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  • Why Some Men Keep Their Prostate Cancer a Secret

    Why Some Men Keep Their Prostate Cancer a Secret

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    When it was revealed in January 2024 that Defense Secretary Lloyd J. Austin, III was privately being treated for prostate cancer, many wondered why he hadn’t disclosed his diagnosis sooner. Austin later explained that he felt President Joe Biden had enough going on and didn’t need to be burdened further. “When you’re President of the United States, you’ve got a lot of things on your plate,” Austin said at a press conference. “I just didn’t feel that that was a thing that I should do at the time.”

    While few people with prostate cancer are in quite as public a position as Austin, the desire to avoid disclosing the diagnosis is common. In fact, some research has found that a majority of men keep a prostate cancer diagnosis secret when they can, due to a number of factors, including fear of being stigmatized or seen as a burden.

    Ultimately, any person going through any type of cancer gets to decide how much they share about their experience and who they share it with. But people with prostate cancer generally report receiving positive, supportive feedback when they disclose, and may miss out on opportunities for connection and care if they never speak up.

    “Keeping a cancer diagnosis a secret is a choice probably made a little less commonly these days because of social media and the growing prevalence of discussions of cancer in the media and everyday conversations,” says Dr. Jesse R. Fann, medical director of psychiatry and psychology at the Fred Hutchinson Cancer Center in Seattle, and a professor at the University of Washington. But that doesn’t mean every cancer patient has gotten that message of acceptance.

    Why disclosure is daunting

    Keeping prostate cancer a secret is likely a little more common at earlier stages of disease, Fann observes. He sometimes sees people delay disclosing a diagnosis until after a first round of treatment so they have a better sense of their prognosis, for example. But with more-advanced, metastatic prostate cancer, treatment may be harder to hide. “Their prognosis may be worse, [which] oftentimes leads to a higher sense of urgency [to disclose],” Fann explains.

    That said, people with all stages of prostate cancer may still choose not to disclose their diagnoses. Here are a few more of the possible reasons.

    They’re not ready to process the news themselves

    For many people with prostate cancer, there’s an initial period of denial after diagnosis. “What people experience at first is, ‘No, it’s not true,’ and then they struggle to accept that they have cancer, so keeping it a secret is really just protective psychologically,” says Vittorio Comelli, a clinical psychologist in psycho-oncology at the UCSF Helen Diller Family Comprehensive Cancer Center.

    As Fann adds, “In general, the diagnosis of cancer can certainly impose a significant sense of vulnerability on individuals, and disclosing their diagnosis can certainly heighten that sense of vulnerability for some.” That might be especially true of someone who “strongly values their identity as a healthy and self-reliant person,” he notes, or if they have a public persona to uphold, as in Austin’s case.

    Read More: Why Are So Many Young People Getting Cancer? It’s Complicated

    They don’t want to be a burden

    Some men feel they have a responsibility to play a certain role as a strong, healthy, provider, Fann says. A prostate cancer diagnosis may not fit into that narrative, and men may end up keeping their diagnosis a secret to avoid feeling like a burden or causing worry to the people they love.

    Comelli, who has been working with people with prostate cancer since 2005 and estimates he’s seen thousands of patients in his support groups, notices this most frequently in people with prostate cancer in high-powered jobs. “They have a very hard time disclosing … because they believe that others would think less of them, feel pity on them, treat them differently,” he says.

    “I think that’s changing, [but] I think there’s this feeling that men have to … take care of everybody, and then all of a sudden they’re in a situation where they’re very vulnerable, so they may not want to share that, even with their closest loved ones,” says Lorelei Mucci, director of strategic research partnerships at the American Cancer Society and the director of the Cancer Epidemiology and Cancer Prevention Program at the Harvard T.H. Chan School of Public Health, who has been researching prostate cancer for more than two decades.

    The symptoms and treatment side effects feel private

    Prostate cancer and its treatments can cause stigmatized symptoms like urinary incontinence, sexual dysfunction, and breast enlargement in men that may simply feel unpleasant or undesirable to discuss.

    “When you can’t control your basic bodily functions, it carries a particular kind of psychological regression that has a lot to do with shame, and that’s another thing that prevents people from disclosing,” Comelli says. “And with erectile dysfunction, that is a particularly injurious thing for men in their sense of sexual functioning and their sense of being a man.”

    The benefits and downsides of disclosure

    In the short-term, keeping a diagnosis private can have benefits, Fann says, especially if the person feels stressed, vulnerable, or anxious about disclosing; by avoiding the conversation, they get to avoid these uncomfortable feelings. 

    But “short-term advantages can dissipate quite quickly, as a person may need more help managing their cancer in different ways, including emotional and practical needs,” he says.

    Plus, there are more serious risks to consider over time. “In the long term, holding emotions back without an outlet can lead to an increase in stress, anxiety, depression, [and] social isolation,” Fann says. Greater social support has also been linked with improved outcomes for certain types of cancer, according to the National Cancer Institute.

    But talking about a diagnosis doesn’t just help a person with prostate cancer access more support; it may also help their loved ones. “Disclosing with family and friends can actually help them cope better and feel like they can better help their loved one with cancer,” Fann says.

    How to encourage disclosure without pushing too hard

    If you’re a doctor treating someone with prostate cancer who doesn’t want to disclose their diagnosis and you’re concerned for their long-term well-being, it’s appropriate to have a conversation about the potential risks and benefits. But it shouldn’t feel like you’re trying to coerce them into something they aren’t ready for. “It’s always the person’s choice, if they want to [disclose or not], and when and how they do it, and I always validate that choice and never force someone,” Fann says.

    He suggests putting the discussion in perspective: “I often ask, ‘Would you want to know if someone you care about got a similar diagnosis?’ That often allows them to think about things from the other person’s standpoint,” he says.

    You can also help a patient brainstorm and even role-play ways of bringing up the topic with various loved ones to make the conversations a little more comfortable when they occur, Fann suggests.

    Remind them they can establish boundaries about whom they choose to share their diagnosis with. “People often ask me not, ‘Should I disclose or not disclose?’ but ‘Who should I talk to about this?’” Comelli says. His answer: “Disclose things proportionate to the level of intimacy that they have with particular people.”

    The level of detail someone decides to share with a close family member is likely not the same detail they’d share with an acquaintance or employer, Fann says, and that’s absolutely normal. If they’re having a hard time disclosing to loved ones, consider encouraging them to lean on a support group, which can help alleviate the mounting pressure of keeping a diagnosis a secret. “Maybe they still aren’t ready to disclose more broadly, but at least they feel they have people going through an experience like them,” Mucci says.

    That connection is strengthened when the group focuses on a specific aspect of their identity, she says: Educate your patients that there are prostate cancer support groups specifically for, say, Black men or for gay men. “The stigma can be very unique for different populations of people,” she says.

    Read More: How to Cope With the Financial Toll of Cancer

    Comelli has run some of those support groups specifically for gay men. “Just being in a group with other gay men has a protective and somewhat psychologically healing function,” he says. “These are [often] people who have grown up in a homophobic environment and their experience of prostate cancer and the side effects of treatment [can] really ramp up the trauma of growing up gay.”

    That protective environment could be even more pronounced if the person with prostate cancer is a trans woman, Mucci says, as receiving care for an organ that doesn’t match their identity may bring up additional trauma.

    Keep an eye on people with prostate cancer who always come to appointments alone. It might be worth asking, “Do you have people in your life who are supporting you?” Mucci suggests. If they say no, that gives you an opportunity to remind them of upcoming support groups at your medical facility or ask if they’d like to be connected to an oncology social worker, a member of a psycho-oncology team, or a patient navigator who can help connect them with even more resources, Comelli says.

    Prostate cancer hasn’t experienced the type of public support that some other cancers have. “In contrast to breast cancer, where you had celebrities coming out and talking about their diagnoses, and then patients really rallying around the diagnosis and coming together, we didn’t really have that in prostate cancer,” Mucci says. No one needs to tell everyone at the office or on Facebook or start their own prostate cancer awareness organization, but even just having one person in their corner can make a big difference for their mental and emotional health throughout their treatment journey, she says.

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    Sarah Klein

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  • 11 Things to Say to Persuade Someone to Vote

    11 Things to Say to Persuade Someone to Vote

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    You may not be a political pundit or consider yourself any type of expert on the upcoming presidential election. But you still have influence—at least with the people you’re closest to.

    “The conversations we have with family and friends and colleagues and acquaintances could matter more than almost anything else that happens in a campaign,” says Jon Favreau, founder of the liberal media company Crooked Media, as well as the community organization Vote Save America, and host of the podcast Pod Save America. “More than the television ads, and more than what the candidate says.”

    As trust in major institutions declines, people are increasingly persuaded by those in their social network, he adds. When you have a basic level of trust established with someone, they’re more likely to listen to you than they are to talking heads on the TV or strangers knocking on their door. That means you have the opportunity to convince them to vote if they’re not already planning to show up at the polls in November. We asked experts exactly how to word what you say.

    “Hey, are you registered to vote?”

