up its mind, as is sometimes said. Reassessment and correction, when warranted, is how science is supposed to work.

Climate change is an escalating threat to the health of people everywhere. As emergency medicine physicians practicing in Australia and the United States, we — and our colleagues around the world — already see the impacts of climate change on those we treat.

Will we be seeing you one day soon? Hopefully not. Yet an ever-growing number of us will face climate-related emergencies, such as flooding, fires, and extreme weather. And all of us can actively prepare to protect health when the need arises. Here’s what to know and do.

How is climate change affecting health?

As the planet warms, people are seeking emergency medical care for a range of climate-related health problems, such as heat exhaustion and heat stroke, asthma due to air pollution, and infectious diseases related to flooding and shifting biomes that prompt ticks, mosquitoes, and other pests to relocate. News headlines frequently spotlight physical and emotional trauma stemming from hurricanes, wildfires, tornadoes, and floods.

We care for people displaced from their homes and their communities by extreme weather events. Many suddenly lack access to their usual medical team members and pharmacies, sometimes for significant periods of time. The toll of extreme weather often lands hardest on people who are homeless, those with complex medical conditions, children, the elderly, people with disabilities, minoritized groups, and those who live in poorer communities.

On a recent 110º Fahrenheit day, for example, a woman came to an emergency department in Adelaide, Australia complaining of a headache, fatigue, and nausea, all symptoms of heat exhaustion. She told medical staff that she had just walked for two hours in the sun to obtain groceries, as she had no car or access to public transportation. While health advisories in the media that day had advised her to stay inside in air conditioning, walking outside was only the only option she had to feed her family. For this woman and many others, well-intended public health warnings do little to reduce the risk of illness during extreme weather. Achieving safe, equitable health outcomes will require addressing access to shelter, access to transportation, and other societal factors that put people at risk of bad health outcomes.

Extreme weather contributes to large-scale health and safety issues

Increasingly, climate-related extreme weather is leading to interrupted access to medical care, contributing to later illness and death. Extreme weather can damage key infrastructure like the electrical grid, so that those relying on home medical equipment cannot use it. It may shut down health care facilities like a dialysis center or emergency room, or slow care in facilities that stay open.

People fleeing a fire or hurricane can be displaced into settings where they may have difficulty getting medical care or obtaining much-needed medicine, such as insulin, dialysis, high blood pressure treatments, and heart medicines. Such factors can worsen chronic conditions and may even cause death, particularly in people with existing medical conditions like heart failure, lung disease, and kidney disease.

How can you be ready to protect your health?

We all have a part to play in keeping ourselves and our communities well in the face of increasing dangers from climate change. Taking these steps will help.

If you or a loved one has health issues:

• Keep a printed summary handy listing all medical conditions, medications and dosages, and phone numbers for your health providers.
• If you have to leave your home, try to bring all medications with you — even bringing empty pill bottles will help a doctor trying to restart your medications.
• Store medicines in a waterproof bag in a place where you can easily find them. This will help if you need to evacuate quickly.

Think about what to do if you need to leave home quickly. Now is the time to figure out your basic emergency plan:

• Where will you go if you need to evacuate?
• How will you get there?
• How could you communicate with others if there is no electricity or phone service?
• Do you have written contact info for a few family members and friends, in case you lose your phone or the battery dies?

Finally, we all need to look out for others in our community. Check in on elderly neighbors and those around you who may be socially disconnected, and make sure that they are safe where they live and are able to access the medical care they may need when the weather turns hot, cold, smoky, fiery, snowy, wet, or windy.

Climate change is here. It is already having tangible and significant impacts on our communities and the health of people around the world. Moreover, the increased risk of climate-related extreme weather is here to stay for the foreseeable future, and we must prepare for the threats it poses to our health, both now and in decades to come. We all have a part to play — health professionals, communities, and individuals — in keeping ourselves and each other healthy and safe.

Screening tests, such as Pap smears or blood pressure checks, could save your life. They can detect a disease you have no reason to suspect is there. Early detection may allow treatment while a health condition is curable and before irreversible complications arise.

Some screening tests help prevent the disease they are designed to detect. For example, colonoscopies and Pap smears can identify precancerous abnormalities that can be addressed so they cannot continue to grow and become cancerous. And missed screening tests contribute to thousands of avoidable deaths each year in the US. Yet there’s a point of diminishing returns, as a new study on Pap smears illustrates. And many of us could benefit from a better understanding of the limits of screening, and how experts decide when people should stop routine screening tests.

Know the limits of screening tests

Even the best screening test has limitations. It can miss the disease it’s intended to detect (false-negative results). Or it can return abnormal results when no disease is present (false-positive results).

Equally important, as people grow older life expectancy declines and screening benefits tend to wane. Many conditions detected by routine screenings, such as prostate cancer or cervical cancer, typically take a while to cause trouble. A person in their 80s is more likely to die from another fatal condition before cervical cancer or prostate cancer would affect their health. Additionally, certain diseases, such as cervical cancer, become less common with advancing age.

As a result, many screening tests are not recommended forever: at some point in your life, your doctor may tell you that you no longer need to repeat a screening test, even one you finally got used to having.

Know when screening tests usually end

Expert guidelines for many common screening tests include an “end age” when people can reasonably stop having the test. For example:

There are exceptions, of course. For example, if a colonoscopy found abnormalities in an otherwise healthy 72-year-old, repeat testing after age 75 may be recommended.

Many women have Pap smears after guidelines suggest stopping

Pap smears screen for cervical cancer. In 1996, new guidelines recommended that women who received Pap smears at appropriate intervals before age 65 could safely stop.

Yet many women continue to have this screening after turning 65, according to a recent study published in JAMA Internal Medicine that looked at data from 15 to 16 million women per year between 1999 and 2019. Their average age was 76, most (82%) were white, and all were enrolled in Medicare.

The study found:

• In 1999, nearly three million women over age 65 (almost 19% of the study population) had Pap smears. By 2019, the number had fallen to 1.3 million (8.5%), a reduction of more than half.
• Among women older than age 80, about 3% had Pap smears.
• In 2019, the estimated cost related to Pap smears in these older women was $83.5 million.

Possibly, some women in this study had good reasons to continue having Pap smears. Perhaps they weren’t adequately screened when they were younger. Perhaps they had previous Pap smear abnormalities. Maybe their doctors recommended they continue having Pap smears despite their advanced age. We don’t know, because this study didn’t collect that information. Still, it’s quite likely that many (or even most) of these Pap smears represent overscreening: routine testing with little chance of benefit.

Why does overscreening matter?

Overscreening may cause

• discomfort that may be tolerable when there’s an expectation of benefit, but less acceptable when the test is unnecessary
• anxiety while awaiting the results of the test
• false-positive results that lead to additional testing and unnecessary treatment
• complications of testing, such as infection or bleeding after a Pap smear, or perforation or bleeding after a colonoscopy. (Fortunately, complications are rare.)
• unnecessary costs, including medical appointments and lab fees, time wasted, and taking health providers away from more valuable care.

The bottom line

Screening tests are typically performed for people without symptoms, signs, or a high suspicion of disease. In many cases, they’re looking for a condition that is probably not there. For most screening tests, we have guidelines developed by experts and backed by data suggesting when to start — and when to stop — screening.

But guidelines are only general recommendations, and individual preferences matter. If foregoing a screening test will cause you excessive anxiety, or if having a test will provide significant peace of mind, it may be reasonable to have a test even after the recommended end age. Be sure you understand potential downsides, such as additional tests and complications.

So, never hesitate to ask your doctor when your next screening tests are due — but don’t forget to also ask if they are no longer worth having.

Key safety tips as legal medical and recreational marijuana evolve.

It’s fair to say that society’s views on cannabis have been evolving. Today, adult recreational use is legal in 21 states and medical use is legal in most other states, to varying degrees. The use of cannabis doesn’t seem to be going away. Given that, here is what you need to know to make using cannabis safer.

Buy it legally

If you live in a state with legal cannabis — whether medical or recreational — go through the legal market rather than the illicit market, despite the temptation of lower prices. While many state programs are less than perfect, buying cannabis through the legal market generally offers some advantages and protections:

• The product is tracked throughout its entire cycle “from seed to sale.” It’s tested for potency and to ensure it is free of contaminants. Legally bought cannabis should be free of heavy metals, disallowed pesticides, fungus, and lead.
• Labeling is increasingly accurate and helpful, showing what is actually in the cannabis you are purchasing. Different types of cannabis have different effects. You need to be able to understand what you are and aren’t consuming.
• In states where its use is legal, it is still illegal to purchase marijuana from illicit sources.
• If a contaminated product is discovered, there can be a recall.
• Keeping transactions aboveboard helps to facilitate communication with health care providers and to lessen stigma that harms medical users.

Some things to watch out for in the legal market:

• Safety and monitoring are by no means foolproof. This will get better once there are consistent federal standards.
• Do not rely on well-intentioned dispensary employees (known as budtenders) to make medical suggestions when you are purchasing. Health care providers should be answering these questions — though many are still getting up to speed on the cannabis issue.
• Be extremely careful of dosages. Don’t be upsold into buying a product that is too strong for you.
• Not all products are safe to have around the house, such as THC-infused sodas, chocolates, or gummies that any child or pet would gladly overconsume.

Pay attention to potency

The most straightforward way to get into trouble with cannabis is by consuming too high a dosage of the main active ingredient, THC. As with any medicine or drug, it is safest to use the lowest effective dose for the shortest time permitted.

Cannabis flower is far more potent than it was back in the 1970s. People who haven’t used cannabis in the modern era may inadvertently overconsume, assuming it is the same weed that they had back in the day.

Taking too much cannabis, or using cannabis that is too strong for you, can cause a severe anxiety attack, possibly landing you in the emergency department. You do not want this! Too high a dosage can also potentially trigger other medical conditions, such as cardiac arrhythmias and syncope.

Some people develop cannabis hyperemesis syndrome — uncontrolled vomiting in response to cannabis use — which can only be treated by ceasing use. Start low, go slow, and stay low is good advice, especially if you’re new to (or newly back to) using cannabis. Be careful with all edibles, especially any you make yourself: licking batter off the spoon means you’re consuming the marijuana.