    Do your best to stay nonpartisan and confident in these conversations, advises Chyann Sapp, campaign director of Nonprofit Vote’s National Voter Registration Day. When you’re not taking sides, “you’re able to focus on why voting matters and why voter registration matters.” If someone’s not sure if they’re registered to vote, point them to online resources, like their state’s voter registration website, that allow them to quickly check. You can even help them register on the spot, Sapp notes, and encourage them to make voting a habit. She suggests framing it like this: “Just like you go to the doctor annually to keep yourself healthy, you should be voting to keep our democracy healthy.”

    “What matters to you?”

    Persuading someone to vote hinges on truly listening to them—and showing that you understand what they’re saying. “It requires giving people the benefit of the doubt and a little grace,” says Favreau, who also co-wrote Democracy or Else: How to Save America in 10 Easy Steps. “Getting someone to vote isn’t about proving whether you’re right or wrong. It’s about trying to bring someone to your point of view, and to do that, you have to find some commonality with that person.”

    Read More: 11 Things to Say When Someone Dies Besides ‘I’m Sorry’

    One of the easiest ways in, he says, is to ask them what issues they care about, even if they’re not a “political junkie or policy nerd.” What do they hope to see happen in the country over the next four to eight years? What are they worried might play out? “Once they tell you what they really care about, you can talk about the very stark difference between the two parties on that issue,” Favreau adds.

    “Thousands of local elections have been determined by a single vote.”

    Maybe your friend or family member is adamant that their vote doesn’t matter. They’re one among millions; who will notice if they skip the polls? In those cases, draw attention to local elections—which don’t get nearly as much attention as presidential elections but can have even more of an impact on daily life, says Andrea Hailey, CEO of the nonpartisan nonprofit Vote.org.

    These down-ballot races, including for county judges and officials, can be super tight. And they really matter: “Major policies are getting decided, and there’s a real difference in what parties think and want to see happen,” she says. “I think people get scared because they think of these conversations as inherently political, but in truth, they’re inherently community-based. We’re really talking about, ‘How are we going to run as a local community?’” 

    At stake: local public schools’ budgets and curriculum; whether potholes in the roads will be repaired; and who’s the sheriff, which will affect arrest priorities. Remind the person you’re trying to persuade to vote that by voting early or showing up to the polls on Nov. 5—and on each election day thereafter—they get to shape the way the community they live in operates every day.

    “Vote with your gut.”

    People often cite a lack of knowledge as their reason for not voting. “You’re going to run into this obstacle very frequently,” says Brian Duff, an associate professor of political science at the University of New England. “People who say, ‘I don’t know enough about X—the policies, the parties, the candidates.’” Some people treat voting as a research project, he adds, and think that if they haven’t studied up enough, they should opt out on election day. He tells them nobody knows enough. “People are not good at being informed voters,” he says. “People don’t have consistent ideas about the issues. People don’t know what the candidates will actually do.” If you’re trying to convince someone to vote, focus on reassuring them that they’re up to the task—and that they ought to vote with their gut. After all, “that’s what almost everyone is doing,” Duff says.

    “Don’t let somebody else make the decision for you.”

    What if your friend’s cynicism is the reason they won’t vote? Work on reframing their perspective by reminding them that when they abstain, they’re handing their rights and freedoms over to those who do vote. How is that superior to “proving a point” by abstaining? “Decisions that are going to affect your life, your family’s life, and the direction of the country are going to get made either way, whether you participate or not,” Favreau says. “You can either decide that it’s OK for you to have those decisions made by complete strangers, or you can influence those decisions yourself.”

    Read More: 7 Things to Say When Someone Gaslights You

    Deep trust—or even mild faith—in politicians isn’t a prerequisite for showing up at the polls, Hailey says. Politicians don’t stop getting elected, and policies implemented, because you left your ballot blank. It simply means you have no voice. “Do you care about reproductive rights? Somebody else just made that decision for you. Do you care about what time your trash is getting picked up? Somebody else just made that decision for you,” she says. “Do you care about what they teach in the local schools? Somebody else just made that decision, because you didn’t show up.”

    “I was listening to this politician, and they just sound different. The mood and the supporters feel different. You should give it a try, because I was skeptical myself, and now I’m feeling pretty great.”

    Organizing in politics is about building a sense of community and joy, Favreau says. He’s been heartened recently to watch a sense of heightened excitement spread among voters—and notes that it can be helpful to describe that buzzing energy to others. “To the extent that you can make your case feel as inviting and joyful and inspiring as possible, that’s just always going to get people to show up,” he says. That’s why so many voter registration events are paired with ice cream or live music. “You’re dealing with human beings, and humans want to do what’s right, but they also want to have fun and connect with other people who are like them.”

    “We’re taking control of our health, and we need to take control of our health as citizens.”

    Targeting someone’s “group membership” can be an effective way to persuade them to vote, Duff says. Unions have long done a great job encouraging members to show up to the polls, for example, and Black churches run “Souls to the Polls” events. Duff has researched what it takes to get young women, in particular, to turn out to vote. While few belong to a union or go to church regularly, many consistently attend fitness classes. In his ongoing study, fitness instructors brought up voting throughout classes, saying things like: “We’re taking control of our health, and we need to take control of our health as citizens.” “They don’t push either candidate,” he says. “They just bring it up and have some resources available, like voting registration cards.” The efforts tend to pay off, Duff says: During the 2016 election cycle, voting turnout among attendees increased “significantly.”

    “If you care about me, it’s important you go out and vote, because who leads is going to determine whether I can do X, Y, or Z.”

    Years ago, a platform called The Love Vote served as a voice for the millions of people who can’t vote in the U.S., because they’re teens, not citizens, or disenfranchised. Those under 18, for example, would tell their parents what’s important to them and why—and their mom or dad would pledge to vote on their behalf. “I love the way that works,” Hailey says. “It got all these people to register to vote.” If you’re unable to make your voice heard this year, you can still help shape the election by talking to your friends and family about how their voting decisions will affect your daily life, she adds.

    Read More: 10 Ways to Respond to Someone’s Bad News

    “Let’s have a party and make this fun and figure out what’s on our ballot.”

    There are all sorts of ways to make election season not only bearable, but fun. If your friends want to spend some time reviewing their election-season choices, invite them over for takeout, and figure it out together. Vote.org offers a tool that allows people to enter their zip code and see exactly who’s running in each different race, from state senators and representatives to the attorney general and treasurer. Then you can research where each person stands on the issues you care about, and email yourself a handy sheet of who you want to vote for.

    It can also be helpful to make plans to go to the polls together, followed by breakfast at your favorite diner or a stop at the coffeeshop down the street. Some people are even prepping special voting outfits; if you hit the thrift shop together and pick out what you’d like to wear, election day will become a can’t-miss occasion for those who might otherwise be apathetic. “Once you have your house in order, gathering everyone else becomes really important,” Hailey says. “Collectively, you can build the future you want to see.”

    “If you start rethinking some of the positions you’ve taken, I’m here to talk it through. We don’t have to argue.”

    Not every conversation about politics will be productive. (Who would have thought?) Some might even veer off the rails. Before that happens, let your conversation partner know you’d like to keep the line of communication open. Emphasize that you don’t have to yell, Favreau adds, and that you’re not expecting them to come over to your side of the party line. And remember: It’s fine if you strike out. “Don’t worry at all about failure to connect or failure to persuade, because it happens to even the best political organizers all the time,” he says. “You don’t have to persuade everyone in your life. You just have to persuade a couple people.”

    “When you don’t exercise your rights, they can be taken away.”

    This realization tends to be a wake-up call. “I can’t promise that if you don’t show up for elections, year after year, that everything will remain the same,” Hailey tells people who are on the fence about voting. The best way to celebrate democracy is by registering to vote and showing up to the polls every election day, big or small.

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    Angela Haupt

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  • In Defense of Spoiling the End of the TV Show

    In Defense of Spoiling the End of the TV Show

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    The premiere of the first-ever season of The Golden Bachelorette has been on my calendar for months. I can’t wait to watch 24 men who have aged exceedingly well climb out of their limos and greet the star, Joan Vassos, on Sept. 18 at the Bachelor Mansion. I’ll pay special attention to a few of them—because I already know exactly which guys are making it to hometowns and fantasy suites, and which one will walk away with the final rose.

    No, I’m not clairvoyant—don’t ask me how long Vassos and her leading man will last in the real world—and no, I don’t have an in with the network. I just happen to love spoilers. If I don’t know exactly how a TV show or movie I’m watching ends when I’m at the beginning, I won’t watch. I flip to the last few pages of books for the same reason. The uncertainty—and possibility that the ending will crush me into smithereens—gives me a boatload of angst that I definitely don’t need.

    I’m far from alone: Just ask the guy who’s made a career out of spoiling The Bachelor franchise. “I’m not getting people to turn off the show, or not to watch,” says Steve Carbone, a Dallas-based blogger better known by his internet moniker, Reality Steve. “It’s just watching differently.” Carbone started blogging about The Bachelor in 2003, and in 2009, he received his first spoiler from a tipster—correctly revealing a couple weeks in advance that Jason Mesnick would dump his chosen winner, Melissa Rycroft, in favor of his runner-up and now-wife, Molly. It was Carbone’s big break: After he posted the spoiler, his following and credibility skyrocketed. “Then every season, people just kept coming to me with info.” He started dropping tidbits about Vassos’ season of The Golden Bachelorette during filming in July, and revealed her final four on Aug. 27, three weeks before the show was slated to air.