Concentrates (called wax, shatter, or crumble) feature extremely high levels of THC. They often don’t have other medicinal cannabinoids such as CBD, which can mitigate some of the unwanted effects of THC. It is much easier to overconsume with these concentrates, as the THC content ranges from 40% to 90%.

Who should not use cannabis?

As with all things in medicine (including medical cannabis), there are exceptions to all rules, but generally:

• Teens should absolutely avoid using cannabis due to concerns about the effects it can have on brain development.
• Women who are pregnant or breastfeeding should abstain from cannabis due to safety concerns about its effects on a newly developing brain.
• People with certain psychiatric conditions, such as any type of psychosis, or those with a family history of schizophrenia, should avoid using cannabis, as this can worsen their condition.

If you are having trouble controlling your cannabis use or if you find it is escalating, seek professional help.

What else to know

• Don’t smoke cannabis, which can inflame your lungs. Use an under-the-tongue tincture, an edible, a topical product, or a dry herb vaporizer.
• If you do smoke cannabis, don’t hold it in your lungs for more than a second or two; holding it in longer doesn’t give you more effect, it just irritates your lungs.
• Don’t drive for at least four hours after smoking cannabis, even if you feel you are able to drive safely sooner than that. After an edible, wait eight to 12 hours before driving.
• Communicate with all of your health care providers about your cannabis use. Open dialogue helps coordinate care and avoids drug interactions.
• Avoid using cannabis for 24 hours before your shift if you work in a safety-sensitive job. You should also abstain if are on call for your job or a sick relative, or if you are in charge of children.

If a 3-year-old finds a cookie on the table, chances are they are going to eat it.

Even if it is made with marijuana or THC, CBD, or other components of cannabis.

As more states have legalized the use of marijuana and an ever-widening range of derivative products, it’s not surprising that more children are being exposed — including by eating marijuana edibles. A research brief published in the journal Pediatrics found that between 2017 and 2019, there were 4,172 calls to regional poison control centers about exposures to cannabis in babies and children through age 9. About half of the calls were related to edibles.

The frequency of these calls, and the percentage related to edibles, went up over the two-year period. Not surprisingly, the exposures were about twice as common in states where marijuana use is legal than in those where it is not.

More calls about edibles involving younger children

The most common age group involved was 3- to 5-year-olds, which makes sense: this is the age where they are old enough for parents to take their eyes off them for a minute or two, but not old enough to understand why they shouldn’t eat that brownie, gummy bear, or piece of chocolate.

Thankfully, the effects of these exposures were mostly minor — but in 15% they were moderate, and in 1.4% they were severe. In rare cases, significant ingestion can lead to trouble breathing or even coma. That’s the problem with edibles: it’s hard to know how much cannabis is in each one, it’s easy to ingest a lot, and the effects can last a long time.

It’s important to remember, too, that this was just a study of calls to poison centers. It’s impossible to know how many exposures there have been that were never reported — including how many went completely unnoticed by parents or caregivers.

Safety first: Children and cannabis

Clearly, there will need to be some regulation around labeling and child-safe packaging. But as an immediate step, parents and others shouldn’t buy marijuana edibles that might appeal to children (just like it’s best not to buy detergent pods that look like candy). If you do buy marijuana edibles that a child might want to eat, they need to be stored securely, out of reach, always.

When parents bring their children to visit friends, it may be a good idea to add marijuana edibles to the list of safety issues to ask about. Think of something along the lines of, “Hey, our daughter is still little and curious, so we like to ask about things like matches, guns, medications, marijuana edibles, or other things that might be dangerous for her if she gets into them. Is there anything that might be in her reach?”

It might be a bit awkward, but if you make it quick and routine, you can decrease the awkwardness. And ultimately, it’s worth a bit of awkwardness to keep your child safe.

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Recent events underscore the importance of knowing how to do lifesaving CPR.

The collapse on the football field of Buffalo Bills safety Damar Hamlin following a hard hit to his chest brought emergency responders running to do cardiopulmonary resuscitation (CPR) to help restart his heart, which had stopped beating.

When a heart stops beating (cardiac arrest), receiving even a simplified, hands-only version of CPR can at least double a person’s odds of surviving. Yet fewer than half of people who have cardiac arrest outside of a hospital receive CPR from someone nearby. And since four out of five cardiac arrests happen at home, the life you may save with CPR is more likely to be a loved one or someone you know than a stranger. Here are the CPR basics to know for adults.

Know two key features of cardiac arrest

How can you recognize whether a person is suffering cardiac arrest? Two key features are:

• Not responding. No reaction if you loudly say, “Are you okay?” and firmly shake a person’s shoulders.
• Not breathing normally. Check if their chest is rising and falling or put your face close to their nose and mouth to listen for the sounds of normal breathing. Labored, irregular breaths that sound like snorting or gasping aren’t normal breathing, and can’t provide the brain with adequate oxygen.

Know how to do hands-only CPR

1. First, call 911 — or better still, tell someone nearby to make that call. Put the phone on speaker so you can start CPR and receive instructions from the emergency operator.
2. Next, place the heel of one hand on the center of the person’s chest, right over the breastbone and between the nipples. Put the heel of your other hand directly on top. Lace the fingers of your top hand through the fingers of the bottom hand.
3. Position your shoulders directly above your hands and push down, keeping your arms straight. Push hard: use your body weight to compress the chest at least two inches.
4. Do the compressions repeatedly, aiming for a target of 100 to 120 pushes per minute.

Watch a video to help understand the steps

Knowing what to do in an emergency is invaluable. These one-minute hands-only CPR videos from the American Heart Association can help you learn the steps and the right speed for compressions.

CPR classes are offered through community education, hospitals, workplaces, and the American Heart Association. The hands-on practice of a CPR class can give you a better sense of the correct pressure and timing for compressions.

Worried about the time involved? Even a single, 20-minute training session — face-to-face or using virtual reality — offers skills and confidence, according to a 2022 JAMA Network Open study done in the Netherlands. When asked if they’d be willing to perform CPR on a stranger, just over 75% of young adults who had done the short training session six months earlier said yes.

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No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

If you’re a trauma survivor or dislike physical touch, health care visits may be hard.

Physical touch has long been linked to the healing process of medicine. During physical exams, the laying on of hands — broadly known as therapeutic touch — offers many clues to help health practitioners decide on the best course of treatment.

Yet therapeutic touch has begun to fall out of practice, as doctors tap away at electronic medical records during patient visits and diagnostic tools like CT scans and echocardiograms pull time and energy away from the bedside. Whether or not you view this as a loss may depend on your feelings and life experiences — particularly if you’re a trauma survivor. Here’s why therapeutic touch matters during medical visits, and how to help strike a good balance to get the care you need.

Why is touch helpful to good health care?

The idea that touch can be therapeutic is more than a theory. Physicians use touch as a way of comforting a patient, as well as in physical exams to detect clues to possible abnormalities: a tender upper right abdomen pointing toward a gallstone, let’s say, or a lump that might signal cancer. While listening to your heart, they may place a hand on your back to listen for murmurs. Taps on your knee with a reflex hammer assess your nerves. In many cases, without a physical exam, clues about the underlying health issue could easily be missed.

While many people report feeling reassured by a doctor’s touch, some forms of touch are more charged than others. If you have certain health concerns, your doctor may suggest doing an exam of more private areas, such as a rectal or breast exam. When doctors forego components of a physical exam, some people may be dissatisfied and may worry something important could have been missed. Others may feel relief.

Therapeutic touch is used by some nurses and many alternative or integrative health practitioners. A few examples are spinal manipulation performed by chiropractors, and body work like reiki (which requires light touch or no direct physical touch) or massage.

What if physical touch is hard for you to tolerate?

Not everyone welcomes touch during medical visits. Some people feel uncomfortable with the invasion of their personal space, or some unease depending on their health practitioner’s gender.

Survivors of trauma, including sexual assault, have higher rates of anxiety and are less likely to engage with the health care system than the general population. Pelvic exams in particular can seem unbearable to some people. An uncomfortable or traumatizing visit to the doctor can turn the health care system into an intimidating entity and prevent people from receiving the care they need.

If you recognize yourself here, there are actions you can take to make health experiences easier to handle.

How can you get the health care you need?

Often, the physical exam is important for the physician to make the right diagnosis. While you are always able to completely refuse any recommendation, there may be ways your doctor can make the experience more comfortable to ensure you’re getting the best assessment possible.

Fortunately, more and more physicians are trained in trauma-informed care. Trauma-informed care assumes that all patients might have a history of trauma, and encourages health practitioners to work to create a safe space for everyone they see. This might mean asking you up front how they can make the encounter more comfortable, and fully explaining each step of the physical exam.

Even without a history of trauma, you may have cultural or personal reasons for wanting to avoid touch that are valid and worthy of your medical team’s attention. For example, I’m still taken aback if someone offers me a handshake at the beginning of a health visit. I’m out of practice, despite our days of social distancing ending.

If you’re nervous about an upcoming visit, here are ways to help make it a more comfortable experience:

• Mention your concern to the nurse or medical assistant as you are getting checked into the exam room, or tell the physician when they arrive. Remember that you do not have to go into details that you do not want to share. Just indicating that you have a preference about physical touch can help the physician understand your needs and work with you to help you feel safe.
• Ask your provider to explain all the steps involved in the physical exam before it starts, so there are no surprises. Many doctors will do this even if not asked.
• If you’d prefer a chaperone, such as a medical assistant or a friend or family member, to be present during any or all parts of the exam, it’s fine to ask for one. This is a standard practice for particularly intimate exams like a pelvic exam.

If therapeutic touch by a doctor or other health practitioner is not actually therapeutic for you, I encourage you to communicate with your providers. They should listen carefully to your needs to create a nonjudgmental and trusting relationship.

How to safely explore the joys of winter hiking.

By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter backdrops are stark, serene, and often stunning. With fewer people on the trail, you may spot more creatures out and about. And it’s a prime opportunity to engage with the seasons and our living planet around us, says Dr. Stuart Harris, chief of the Division of Wilderness Medicine at Massachusetts General Hospital. But a multi-mile trek through rough, frosty terrain is far different than warm-weather hiking, requiring consideration of health and safety, he notes. Here’s what to know before you go.