    Carbone now has hundreds of thousands of spoiler-hungry followers on Instagram and X, as well as a popular podcast, and his spoilers are the subject of much discussion in niche corners of the internet, like the daily “spoiler” thread in The Bachelor subreddit. While he doesn’t personally like his entertainment spoiled, he gets why other people do. “The biggest thing I’ve gotten from people is that they tell me they watch for a particular edit”—like who’s being portrayed as a villain or set up to be the heartbroken runner-up—“because they know when this person is leaving, or when this person is getting a one-on-one date,” he says. “It’s like a CliffsNotes guide to watching.”

    Why do some people love spoilers, while others run away from them? I asked experts, including psychologists and researchers, to dig into spoiler culture and help make sense of the appeal.

    Spoilers don’t ruin stories

    When Jonathan Leavitt started researching spoilers, he wanted to prove that suspense is good—that waiting with bated breath to find out what happens enhances the reading or watching experience. Instead, according to study results published in Psychological Science, it turned out that people enjoy a story more when they know how it ends. (Hello, validation!) “It was definitely surprising,” says Leavitt, who now works as a data scientist.

    Why all the spoiler love? Leavitt suspects it has to do with the fact that stories are often complex and intentionally misleading—prompting tension and confusion. “When you know the outcome, you get to feel a lot smarter and make better inferences,” he says. “And, I believe, you ultimately understand the story better in the end.”

    Read More: 15 Things to Say When Someone Comments on Your Weight

    Take a mystery book, for example. Many of the clues sprinkled throughout the novel will be misdirects—but you already know who the killer is, because you flipped to the last page. “You’re seeing this one character act very suspicious, so it’s like, ‘People are going to think this person did it, but I know they didn’t,’” Leavitt says. “And then you might actually get a better idea of why they’re acting that way. You organize the elements of a story better in your mind, and you’re less fooled. There are fewer pathways to go down.”

    People often tell Leavitt they hate spoilers; maybe their favorite movie is The Sixth Sense, and they say that if they had known what happened, it would have ruined the whole thing. He likes to ask how many times they’ve watched it—and can’t help but smile when they say four or five times. It’s more evidence, he believes, that knowing what happens doesn’t derail enjoyment.

    During the many times Leavitt has rewatched The Lord of the Rings, for example, he’s found that he has the same fulfilling viewing experience he did the first time he watched. Once you’re transported into a different world and engaged in the production, that sense of immersion overrides what you already know about it. “We went in thinking spoilers are the antithesis of suspense,” he says, “but they are absolutely not.”

    A sense of comfort and control

    Alison McKleroy, a therapist in Oakland, Calif., sees a lot of spoiler lovers in her practice—and she, too, is one of them. “Earlier in my life I wanted a little more surprise and adventure, and now I love peace and relaxation,” she says. “I’ve done so much work to have a more peaceful nervous system with yoga and mindfulness. It just feels like I don’t need to undo that.”

    People who prefer spoilers typically value predictability, ease, comfort, clarity, and a sense of control, McKleroy says. The world is rife with uncertainty—she calls it “free anxiety”—so why subject yourself to more? For many people, not knowing what happens leads to anticipatory stress, or an increased stress response triggered by an unpredictable plot. “When you’re anticipating something bad happening—like for me, when the music starts to turn—your heart starts pumping, and you’re not enjoying yourself anymore,” she says. My anxiety, which is already high at baseline, spikes so much when I’m reading a thriller, or even watching a couple I’m rooting for break-up in a rom-com, that I simply can’t enjoy myself until I’m certain things will end in a satisfying way.

    Read More: Is Green Tea Really That Good for You?

    That resonates with Christina Scott, a social psychology professor at Whittier College in California and devoted spoiler lover. Her 10-year-old twins have even started asking for spoilers for the books they’re reading—maybe it’s genetic to a degree, she speculates. Either way, she likens a preference for spoilers to what people enjoy at amusement parks. “Some people want to go on roller coasters that flip them upside down,” she says. “I just want to go on the cute little merry-go-round. You need to do whatever’s going to help you enjoy the ride.”

    A desire to know what happens, from start to finish, might reflect an unmet need for certainty in our own lives, Scott theorizes. “There’s enough ambiguity and stress—enough cliffhangers in real-life existence—that you want to sit down and enjoy a movie that should be relaxing,” she says. “I think in some ways we also want that reassurance in our life, but it’s not possible.” She’s told her kids that she wishes she could see what they’ll become a couple decades down the line—and then she could easily weather the ups and downs of the impending teenage years. That same outlook translates to how she feels about what she watches and reads.

    Plus, while many people can keep some distance from the book or movie they’re consuming, spoiler lovers tend to be deeply empathetic. We put ourselves in the characters’ shoes and feel what they feel, at times perhaps because what they’re going through triggers a memory from our own life. “To invest in a character who’s now going to be blown to pieces—that’s the ultimate worst,” Scott says. “Knowing they’ll be OK allows you to feel safe in rooting for them and empathizing with them, because you know it will be worth the investment.” 

    Spoiler alert: No, she’s not going to change her ways

    Daniel Green, director of the master of entertainment industry management program at Carnegie Mellon University, does not seek out spoilers. He’s worked in TV production on shows like The Sopranos and Party of Five, so he has a traditional view of how media is meant to be consumed. “I like to go on the journey in my head, because all the writers took so much time to come up with it,” he says. “Really good stories are built on structure, and it goes 1-2-3. It doesn’t necessarily go 1-2-5-4.”

    It’s a convincing argument, and I admitted to Green that I can recall a couple times when I skipped to the end of a book—like Gillian Flynn’s Gone Girl—only to become wildly disappointed that the big reveal was ruined. On the other hand: There have been countless more times when I let out a sign of relief after reading the last chapter, and then enjoyed it in its entirety, from start to finish. On other occasions, I’ve discovered a movie or book ending that rattled me to my core—looking at you, One Day—and crossed it off my list before ever starting, relieved I didn’t waste even more time on it.

    Plus, I keep returning to a point made by McKleroy, the therapist in California. When we’re in fight-or-flight mode, it’s hard to focus because our brain is working overtime to help ward off a threat. “If we’re running from a tiger in nature, we’re not going, ‘Oh, look at that beautiful butterfly going by,’ or, “Gosh, the sun is so pretty,’” she says. “From a nervous system perspective, people who engage in spoilers are actually getting to savor the beauty as it unfolds—and they have space to treasure the less obvious elements of the story.” It might not be exactly what a writer intended, but spoilers grant some of us the ability to enjoy and appreciate their work to the fullest possible extent.

    Read More: 8 Ways to Read More Books—And Why You Should

    There’s nothing wrong with needing to know what happens, Scott says, and no one should make you feel bad or embarrassed about it. If you’re watching a movie with someone, and they don’t get why you’re reading an annotated recap first, try explaining where you’re coming from. Scott advises wording it like this: “I understand this doesn’t work for you, but just like you want plain popcorn and I want mine buttered, this is what will help me enjoy the movie the most.” Sometimes, she says, your viewing partner might feel like you have an unfair “leg up” on them, because you know what happens and they don’t. “They might think they’ll look foolish based on their reaction [to certain parts], and feel like you have extra armor,” she says, which is why it’s helpful to shine light on your perspective—and to assure them you won’t spoil anything for them.

    Of course, it’s easiest when you don’t have to offer any explanation. Scott and I joked that we ought to start a spoiler lovers support group, a place for people like us to come together, no judgment, and bond over the joy of knowing what to expect. We’d all meet at the movie theater—and ease into the film with the comforting knowledge of what comes last.

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    Angela Haupt

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  • How Hospitals Can Make Patients Safer

    How Hospitals Can Make Patients Safer

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    Technology is changing the world faster than ever—but medicine still doesn’t move quickly enough when it comes to adopting innovations that prevent harm and make patients safer.

    When the Institute of Medicine in 1999 released a landmark report on just how common medical errors were, patient safety jumped onto the radars of hospitals across the world. Though the report was published 25 years ago, most of the changes hospitals have made haven’t been enough. One recent study showed that 1 in 4 hospitalized patients experience preventable harm. 

    As a new generation of clinicians enters the medical workforce, it is crucial that the system modernizes itself with tools that other industries have been using for years. From AI machine learning to virtual reality, these innovations are starting to be used in medicine. But tech startups and entrepreneurs still have a steep climb to bring their life-saving technologies to the bedside.

    The Pitch: Patient Safety’s Next Generation, a new documentary available Sept. 17 on Apple TV and Prime Video, explores how the health care system is wrestling with this. It follows a young entrepreneur on his quest to help reduce the too-high maternal mortality rate in the U.S.; compared to other high-income countries, it’s a relatively dangerous place to be pregnant and give birth, especially for Black women.