Winter hiking: Safety first

“The challenge of hiking when environmental conditions are a little more demanding requires a very different approach on a winter’s day as opposed to a summer’s day,” Dr. Harris says. “But it gives us a chance to be immersed in the living world around us. It’s our ancient heritage.”

A safety-first attitude is especially important if you’re hiking with others of different ages and abilities — say, with older relatives or small children. It’s crucial to have both the right gear and the right mindset to make it enjoyable and safe for all involved.

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

People at the extremes of age — the very old or very young — are most vulnerable to frigid temperatures, and cold-weather hiking can be more taxing on the body. “Winter conditions can be more demanding on the heart than a perfectly-temperatured day,” Harris says. “Be mindful of the physical capabilities of everyone in your group, letting this define where you go. It’s supposed to be fun, not a punishing activity.”

Before setting out:

• Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.
• Know if you’ll have access to emergency cell coverage if anything goes wrong.
• Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

• Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. “As they say, there’s no bad weather, just inappropriate clothing,” Dr. Harris says. “Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes.”
• Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.
• Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

• Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.
• First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.
• Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. “A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight,” Harris says.
• Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. “Make sure that you have the technology and skill set to be able to navigate on- or off-trail,” Harris says, “and that you have a means of outside communication, especially if you’re in a large, mixed group.”

A long-term study explores risk factors for glaucoma and treatment options for people with high eye pressure.

Often described as the silent thief of sight, glaucoma is the most common cause of irreversible blindness in the world. High pressure in the eye damages the optic nerve, first stealing peripheral vision (what you see at the corners of your eyes) and later harming central vision (what you see when looking straight ahead). Usually, people notice no symptoms until vision loss occurs.

Lowering high eye pressure is the only known treatment to prevent or interrupt glaucoma. But does everyone with higher-than-normal eye pressure need to be treated? A major long-term study provides some clues, though not yet a complete answer.

Does everyone with high eye pressure develop glaucoma?

In the US, glaucoma affects an estimated three million people, half of whom do not know that they have it. An ophthalmologist can perform a comprehensive eye exam to determine if someone has glaucoma, or is at risk for developing it in the future due to high eye pressure (ocular hypertension). Research from the long-running Ocular Hypertension Treatment Study (OHTS) shows that some people with high eye pressure may never develop glaucoma, while others will.

Launched in 1994 as a multicenter, randomized clinical trial, OHTS continues to inform our understanding of people who have high eye pressure, their risk of developing glaucoma, and whether they can take medications to prevent glaucoma.

The researchers enrolled a diverse group of 1,636 participants with ocular hypertension from 22 sites across the US. To study glaucoma prevention, participants were randomly assigned to start either early eye pressure-lowering eye drops (medication group) or close observation (control group).

At five years the data showed that 4.4% of participants developed glaucoma in the medication group, compared to 9.5% in the control group. This tells us that early use of medicated eye drops helps delay over 50% of glaucoma cases in people with ocular hypertension.

During later phases of the study, the control group could receive eye pressure-lowering medications to see whether starting medication later could still delay glaucoma; it did. At 20 years, about 49% of those in the control group and 42% of those in the medication group developed glaucoma. However, since the study was no longer randomized, the researchers were unable to compare the 20-year risk reduction between the initial starting groups.

Who took part in the study?

A high proportion of study participants (25%) were Black, which is important because minorities have historically been underrepresented in clinical trials. The other participants were mostly white. Ages ranged from 40 to 80 years (the average was 55). Except for ocular hypertension, all participants had normal eye exams, normal vision, and eye anatomy known as open angles. None had pre-existing glaucoma.

Has this research changed thinking on when to start treating glaucoma?

At first glance, the five-year data suggested that Black individuals had a higher rate of glaucoma than people of other races. However, this apparent difference disappeared when the researchers controlled for important characteristics such as age, thickness of the cornea, a measure called optic nerve cup size, and initial peripheral vision test scores.

Glaucoma risk, it turned out, did not depend solely on eye pressure and race, but on a combination of exam findings. This information helps guide clinicians in determining whether a person with ocular hypertension is at a low, medium, or higher risk for developing glaucoma. Having such information could help people decide when to begin using medicated eye drops to prevent vision loss or slow its progress.

What are the limitations of this long-term study?

The study has several limitations:

• Trial participants usually comply better with medications and appointments than those not participating, which might make real-world rates of glaucoma higher than what occurred with either group in the study.
• While the first five years of OHTS were randomized, during later phases both groups could receive eye pressure-lowering medications. By 20 years, most participants were using these medications: about 81% in the medication group and 66% in the control group. That makes it hard to compare the long-term effect of each starting approach.
• Glaucoma detection has improved over the years, with new diagnostic tests such as ocular coherence tomography and newly discovered risk factors such as corneal hysteresis. This may further support watchful waiting as a reasonable option for people at lower risk for glaucoma based on a combination of factors.

And, of course, study results do not apply to those who already have glaucoma or other eye diseases, and the eye anatomy known as narrow angles.

What’s the bottom line?

Overall, the 20-year follow-up data supports making decisions on preventive glaucoma therapy for people with ocular hypertension based on a combination of additional exam findings. People with a higher number of risk factors — including higher eye pressures, older age, thinner corneas, larger optic nerve cup sizes, and worse initial peripheral vision test scores — are more likely to develop glaucoma.

If you have ocular hypertension, particularly combined with several other risk factors, eye pressure-lowering eye drops or a brief office procedure known as selective laser trabeculoplasty can help prevent glaucoma. If you have ocular hypertension and fewer additional risk factors, you can likely delay treatment if you receive regular exams to detect early signs of glaucoma. But because glaucoma is an often silent condition, anyone who has ocular hypertension should receive lifelong monitoring regardless of treatment status.

A new imaging technology forecasts the likelihood of recurrence.

Outcomes after prostate cancer surgery can vary: in some men the cancer never returns, while in others it does. Doctors try to gauge the odds of recurrence by evaluating certain types of clinical information. For instance, if a man’s biopsy results reveal highly aggressive cancer, then recurrence is more likely. Very high or rapidly increasing levels of prostate specific antigen (PSA) before surgery are also associated with worse outcomes.

Researchers are working hard to develop even better tools for identifying which men could benefit from additional therapy or closer monitoring. Genetic tests are helping with these risk-based classifications, and so are new types of medical imaging.

In December, scientists at Stanford University reported promising findings with a new technology that lights up prostate tumors on specialized imaging scans. The approach relies on a minimally-radioactive tracer that travels the body hunting for cancer cells. Called ⁶⁸Ga-PSMA-11, and delivered intravenously, the tracer binds exclusively with a protein called prostate- specific membrane antigen (PSMA). Prostate cancer cells contain far more of this protein on their surfaces than normal prostate cells do. Tumors flagged by ⁶⁸Ga-PSMA-11 show up on an imaging scan like lit matches in a dark room. Doctors are already using PSMA scans to diagnose early metastatic cancer, and the tracer can also be used to ferry drugs directly into malignant tumors.

Research methodology and results

For this research, the Stanford team wanted to know if the scanning technology would predict prostate cancer recurrence after initial treatment. The researchers enrolled 73 men with intermediate or high-risk features on tumor biopsies, and gave them each a dose of ⁶⁸Ga-PSMA-11. Then they measured how much of the tracer was taken up by the prostate, as well as any bits of cancer that were potentially spreading in the body. Following that, the men had their prostates taken out.

Cancer recurrence was assessed by evaluating changes in PSA levels. The levels should fall to zero if a man’s prostate has been removed, so continued elevations or a sudden spike in PSA after surgery indicate that cancer still lurks in the body. This type of recurrence is called biochemical failure.

The men were followed for roughly three years. According to the final results, men with lower tracer uptake values before surgery fared better over time than men who had higher uptake values. The men with lower tracer uptake values avoided biochemical failure for at least two years after their operations. Conversely, men with the highest tracer uptake values and/or PSMA-detected metastases prior to surgery were more likely to experience biochemical failure during the study period.

Commentary from experts

“We found that the information we could get from PSMA scanning in patients with newly-diagnosed prostate cancer before surgery was at least as reliable and useful as other information from biopsy, PSA levels, or clinical exam for predicting how patients would do after surgery or other treatment,” says Farshad Moradi, a radiologist at Stanford who co-authored the study. “The information from PSMA scans can help patients and their doctors to make more informed and better decisions about treatment options and follow-up, which we hope will also improve long-term outcomes.”

“This study adds to the excitement over PSMA scans, and how they can be used to predict prostate cancer outcomes,” adds Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. “Many improvements enabled by PSMA are positively influencing the management of prostate cancer and the follow-up of patients after they are diagnosed and treated, and this study further illustrates the value of this important technology.”

5 takeaways from the 2023 diabetes guidelines.

At nearly 300 pages long, the recently released 2023 American Diabetes Association Standards of Medical Care are quite comprehensive. And given the strong link between obesity and diabetes, one major theme is weight loss. For the estimated 37 million Americans currently living with diabetes, what other changes are worth noting?

Collaborating on lifestyle change is key

There aren’t any dramatic shifts in this update, says Harvard Medical School professor Dr. David M. Nathan, who co-authored and chaired earlier versions of some of the guidelines, which have been published annually for more than three decades. “Most of the standard lifestyle advice for managing diabetes are the same common-sense things your grandmother told you: eat your vegetables, go outside and exercise, and get enough sleep.”

One subtle shift in the association’s advice over the past five to 10 years, however, is an overarching effort to make care for people with diabetes more person-centered, says Dr. Nathan, who directs the Diabetes Center and the Clinical Research Center at Massachusetts General Hospital. “That means collaborating with your physician to figure out a lifestyle and medication plan that works for you,” he says. “Doctors don’t stand by your dinner table or bedside telling you what to do. They can help you make plans and informed decisions to better manage your diabetes, but you have to play an active role.”