    Reetam Ganguli, a 22-year-old MD candidate from San Jose, developed a machine-learning algorithm to spot high-risk pregnancies long before traditional tests, measures, and markers would typically be able to detect them. Through his new startup Elythea, the algorithm can alert a woman’s doctor to these warning signs at a stage in her pregnancy when intervention would make the difference between a healthy pregnancy and a potentially fatal one. Such an advance would be impossible without tools like Elythea. And that is exactly where technology can make the biggest difference in medicine.

    But even after winning multiple pitch competitions and acquiring funding from high-profile incubators, Ganguli still is trying to convince hospital administrators that Elythea is worth the investment; he’s found the most success by partnering with clinicians directly.

    Read More: Long Waits, Short Appointments, Huge Bills: U.S. Health Care Is Causing Patient Burnout

    When hospitals do embrace AI and machine learning, patient care can become safer—in part because it can relieve overworked doctors and understaffed nurses. Command centers, for instance, are popping up in health systems around the world. Inspired by operational centers like NASA or Dell, these rooms—filled with screens of information like bed availability, emergency department capacity, and patient vitals—are the epicenter of decision-making at the hospital. The software collects and translates the incredible amount of data associated with each patient, freeing up providers and quickly alerting them to areas of care that might soon require urgent attention. And if there is nothing to report, nurses will waste less time checking on patients who would benefit more from uninterrupted recovery.

    In the documentary, Jeff Terry, former founding CEO & managing principal of command centers at GE HealthCare, explains them as “the ultimate connector of all the data,” allowing health care providers to “apply algorithms to it to predict the future.” Humber River Health, a hospital in Toronto, started using its command center about a decade ago to improve patient safety and has seen a significant reduction in the rate of harm across the hospital.

    Some worry about a future like the one we see in the movies, where artificial intelligence replaces and destroys mankind. We should perhaps be more concerned about a future in which we are too afraid to use what can actually save it.

    Read More: Private Programs Provide Access to Birth Control. They Can Also Deprive Women of Choice

    This type of technology is already revolutionizing safety in other areas of medicine. Dr. James Clarkson, an orthopedic surgeon in East Lansing, Mich., is using virtual reality to replace unnecessary sedation, allowing more of his patients to walk out of the facility immediately after their procedure and reducing the likelihood of infections that often come with an extended hospital stay. A group of epidemiologists at the University of Pittsburgh, led by Dr. Lee Harrison, are using genomic testing to enhance the detection of hospital-associated infections. When combined with machine-learning technology, the Harrison Lab can reduce the amount of time it takes to identify the source of the outbreak. This has saved countless lives, and without the collaboration between technology and medicine, it would never exist.

    But these innovative solutions are still too few and far between. The reason is much of the burden of finding answers to the chronic problems in health care has been placed on clinicians. “To really solve a problem and bring in a disruptive innovation, it can’t really be a part-time hobby,” says Ganguli in The Pitch. “A full-time doctor or surgeon or health care administrator whose really important work of dealing with patients all day consumes most of their time is not going to have the flexibility to either leave their job or manage this on the side as well.”

    Hospitals must be transparent with the problems they need help solving and create opportunity for entrepreneurs to dedicate themselves to an answer. Innovators like Ganguli are searching for opportunities to make a difference in the world. Their best bet is to collaborate with doctors and nurses who experience the everyday inadequacies of patient care. 

    It is time for hospitals to open the door to more than just new patients. It is time to open up to new ideas and technologies.

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    Mike Eisenberg

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  • 8 Signs You’re in Perimenopause

    8 Signs You’re in Perimenopause

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    Carin Luna-Ostaseski still recalls the shock of discovering her periods had become monsoons. Short monsoons, she clarifies—her cycle went from lasting a week to two to three days—but still monsoons. She realized she was going through at least one tampon every hour.

    Then, more confusion: Earlier this year, partway through a flight, she became convinced she was having a heart attack—her heart was racing wildly, and she felt scared. It turned out she was actually experiencing a panic attack, triggered by—surprise!—perimenopause, which can lead to symptoms like weird periods, mood swings, and anxiety. “You Google the symptoms, like ‘I’m bleeding too much,’” says Luna-Ostaseski, 47, who lives in San Francisco. “You don’t think, ‘This is perimenopause.’ Our parents’ generation knew about menopause, but I think perimenopause is a new concept for our generation.”

    So what exactly is it? In a nutshell: the conclusion of a woman’s reproductive life, starting anywhere from age 40 to 44, though there can be variances on either side. While it’s still possible to get pregnant during perimenopause, it becomes more difficult; experts caution that you shouldn’t suddenly stop practicing safe sex. The transition lasts until someone officially enters menopause—which is exactly one year after their last period, usually around age 51. During perimenopause, hormones like estrogen and progesterone fluctuate wildly: “What used to be a predictable, EKG-like ebb and flow becomes chaotic,” says Dr. Mary Claire Haver, an ob-gyn who specializes in menopause care (and has developed a large social-media following around it).

    Read More: Menopause Is Finally Going Mainstream

    The vast majority of women are “so confused” when they start experiencing symptoms, Haver adds. “They go to their provider, and depending who they see, are told there’s nothing they can do—this is a normal part of life. Or they’re offered a hysterectomy, which is a surgical treatment of a medical issue, not a hormone issue, so they’re being castrated to cure their menopause.” That tracks with Luna-Ostaseski’s experience: She and her friends talk about their symptoms “constantly,” and share helpful services and products with each other. (She even created a website and newsletter called “Hot or Just Me?” to dispense those resources to a wider audience.) They call it “girlfriend medicine” to reflect the way they’ve stepped up to support each other, since doctors often don’t grasp what they’re going through.

    Complicating matters: There’s no single, accurate test for perimenopause. To arrive at a diagnosis, Haver does blood work to rule out conditions like hypothyroidism or autoimmune disease, and then narrows things down to perimenopause based on symptoms and through process of elimination. After that, she starts talking about treatment: Many patients benefit from medications like hormone therapy and low-dose birth control pills, in addition to lifestyle changes. “Menopause is inevitable,” Haver says. “But suffering is not. It might mean you need to make some changes in your life, or that pharmacology is going to be helpful—but if you just ignore it, it’s going to get worse.”

    With that in mind, we asked experts to describe the symptoms that can indicate you might be experiencing perimenopause.

    Irregular periods

    Perimenopause is a transitional stage characterized by having an irregular period, says Dr. Christine Greves, an ob-gyn at Orlando Health Women’s Institute. Someone who has always had a 28-day cycle, for example, might find that her periods start to vary by about seven days. “They can be shorter or longer,” she says, or not arrive at all. “Sometimes, you might not release an egg and will skip a period.” Women often report changes in flow, too, noting that their periods become heavier or lighter.

    The reason for the change? Unlike men, who make new sperm every day, women are born with all the eggs they’ll ever have. Over time, those eggs “start becoming less sensitive to our hormonal stimulation, and we don’t ovulate as regularly,” says Dr. Mary Farhi, an ob-gyn at Rush University Medical Center. As a result—given that the ovaries are producing fewer hormones—your periods naturally become irregular, she explains.

    Hot flashes

    About 75% of women experience hot flashes and night sweats during perimenopause, says Dr. Mindy Goldman, chief clinical officer of Midi Health, a virtual care clinic focused on perimenopause and menopause. You might experience intense heat and start sweating or turn bright red, mostly around your head, neck, chest, and upper back. Though scientists don’t understand exactly what causes hot flashes, hormones likely play an important role. Vasomotor symptoms tend to be especially bothersome at night, leading to frequent wake-ups, which is one reason why many perimenopausal women report fatigue.

    Read More: How to Deal With Menopause When It’s Hot Outside

    They’ve hit Luna-Ostaseski hard: At least once a week, she asks her husband if it’s hot or just her. “He’s wearing a sweater, and I’m stripping off layers of clothes for relief,” she says. She’s found that wearing natural fabrics helps, as does setting her bedroom temperature to 65°F. She avoids alcohol, spicy foods, caffeine, and hot drinks—all of which can trigger flashes—and prioritizes deep breathing, meditation, and stress management. She’s also learned that taking magnesium glycinate before bed is helpful, and she sleeps on cooling sheets and blankets. “I’ve gotten the hot flashes a little more under control,” she says, “but they still come and go.”

    Vaginal dryness

    Vaginal dryness triggered by hormonal changes is another hallmark symptom of perimenopause. “You can experience dryness in general, or dryness with intercourse,” Greves says. Depending on severity, over-the-counter lubricants can be effective. But she also recommends a more surprising antidote: cooking oil. Coconut oil works particularly well and doesn’t contain any irritants. “It’s in your cabinet, and it’s cheap,” she says. “That is an option to conquer the dryness.” In some cases, Greves adds, vaginal estrogen works best, especially among those experiencing painful intercourse. “Estrogen is like putting lotion in the vagina—it makes it nice and supple,” she says. There are a variety of ways to take it, including creams, gels, and rings; ask your doctor what might work best for you.

    Joint pain

    More than 70% of women experience musculoskeletal pain during perimenopause—and for 25% of them, it’s debilitating, according to recent research. Changing levels of estrogen, paired with a loss of muscle mass and bone density, can lead to rapid progression of arthritis, frozen shoulder, and other types of joint pain. As the study authors noted, these symptoms can be “silent, devastating, and permanent unless addressed.”

    While physical therapy is helpful in some cases, hormone therapy “is actually really, really powerful,” Haver says. Research suggests it can reduce inflammation and pain, while also helping prevent osteoporosis, which weakens bones. Prioritizing good nutrition and resistance training also plays an important role in improving symptoms and preventing falls and frailty.

    Weight gain

    When Haver entered perimenopause, her biggest complaint was the unexplained belly fat she gained. She had been privileged to not have to worry about her weight for most of her life, she says, and suddenly, without changing her habits, she no longer recognized her own body.

    Read More: 15 Things to Say When Someone Comments on Your Weight

    That’s a familiar experience, experts say. “We know that metabolism slows, and we know that after menopause, there’s an average of about five pounds of weight gain,” Goldman says. “Perimenopause is when people may gradually start noticing an increase in weight.” She coaches them to focus on eating well—protein and whole foods are important—and employing healthy exercise habits. That can help stave off additional weight gain as you progress through menopause, experts agree.

    Brain fog

    Do you ever feel like there’s a cloud over your head, or that you can’t multitask the way you used to? It could be a lot of things, including perimenopause. Luna-Ostaseski says she occasionally walks into a room and forgets why she’s there—and while driving, she once blanked on why she was headed in a particular direction. “To someone who prides herself on a sharp mind, it’s concerning,” she says. She hasn’t found an effective solution yet, but makes it a point to journal on her foggy days to see if she can identify triggers.

    Women frequently tell Goldman they can’t remember a person’s name or summon words as quickly as they’d like. “We know that estrogen withdrawal can clearly have a cognitive impact,” she says. Researchers are currently exploring exactly how estrogen affects the brain, and Goldman notes that many women see cognitive improvements after starting hormone therapy. That’s not, however, always the only factor: If someone isn’t sleeping well because of hot flashes, their fatigue can dampen mental clarity. Plus, “there’s data that says when you’re tired, you don’t exercise as much, and you don’t make healthy food choices,” she adds, which can affect cognitive health. “It’s all tied together.” That’s why treating perimenopause requires thinking holistically.

    Mood changes

    Perimenopause clues often arrive in the form of mood changes: PMS symptoms sometimes worsen, and you might notice you feel super irritable or angry, or that you’re crying more often. Plus, women who have had postpartum depression could be at increased risk for recurrent depression during perimenopause and menopause. “That’s part of the history I always ask people,” Farhi says. “We can only take so much stress, and once it gets too heavy, it can tip us over. I always tell people that your 40s are the time to fill your tank, because you don’t want to hit menopause with an empty tank.”

    Read More: Does Text Therapy Really Work?

    Therapist Jessika Fruchter was “blindsided” when she began experiencing perimenopause symptoms about a year and a half ago. She recalls traveling to a favorite spot by the ocean where she lives in Southern California and bursting into tears. “Because I know myself really well, and also because of my clinical training, I was like, ‘Something’s off here,’” she says. In addition to working to find specialized providers to support her own health, she shifted her practice to focus on serving women in perimenopause. It’s much easier to find a therapist who specializes in perinatal health than it is to find one with menopause expertise, she points out, and she wants to change that. She’s starting to offer menopause training courses for other therapists, as well as support groups for her clients.

    To find resources near you, tap into online tools like Psychology Today’s therapist and support group directories, Fruchter suggests. Make it a point to practice self-compassion, too, she urges. “It’s about cultivating that nurturing, calming, caregiver voice inside of us,” she says. “It’s telling yourself that you got this—this is natural, and it’s going to pass—and lowering the bar.”

    Shattered sense of identity

    Many women feel a sense of grief as they navigate perimenopause. “For some, it’s really about the end of the reproductive years,” Fruchter says. “Others are very attached to their menstrual cycle. And there’s this constant bump up against toxic youth culture and middle-aged invisibility.”

    Fruchter suggests reframing perimenopause as stepping into a new—and potentially liberating—chapter of life. She often hears from people who find they don’t have as much of a filter once they hit the years surrounding menopause, finally squashing their people-pleasing tendencies and setting firm boundaries. Some treat it as a literal “pause,” seizing the opportunity to take inventory of their life.

    Fruchter—who describes perimenopause as “a second puberty”—stresses that there’s no reason to feel ashamed or to suffer mentally or physically. “There’s so much beauty in this transition if we have the right support,” she says. “Most of the women I know are incredibly resilient and used to white-knuckling through challenges on their own. But just because we can doesn’t mean we should have to.”

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    Angela Haupt

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  • Why Bill Gates Is Prioritizing Solutions to Childhood Malnutrition

    Why Bill Gates Is Prioritizing Solutions to Childhood Malnutrition

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    The numbers are hard to ignore. Around the world, 48 million children experience stunted growth, 45 million suffer from wasting, and nearly half of all children who die every year die from malnutrition.

    “Even for kids who survive [malnutrition], their ability to be physically and mentally at their full potential is such a big thing for their quality of life and that of the country they live in,” says Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “Tragically, in Africa, 40% of kids never get to their full physical or mental development.”

    Each year, the Bill and Melinda Gates Foundation highlights an issue in its Goalkeepers Report with a large unmet need, and for which the organization provides proven, actionable solutions. This year, the group focused on childhood malnutrition, and the consequences it has throughout children’s lifetimes. Addressing nutrition in young children allows more kids to attend and remain in school, and if more of a country’s population is educated, it can then develop further economically, says Gates.

    In the report, the Foundation highlights several ways to improve nutritional deficiencies around the world, some of which are more direct and others that involve boosting food production strategies in various countries.

    One of the most straightforward interventions involves piggybacking nutrients onto existing food staples, such as salt, oil, and bouillon cubes, which many low-resource households rely on to flavor their foods. Fortifying bouillon cubes with iron, folic acid, zinc, and vitamin B12, for example, could prevent 16.6 million cases of anemia each year in Nigeria. Folic acid is already added to staples like wheat and other flours, but it could also be added to iodized salt to substantially reduce the risk of neural tube defects in newborns. The Ethiopian government is now exploring such an approach, which could avert 75% of deaths and stillbirths due to these defects, which generally occur in the first month of pregnancy and lead to nerve damage that contributes to learning disabilities, paralysis, and death.

    Read More: Famine in the 21st Century Must be a Red Line. Here’s What We Can Do

    Another strategy is related to food fortification: boosting the distribution of multiple micronutrient supplements, a complete set of 15 prenatal vitamins and minerals established by the United Nations that are critical for early fetal development and maternal health. If current low-and middle-income countries provided these supplements to expectant mothers, the Foundation estimates that nearly half a million lives could be saved by 2040. The supplements can reduce the risk of babies being born at a low birthweight, which increases their risks of other health conditions, as well as their chance of developing anemia. They could also lower stillbirth and maternal mortality rates.

    Even beyond providing nutrients directly to babies or pregnant women, the Foundation also encourages more long-term strategies for sustaining nutritious food supplies. Those include adopting agricultural practices and breeding animals used in developed countries to increase the eggs produced by chickens and the milk produced by cows. “Chickens [and cows] in the West produce four times more eggs and milk than those in Africa,” says Gates. “By blending that productivity with key tolerance and disease resistance in the African animals, we can create chickens and cows with higher egg and milk output. And as we see the cost of eggs go down, more children will have access to them.” About 80% of cows in Kenya produce only 2 liters of milk per day, but that’s been changing as farmers breed cows that are more productive, and rely on higher quality crop waste for feed. That’s led to some cows in the country producing six to 10 times more milk than they had before. By boosting dairy productivity in just five countries in Africa, the Foundation estimates 109 million cases of stunted growth could be prevented by 2050.

    Gates says these interventions are intentionally ones that are both easy and inexpensive for countries to adopt. The prenatal supplements, for example, cost $2.60 to provide for a woman’s entire pregnancy. But overall reductions in aid over the past two decades mean that gains that were achieved in the 2000s are already slipping or in danger of disappearing completely. “I’d put the financial challenges they face in African countries in funding primary health care as the top thing,” says Gates of hurdles to implementing even these relatively simple solutions. “The research work [to find more interventions] I’m not as worried about; we’re not in a research crisis. [The crisis is in] the need for aid budgets that are affordable.”

    Gates says that all it takes is 1% to 2% of the budgets of wealthier nations to spend about $1,000 per life saved in the poorest countries. “That should be doable, but we have to have a value system where voters say that it’s worth spending 1% to 2% to help people who are far away,” he says. “The visibility of success can help voters prioritize what to me feels like a moral imperative, but also has other benefits in terms of avoiding conflicts, pandemics, and building strong economic relationships. Having a thriving Africa is good for the world.”

    Read More: The Time Has Come to End World Hunger

    For that success, he points to countries in Asia that have been able to “graduate” from poverty and rely primarily on external aid to fund their own primary health care system. “We’ve seen it in Asia in Indonesia, Vietnam, and India; [they] are able through their own tax base to fund primary health care. We’d love to create those success stories in Africa.”