Five takeaways for a diabetes tune-up

According to Dr. Nathan, here are five key takeaways from the guidelines that people with the most common form of the disease, type 2 diabetes, should know. (Several of these tips also apply to people with type 1 diabetes, but those people should check with their own doctors for targeted advice).

Strive for sound, uninterrupted sleep. Experts have long recognized a link between poor sleep and obesity. Mounting evidence suggests that sleep problems are also associated with diabetes risk. “Altered sleep patterns can affect blood sugar control,” Dr. Nathan says. Obstructive sleep apnea, a serious disorder that causes repeated, brief pauses in breathing throughout the night, is a frequent cause of disrupted sleep. Because it’s more common in people with diabetes (especially those who have obesity), anyone with the hallmark symptoms — loud snoring, snorts and gasps during sleep, and daytime sleepiness despite a full night’s sleep — should be evaluated. Ask your doctor about a home-based test for sleep apnea.

Don’t “diet.” Many popular fad diets — keto, paleo, intermittent fasting, and others — can help people lose weight. But most people regain any lost weight once they stop following the diet. Instead, it’s much more effective to gradually move toward a healthy dietary pattern that you can stick with over the long haul, says Dr. Nathan. Good choices include the Mediterranean eating pattern and the closely related DASH diet. For people with diabetes, it’s especially important to avoid sodas and other sugary drinks. You should also reduce how often you have desserts, sweets, and fatty foods, and eat more high-fiber carbohydrates, such as whole-wheat bread and brown rice.

Exercise safely. Walking is ideal exercise for most people, provided you start slow and ramp up your distance and speed gradually if you haven’t been physically active. People with diabetes need to pay special attention to choosing a well-fitting pair of shoes and check their feet regularly for redness, blisters, or sores. That’s because diabetes can cause neuropathy (numbness due to nerve damage), which can leave you unable to sense minor trauma and injuries to the toes and feet. These can result in more severe foot problems and lead to amputations.

Work toward a healthier weight. The three tips above can help people lose weight, but many people with obesity need medications to lose significant amounts of weight. Metformin, the most commonly prescribed drug to lower blood sugar, may help people lose about 5% of their body weight. And while that modest weight loss improves diabetes and its complications, larger losses — in the range of 15% — are even more beneficial.

Two relatively new diabetes drugs, semaglutide (Ozempic) and tirzepatide (Mounjaro) can help people shed as much as 15% of their excess body weight, while also lowering hemoglobin A1c levels by as much as two percentage points. (A1c is a three-month average measure of blood sugar.)

“These drugs, which are given by a once-weekly injection, are quite exciting, and should be in the running as a first choice to add to metformin for people with diabetes and obesity,” says Dr. Nathan. But because they’re very expensive (around $1,000 per month before insurance) and must be taken indefinitely, they aren’t realistic for everyone, he adds. In contrast, metformin costs only $4 per month.

Know your treatment targets. As in the past, most people with diabetes should aim for an A1c of 7% or less. Even if you don’t lose weight, reaching that goal reduces your risk for serious diabetes complications like vision and kidney problems and neuropathy, says Dr. Nathan.

Diabetes also raises your risk of heart disease. Target blood pressure is less than 130/80 mm Hg. Target LDL cholesterol is at least a 50% reduction (or reaching 70 mg/dL or lower). If you already have heart disease, the guidelines suggest an even lower LDL target of 55 mg/dL. “Many of the people I treat take cholesterol-lowering statins, and I often increase their doses to help them reach a lower goal,” says Dr. Nathan. In some instances, a combination of cholesterol-lowering medicines can help lower stubbornly high LDL.

Simple shifts toward healthy eating.

While many people might be taking a pass on formal New Year’s resolutions this year, others may mark a fresh start by resolving to make up for poor eating habits of the past. But this motivation is often focused on a diet that’s too ambitious or restrictive. Without a solid plan, you may fail quickly. So consider a compromise: start with these three easy ways to eat a healthier diet.

Aim for real food only

Look at your plate and note what’s processed and what isn’t. Maybe it’s the whole thing (like a frozen dinner), or maybe it’s just part of your meal (like the bottled dressing on your salad). Think of where you can swap processed foods for healthier versions. Ideas include

• eating whole-grain pasta instead of enriched white-flour spaghetti
• having quinoa instead of white rice
• making your own snacks like baked chickpeas, instead of opening a bag of potato chips.

Processed foods are linked with chronic inflammation and other health conditions such as heart disease, diabetes, and cancer. One of the healthiest diets you can eat is a Mediterranean-style eating plan rich in vegetables, legumes, fruits, whole grains, nuts and seeds, fish, poultry, and low-fat dairy products (milk, yogurt, small amounts of cheese).

Schedule your meals and snacks

Set timers on your phone for three different meals and two snacks (if you need them), and don’t eat in between these scheduled times. This might curb your cravings, reduce stress about when you’ll eat next, and cut down on the extra calories of unnecessary snacking — a real challenge if you’re close to a refrigerator all day while at home or work.

Avoid scheduling late-night meals or snacks, when your body’s internal clock (circadian rhythm) senses that you’re supposed to be sleeping. “During the circadian sleep period our metabolism slows, our digestive system turns down, and brain temperature drops, part of the process of clearing toxins during sleep. Eating at different times than our typical circadian awake phase leads to weight gain,” says Dr. Lawrence Epstein, associate physician with the Division of Sleep and Circadian Disorders at Harvard-affiliated Brigham and Women’s Hospital.