    But shifting international priorities—paired with conflicts in many parts of the world, including in eastern Europe and the Middle East—have led to shrinking aid budgets, particularly for helping more African countries move out of poverty. “It’s a pretty acute situation right now,” he says of the health and nutrition needs of the continent. “We have to renew our ability to tell this story. When we have a war in Ukraine, and turmoil in the Middle East—I’m not downplaying those situations at all—but it’s a shame that Africa to some degree has gotten off the agenda, and we see that in the aid numbers. We can address 40% of the malnutrition in the world with the interventions we’ve got now.”

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    Alice Park

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  • Did the Pandemic Break Our Brains?

    Did the Pandemic Break Our Brains?

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    Not long ago, Mark Chiverton, a 33-year-old in the U.K., noticed he was making a lot of silly mistakes. He’d mix up words when writing emails, or blank on a basic term while talking to his wife. None of these slip-ups were all that concerning on their own—but they were happening frequently enough that Chiverton worried he was, to put it bluntly, “getting dumber.”

    “At first I thought, ‘Maybe it’s just general aging, or maybe I bashed my head and didn’t realize it,’” he says. But eventually, a thought occurred to him: could COVID-19 be the reason for his mental slips? Chiverton thinks he caught the virus in early 2020, before tests were widely available, and he knows for sure he had it in 2022. Though he has no lingering physical effects from those infections (and has periods of time when his brain cramps get better), he sometimes wonders whether those mental slips are mild signs of Long COVID, the name for chronic symptoms following an infection.

    He’s not alone in experiencing these problems—and he may not be wrong that COVID-19 is to blame. In the U.S. alone, about a million more working-age adults reported having serious difficulty remembering, concentrating, or making decisions in 2023 compared to before the pandemic, according to a New York Times analysis of Census Bureau data.

    Every mental mistake isn’t cause for concern, says Andrew Petkus, an associate professor of clinical neurology at the University of Southern California’s Keck School of Medicine. Blunders like forgetting why you walked into a room or spacing out on an appointment can be totally normal parts of being busy, distracted, often under-rested humans. Even though you likely did those things before and brushed them off as nothing, they may seem more significant in the wake of a life-altering event like the pandemic. “If we didn’t have COVID, you might have still forgotten,” Petkus says.

    Still, it’s not outlandish to think the pandemic has had an effect on our minds, says Jonas Vibell, a cognitive and behavioral neuroscientist at the University of Hawaii at Manoa. Vibell is currently trying to measure post-COVID inflammation and neuronal damage in the brains of people who report symptoms like brain fog, sluggishness, or reduced energy. When he began publicizing the study, he says, “I got so many emails from lots of people saying the same thing”: that they’d never fully bounced back after the pandemic.

    But why? It’s probably a mix of things, Vibell says. The SARS-CoV-2 virus can affect the brain directly, as many studies have now shown. But the pandemic may have also affected cognition in less-obvious ways. Months or years spent at home, living most of life through screens, may have left a lingering mark. Even though society is now mostly back to normal, the trauma of living through a terrifying, unprecedented health crisis can be hard to shake.

    Your brain on SARS-CoV-2

    It’s clear by now that SARS-CoV-2 is not just a respiratory virus, but also one that can affect organs throughout the body—including the brain. Researchers are still learning about why that is, but leading hypotheses suggest that SARS-CoV-2 may cause persistent inflammation in the brain, damage to blood vessels in the brain, immune dysfunction so extreme it affects the brain, or perhaps a combination of all the above. Studies have even found that people’s brains can shrink after having COVID-19, a change potentially associated with cognitive issues.

    COVID-19 has been linked to serious cognitive problems, including dementia and suicidal thinking. And brain fog, a common symptom of Long COVID, can be so profound that people are unable to live the lives and work the jobs they once did. But COVID-19 also seems able to affect the brain in subtler ways. A 2024 study in the New England Journal of Medicine compared the cognitive performance of people who’d fully recovered from COVID-19 with that of a similar group of people who’d never had the virus. The COVID-19 group did worse, equivalent to a deficit of about three IQ points.

    That’s not a dramatic difference. Our cognitive abilities naturally fluctuate a little from day to day—and in a July interview with TIME, study co-author Adam Hampshire, a professor of cognitive and computational neuroscience at King’s College London, said a three-point IQ difference is “well within” the range of that normal fluctuation, so small that some people might not even notice it.

    But could such a drop be enough to lead to, say, extra typos and absentmindedness? Maybe. In Hampshire’s study, people who’d had COVID-19 consistently performed worse on cognitive tests than people who hadn’t.

    If the brain suffers “mild but ubiquitous” changes after an infection, Vibell says, those effects could feasibly “impact the brain, behavior, and social behavior in so many subtle, but maybe [cumulatively] quite bad, ways.”

    Beyond the virus

    Even for the lucky few who have never been infected, living through a pandemic can impact the brain.

    For a recent study in PNAS, researchers conducted pairs of MRI brain scans on a small group of U.S. adolescents: one in 2018 and one in either 2021 or 2022. Over those years, they observed a notable thinning in parts of the kids’ (and especially girls’) brains, including those that control social cognition tasks like processing facial expressions and emotions. Although the researchers did not analyze the effects of SARS-CoV-2 infections, they concluded that the stress of living through pandemic lockdowns was likely to blame for the change, which they likened to an extra four years of brain aging for girls and an extra year for boys.

    Stress and trauma have well-documented effects on the brain. Plenty of studies show that people who experience trauma tend to be at greater risk for cognitive decline as they age. Stress can also impair someone’s ability to think clearly, reason, and remember, studies suggest.

    “COVID was a generational traumatic event,” says USC’s Petkus. “Everybody was exposed to it.” It’s feasible, then, that the population at large is suffering some of these side effects from trauma and stress.

    Even beyond the mental toll of living through a scary and unsettling time, many people had to abandon habits that are good for the brain—things like socializing, staying physically and cognitively active, and seeking out novel experiences—when they were stuck at home early on, Petkus says. It’s too soon to say whether that dramatic but short-lived period will have long-lasting effects—but four years after the virus emerged, some things are still not as they were.

    For example, student test scores are recovering but have still not bounced back to pre-pandemic levels; declines have been particularly dramatic in low-income school districts as well as those that had remote learning in place for a long time, says Sean Reardon, a professor at Stanford University’s Graduate School of Education and one of the leaders of the Education Recovery Scorecard, a research project focused on pandemic learning loss. The long recovery process probably speaks to a combination of things, Reardon says: not only did kids miss in-person school for a while, they also experienced seismic disruptions in their lives, endured a period of significant stress and anxiety, and are now being asked to learn new material in school while also making up for pandemic-related learning gaps.

    “Falling behind on your math skills or your reading skills is not really about a change in your intelligence,” Reardon says. “It’s a change in your skills, how much you’ve had the opportunity to learn.” 

    It’s hard to say whether the same trends appear among adults, because grownups aren’t taking standardized tests every year at work. Adults were certainly exposed to the same mix of stress, trauma, boredom, and isolation as kids—but Reardon says his hunch is that adults may have an easier time rebounding, since they’ve already developed the skills they lean on to perform complex tasks.

    Returning to normal

    “There might have been a shock for a couple years, but things are getting back to normal,” Petkus agrees. 

    Those who feel like their minds melted a little during the pandemic can likely benefit from adopting or resuming the kinds of brain-boosting habits that fell by the wayside during Netflix-fueled lockdowns, like social interaction and mental and physical exercise, Petkus says. Even the effects of stress and trauma can often be counterbalanced with social support and healthy coping strategies, he says. People who recover well from hard events sometimes even experience what’s known as post-traumatic growth, a blossoming of their mental and emotional health after a difficult period.

    It’s harder to say whether brain changes that result directly from SARS-CoV-2 infections are reversible, as researchers are still studying that question. But there are some positive signs. Some of the potential causes of chronic brain fog—like persistent inflammation or damage to blood vessels—are theoretically reversible with the right treatments.

    Even in Hampshire’s study on post-COVID IQ differences, there was cause for optimism. Hampshire’s team found that people with Long COVID symptoms were, on average, about six IQ points beneath people who’d never had COVID-19. But those whose Long COVID symptoms resolved over time also saw their cognitive scores improve.

    That finding is “quite positive,” he said. “There could be some hope for people who are struggling.”

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    Jamie Ducharme

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  • Do You Need to Take Electrolytes to Stay Hydrated?

    Do You Need to Take Electrolytes to Stay Hydrated?

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    When people are strong and reliable, we describe them as solid, yet the human body is about 60% water. Let’s face it: even the toughest among us is less like concrete, and more like a walking water balloon. Water is essential to most of our bodily functions, like carrying nutrients to our cells and keeping the brain sharp. The problem is that we’re constantly losing water through sweating, peeing, and breathing. We must do our part to keep the balloon full. We must drink fluids.

    Drinks are absorbed and retained better when paired with minerals commonly found in food like sodium, potassium, and chloride. It’s important to replenish these minerals, called electrolytes, during tough, lengthy exercise, as sweat ushers them out of the body.