Reduce your portion sizes

If you’re like most Americans, you’re eating too much food. An easy way to implement portion control: load your plate as you normally would, then put back a third or half of the food. Other ideas:

• Use a salad plate instead of a dinner plate, to fool yourself into taking less food.
• Keep serving bowls off the table, so you won’t be tempted to eat extra helpings.
• Don’t linger at the table and keep eating when you’re already full.

It will also help to know how many calories you should consume in a day. For example, if you’re supposed to eat 2,000 calories per day but you’re scarfing down 3,000, it’s probably time to cut all of your usual portions by a third. How can you figure out your calorie needs? This body weight planner can help you strike a healthy balance between food and activity.

A final thought: Take just one step a week

You don’t need to incorporate all of these steps at one time; try one step per week. Write down what you’re eating and any thoughts or questions you have about the process. After a week, assess what worked and what didn’t. Before long, you’ll have the confidence to attempt new steps.

All parents want their children to be successful in life — and by successful, we mean not just having a good job and a good income, but also being happy. And all parents wonder how they can make that happen.

According to Harvard’s Center on the Developing Child, it’s less about grades and extracurricular activities, and more about a core set of skills that help people navigate life’s inevitable challenges. These skills all fall under what we call executive function skills, which we use for self-regulation. Most people who are successful and happy in life have strong executive function skills.

What are five important core skills?

• Planning: being able to make and carry out concrete goals and plans
• Focus: the ability to concentrate on what’s important at a given time
• Self-control: controlling how we respond to not just our emotions but stressful situations
• Awareness: not just noticing the people and situations around us, but also understanding how we fit in
• Flexibility: the ability to adapt to changing situations.

While these are skills that children (and adults) can and do learn throughout their lifetimes, there are two time periods that are particularly important: early childhood (ages 3 to 5) and adolescence/early adulthood (ages 13 to 26). During these windows of opportunity, learning and using these skills can help set children up for success. In this post, we’ll talk about that second window of adolescence.

The best way to learn any skill is by actually doing it. Here are some suggestions for parents wondering how to help and when to step back.

Planning

When children are little, it’s natural for parents and caregivers to do the planning for them. But as children grow into teens, they need to learn to do it for themselves.

• Avoid micromanaging your teen’s life. Instead, set some ground rules — simple ones like: homework needs to get done, they need seven to eight hours of sleep, and regular exercise is important. You may have some other ground rules, like attending family meals or religious services. Then let your teen figure out how to get it done. Step in only if ground rules are clearly being broken consistently.
• When teens have long-term projects, such as a research project or college applications, sit and talk with them about how they want to get it done. Let them come up with ideas before you do!
• Involve your teens in planning family activities or vacations, home renovations, or other projects. Let them make some of the decisions (even if you don’t always agree).

Focus

The explosion of device use has caused all sorts of problems with focus in people of all ages. There is an instant gratification to screens that makes it hard to put them aside and focus on less stimulating tasks — so now, more than ever, it’s important to

• talk about how social media and the Internet can interfere with daily life (and homework), and help them come up with strategies to manage the distraction.
• have screen-free meals and family time.
• encourage hands-on activities that don’t involve screens, like cooking, baking, building things, sewing, crocheting, drawing, painting, or gardening.

Self-control

This is one where being mindful of your own reactions to situations is important. How do you react to anger and frustration? Is road rage a problem for you? Remember that our children always pay more attention to what we do than what we say. To help your teen learn self-control, you can:

• Talk about feelings, and about strategies for managing strong feelings — like taking a deep breath, stepping away from the situation, screaming into a pillow, etc.
• Debrief after upsets, once everyone has calmed down. What might your teen have done differently? What could they do next time?
• Talk about how their behavior affects others, and why it’s important to be mindful of that (a practice that also teaches awareness).

Awareness

Teens can be very aware — but mostly of their own world. Help them learn to see beyond that.

• Talk about current events and stories in the news. In particular, talk about how these affect people, and how different people might see them differently.
• Go places with your teen — even just a walk in the woods or a visit to a nearby town can give them opportunities to look around them and see things they might otherwise miss.
• Join community service activities as a family; show teens how they can make a difference.
• Have rituals of checking in as a family, like at dinner. Give everyone a chance to talk about their day.

Flexibility

Life throws curve balls all the time, and teens need to be able to adjust.

• Don’t be too rigid about your teen’s schedule. Help them prioritize, and see which things can be missed or postponed when something happens, good or bad.
• Encourage some spontaneity. This, too, is about learning to prioritize and not getting too stuck in routines.
• Be a role model. Be spontaneous yourself — and don’t get too upset when plans change. Make new plans.

Any time you let your teen do something, there is a reasonable chance that they will fail. Resist the urge to jump in right away. While it’s important to have your child’s back (now and for the rest of their life), sometimes teens need to fail in order to learn. Give them a chance to figure it out themselves before you offer help. They may just surprise you.