    Cue the electrolyte products. Commercials show our favorite pro athletes boosting their electrolytes with sports drinks, powders, and gels—with looks of deep satisfaction etched on their faces—but does the average person actually need these supplements?

    Charge up hydration

    Electrolytes are key to hydration, mainly because they enhance fluid retention. “Having more electrolytes can trigger more efficient fluid uptake from the gut,” says Kim Barrett, a gastrointestinal physiologist at the University of California, Davis and spokesperson for the American Gastroenterological Association. 

    Sodium is the most important electrolyte for staying hydrated. When it’s consumed, sodium hangs around the exterior of cells, where its positive electrical charge attracts water molecules into the bloodstream and tissues. Think of sodium-rich water encircling the cells as “the sea water we took with us” when our ancient ancestors left the oceans to live on land, says Craig Horswill, a professor of exercise and nutrition at the University of Illinois, Chicago. Electrolytes help ensure healthy hydration at the cellular level.

    Read More: Is Green Tea Really That Good For You?

    A negatively-charged electrolyte, chloride, clings to sodium, supporting electrolyte balance, Horswill says. Other kinds, also found in food, prevent sodium levels from cresting too high, which could cause the body to retain excess water, straining the heart and kidneys. Potassium is an electrolyte that offsets sodium by getting the kidneys to filter its salty cousin from the bloodstream. “Sodium, chloride, and potassium are the primary ones to consider,” Horswill says.

    If you rely only on plain water without replacing these electrolytes, you’ll start getting headaches and muscle cramps. Eventually, more serious health problems will develop, says Stavros Kavouras, a professor of nutrition and director of the Hydration Science Lab at Arizona State—like swelling of the brain. 

    He points to another benefit: people actually end up drinking more water when it contains electrolytes. Otherwise, we often drink too little. “One benefit of sodium is that it maintains the drive to keep drinking and reduces the risk of dehydration,” says Mindy Millard-Stafford, a physiology professor at the George Institute of Technology and director of the Exercise Physiology Lab.

    Find the salty sweet spot

    But how many electrolytes, especially sodium, do we need?

    The normal range for sodium in the body is narrow: the minimum is 135 mg per liter of blood, with the max just a little higher at 145 mg. It’s rare for people to drop below the minimum, partly because electrolytes are so plentiful in food, and partly because light sweat contains relatively few electrolytes during casual exercise. 

    “Unless there are significant electrolyte losses during illness or heavy, prolonged sweating, most electrolytes can be replenished by a healthy diet,” Millard-Stafford says.

    Read More: 9 Weird Symptoms Cardiologists Say You Should Never Ignore

    It’s also “very challenging” to get too many electrolytes, Barrett says. But that doesn’t mean you should eat pickles all day, she adds, especially for those with hypertension. Some populations, including African-Americans, tend to have more salt sensitivity. Meanwhile, extremely high potassium levels can be toxic.

    Who really needs electrolytes?

    It turns out that electrolyte supplements, popularized through ads featuring sweat-drenched pro athletes, are mostly useful for…sweat-drenched pro athletes. But these supplements can also benefit us exercise-commoners in certain situations.

    One example is people working outside throughout the day in high heat, such as construction workers, delivery drivers, landscapers, and farm laborers. “Workers exposed to hot environments for over two hours need to start replacing electrolytes,” says Hayden Hess, a professor of exercise science at the University of Buffalo. If they just drink water, “they’re essentially diluting the blood.”

    In these conditions, guidance from the U.S. Centers for Disease Control and Prevention recommends having fluids every 15-20 minutes while prioritizing electrolytes—and this doesn’t necessarily mean downing sports drinks. Workers can refuel electrolytes with meals and snacks.

    Read More: 7 Metrics Everyone Should Know About Their Own Health

    Similar advice applies to lengthy leisure activities. When hiking for several hours on a warm day, for instance, “electrolytes could become important for maintaining optimal hydration,” Kavouras says. 

    Another example is training for a long-distance race in hot weather. “Beyond two or three hours, the electrolyte imbalance starts to become an issue, and supplementing becomes important—or you could just salt food a bit more,” Kavouras says. Research shows that when fluid loss results in overall body mass dropping by just 2%, sports performance starts to decline, and the risk of heat illness rises. 

    With shorter exercise—say 30 minutes to an hour—you may not need any electrolyte supplements. Your levels won’t change much, Kavouras says. “You’ll complete your electrolyte needs by eating regular foods.”

    Salty sweaters, beware

    Some people need to replenish electrolytes more than others. “Whether replacing them is warranted depends on the individual, particularly with salt-loss sweat,” Millard-Stafford says.

    People vary widely in how much they lose—from 200 all the way up to 1,800 mg of sodium per liter of sweat. One study found that 20% of runners were salty sweaters. A separate but related issue: how much you sweat overall. “The worst combination is if you’re a salty sweater and a heavy sweater,” Kavouras says. Those who perspire salty and heavy may have large electrolyte losses with shorter workouts, making supplements more important. Commercially available tests can determine your sweat type.

    Another individual difference is how much salty food you regularly consume. Most people in the U.S. consume too much (up to 2,300 mg of sodium is recommended per day, yet the average of American clocks in at 3,400), negating the worry that they’re not getting enough electrolytes. . However, certain diets such as raw vegan and the MIND diet contain far less salt, perhaps justifying an electrolyte supplement.

    Read More: What’s So Great About Cottage Cheese?

    Kids are vulnerable to dehydration. They often don’t consume enough fluids, and about 20% drink no water. During hot exercise, a sports drink with electrolytes could help. Research has found that kids given a low-sugar drink with electrolytes consume more liquid compared to kids given water. “They prefer the taste,” Kavouras says.

    A supplement could also help people exercising in warm conditions for the first time in a while, Horswill says. “As we get heat-adapted and fit, the body does a better job of reabsorbing sodium rather than losing it in sweat.” 

    When in doubt, listen to your body. You may get cramps or feel lightheaded when you’re becoming dehydrated. Another measure is what’s happening in the bathroom. Light yellow urine suggests optimal hydration with balanced fluid intake and electrolytes.

    Optimize your electrolytes

    When exercising for hours at a time, options abound for boosting electrolytes, such as drinks, powders, and salty snacks like rice crackers. 

    The best type comes down to personal preference. “They all get into your system with the same end results, once they’re in your intestine and dissolved,” Barrett explains. An advantage of the drinks is that they deliver both electrolytes and fluids. “The pills and gels are more portable, but you’ve still got to get the fluid into the body,” Barrett says.

    Supplements can vary widely in their ingredients, Hess says. Many sports drinks have significant sugar content for refueling energy, while providing fewer electrolytes than what’s lost through sweating, Horswill says. He suggests aiming for a supplement with more electrolytes: around 1,150 mg of sodium per liter.

    And go easy on the sugar. Electrolyte supplements with lower sugar levels “help transport fluids into the blood” for better absorption, Hess says. Up to 14 g of sugar per 8 oz. is optimal for quick fluid absorption during and right after exercise, according to Horswill. Even less, about 7 g, could be ideal if the supplement includes only the glucose form of sugar.

    Read More: Everything You Need to Know About Caffeine—Including How to Quit It

    Amino acids, the building blocks of protein, also seem to support hydration when combined with electrolytes. More research may reveal whether sugar or amino acids make the better hydration partner for electrolytes, Millard-Stafford says. For now, “a complete fluid replacement beverage would ideally contain electrolytes, sugar, and maybe amino acids,” Hess says. Pedialyte, for example, provides a good ratio of sugar to electrolytes, experts say.

    Some sports drinks have caffeine, which could deplete electrolytes since caffeine is a diuretic, increasing urination in theory. But caffeine has this effect only at high levels: more than 400 mg, Millard-Stafford says. Moderate intake of tea and coffee, below 400 mg of caffeine, are as effective for staying hydrated as water, she adds. 

    Combining different beverages throughout the day works well for hydration, especially if they naturally contain electrolytes. Coconut water is an option with electrolytes and low sugar that may support hydration, according to some studies. However, because coconut water is higher in potassium than sodium, it could be less hydrating than typical sports drinks when exercising, Horswill says. 

    Millard-Stafford points to low-fat milk, which offers electrolytes, carbs, and amino acids. However, “milk could cause gastrointestinal distress during exercise,” Barrett notes. It does a body good for replenishing electrolytes after exercise. 

    The perfect electrolyte potion probably hasn’t been alchemized just yet. “I wouldn’t be surprised if we come up with a new recipe for optimal hydration in a few years,” Kavouras says.

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    Matt Fuchs

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  • Why Gut Health Issues Are More Common in Women

    Why Gut Health Issues Are More Common in Women

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    There’s a hidden gender gap when it comes to digestive problems, with women taking the lead in this unpleasant contest. While men are hardly immune to gastrointestinal woes, certain digestive problems are considerably more common in women. “Women aren’t broken—they’re just different,” says Dr. Jeanetta Frye, a gastroenterologist at the University of Virginia in Charlottesville. For one thing, she says, “women have more visceral hypersensitivity so they may feel gastrointestinal symptoms more intensely.”

    Symptom sensitivity aside, there’s clear evidence that certain digestive disorders are more likely to affect women than men. Irritable bowel syndrome (IBS)—a disorder that involves repeated bouts of abdominal pain and changes in bowel movements (diarrhea, constipation, or alternating bouts of the two)—is two to six times more common among women than men. Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, affects twice as many women as men, according to the American College of Gastroenterology.

    In addition, celiac disease—an autoimmune disorder that causes bloating, chronic diarrhea, constipation, gas, and other GI symptoms and is triggered by eating gluten—is diagnosed nearly twice as often in women as in men. And functional dyspepsia (a.k.a. chronic indigestion) is also more common in women. So is a lesser known brain-gut disorder called cyclic vomiting syndrome—characterized by recurrent episodes of nausea, vomiting, and dry heaving, separated by symptom-free periods in between, says Dr. David Levinthal, a gastroenterologist and director of the Neurogastroenterology and Motility Center at the University of Pittsburgh Medical Center.

    Across the board, “disorders of gut-brain interaction are more prevalent in women than men,” Levinthal says, and the same is true of motility disorders like gastroparesis (delayed emptying of the stomach) and chronic constipation.

    A mysterious gender gap

    Why are women more susceptible to GI disorders? What is it about being born female that puts their digestive systems at risk? The answer is complicated and not completely understood.

    This much is known: Reproductive hormones may play a role. “The female hormones estrogen and progesterone have a profound effect on the GI tract in terms of motility, pain sensitization, and how the brain delivers messages to the GI tract,” explains Dr. David Johnson, chief of gastroenterology at Eastern Virginia Medical School in Norfolk and past president of the American College of Gastroenterology. As a result, women may experience flare-ups of GI disorders at certain times of the month (such as during menstruation) or during pregnancy.

    Read More: 15 Things to Say When Someone Comments on Your Weight

    For another thing, “women have a more easily activated immune system than men do,” says Levinthal. This is significant because immune function, including inflammatory processes, plays a role in celiac disease and inflammatory bowel disease.

    What’s more, the gastrointestinal tract itself is longer in women, and that difference in length can affect transit time through the GI tract, Johnson says. In addition, women’s stomachs empty slightly more slowly than men’s do—“why that is isn’t known,” says Levinthal, but it may explain women’s greater susceptibility to gastroparesis. Research also suggests that the intestine’s nerve cells are more sluggish in women, which may be why IBS and gastroparesis are more common in women.

    Another possible contributing factor has to do with psychological issues. “Anxiety and depression, which are more common in women than men, can worsen the severity of disordered gut function,” Levinthal says. “Feeling stressed or depressed or anxious is linked with how our guts work.” When you’re stressed out or anxious, you may be more likely to experience flare-ups of these GI disorders.

    Giving your gut the right TLC

    Regardless of gender, it’s important to “do everything you can to be proactive about your digestive health rather than just reactive,” Johnson says. That means staying well hydrated and consuming a healthy diet rich in plant-based foods (like fruits, vegetables, whole grains, legumes, nuts, and seeds), and lean protein, and avoiding sugary, highly processed foods.

    Read More: 9 Weird Symptoms Cardiologists Say You Should Never Ignore

    In particular, “fiber helps good bacteria flourish in the gut,” Johnson says, which contributes to the health of the gut microbiome, the community of bacteria and other microbes that naturally live in the GI tract. Research has found a strong correlation between gut bacteria and the risk of GI disorders such as IBS, IBD, and others.

    Being proactive about your gut health also means taking steps to manage stress, get plenty of sleep, and exercise regularly. “The more you move your body, the more your gut is moving, too,” says Dr. Samuel Akinyeye, a gastroenterologist at the Ohio State University Wexner Medical Center. That movement is likely to help with many of these disorders.

    If these measures don’t help sufficiently, there’s no reason to suffer alone. Medications and other treatments are available for all of these digestive disorders. “If you have symptoms you don’t understand, talk to a gastroenterologist,” Frye advises. “A lot of women are embarrassed to talk about their GI symptoms—I want them to feel empowered to discuss them. I tell my patients that it’s a safe space, and I’m not embarrassed to hear anything. This is why I’m here.”

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    Stacey Colino

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  • AirPods and Apple Watches Will Soon Come With More Health Features

    AirPods and Apple Watches Will Soon Come With More Health Features

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    This week, Apple announced that its devices will have two new health-related capabilities: your Apple Watch will soon be able to tell if you have sleep apnea, and your AirPods Pro 2 can now double as hearing aids for those who need them.

    Jeff Williams, chief operating officer at Apple, told TIME in his first interview about the new health features that while Apple began providing health-related capabilities initially focused on fitness, the company will “continue to pull on the threads” in the health space. Already, Apple devices can detect or track heart and respiratory rates, menstrual cycles, body temperature, perform electrocardiograms to record heart rhythms, monitor sleep cycles and detect falls, not to mention serve as a fitness apps for workouts and activity. And those features will likely only continue to grow. “So many people have our devices with them that we view this as an opportunity, and maybe even a moral responsibility, to do more in this space,” he says. “We don’t know where the journey is going in terms of where we’ll end; we’re at the very beginning.”

    Here’s what to know.

    How the Apple Watch can detect sleep apnea

    Apple Watch already detects irregular heart rhythms, and the Apple Health app can track things like steps, activity, and time spent asleep. The latest Apple Watch—Series 10, which goes on sale Sept. 20—also contains an ultra-sensitive accelerometer that can detect tiny changes in breathing patterns via the wrist while someone is sleeping. Over a 30-day period, it analyzes the patterns and informs the wearer if they might have enough sleep disturbances to suggest sleep apnea—even the mild kind.

    According to Apple scientists, the accelerometer is sensitive enough to pick up the smallest physical manifestations of breathing, even if the person doesn’t seem to be moving, as breathing movements from the chest are conveyed to the extremities, including the wrist.

    Read More: 15 Things to Say When Someone Comments on Your Weight

    A past version of the Apple Watch used another way to detect sleep apnea that doctors include when they diagnose sleep apnea: a pulse oximeter, which uses specific wavelengths of light to track differences in oxygen levels in red blood cells. But in Oct. 2023, the U.S. International Trade Commission determined that Apple infringed on patents for the pulse oximetry technology it used that were held by another company, Masimo, and banned the company’s watch imports into the U.S. Apple stopped including the feature in watches sold in the U.S. starting Jan. 2024 while the company appeals the ban.

    Williams said that the decision to rely on the accelerometer for detecting sleep apnea “really had nothing to do with the current legal situation, and was based on science and on studies. We found that the accelerometer and gyroscope data was really beneficial [for detecting sleep disturbances that could indicate sleep apnea]. It was less so for blood oxygen.”

    The feature isn’t designed to diagnose sleep apnea, but can give users an early warning that they might have the condition. Data are stored on Apple’s Health app—encrypted and protected so only the user has access to it and Apple does not, according to Williams—so doctors can analyze it and make an actual clinical diagnosis using other information the doctors collect.

    AirPods Pro: your new hearing aids

    While Apple is introducing updated versions of its entry-level AirPods (called AirPods 4), its AirPods Pro 2, which the company released last year, will remain the same. But with a new, free software update, users will be able to conduct professional-grade hearing tests and turn their AirPods Pro 2 into hearing aids and to make adjustments to refine their hearing, without needing a doctor, to address mild-to-moderate hearing loss. On Sept. 12—three days after Apple announced the pending availability of the hearing aid feature in the devices—the U.S. Food and Drug Administration (FDA) approved the software as hearing aids, making the AirPods Pro 2 the first such hearing aid software device.

    Read More: Green Tea Is Even Better For You Than You Think

    AirPods already contain a feature that can alert wearers when sounds are too loud for hearing safety, and then reduce those levels. The software update, called Hearing Aid Feature, will provide a clinical-grade hearing test similar to the one professionals use to diagnose hearing loss. “In reality, there is no difference in the results from the hearing test from the AirPods than with a clinical audiogram,” Dr. Sumbul Desai, vice president of health at Apple, tells TIME.

    Here’s how the test works: users tap on their iPhone screen to indicate which tones, played at different frequencies through the AirPods Pro 2, they can hear. The app provides a report indicating whether the person has mild, moderate, or severe hearing loss; the data can also be interpreted by a hearing expert to determine what type of hearing loss someone may have.

    Based on the results, people with mild-to-moderate hearing loss can then follow instructions in the Apple Health app to adjust their AirPods Pro 2 into hearing aids, which Desai says are “equivalent to other devices out there” for similar levels of hearing loss. The advantage in having the AirPods Pro 2 serve the dual roles of listening devices and hearing aids, says Williams, include “convenience and simplicity,” as people can conduct the hearing test and improve their hearing with a single device. About 85% of hearing loss falls into the mild-to-moderate range.

    Stay tuned

    The hearing aid feature will be available as a software update for the new AirPods Pro 2 this fall. Apple is still awaiting clearance from the FDA on the sleep apnea feature, which the company expects “soon.” Once approved, users with not only the latest Apple Watch Series 10, but also the Series 9 and Ultra 2, will be able to access the sleep apnea alert feature through a software update.

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    Alice Park

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  • 15 Things to Say When Someone Comments on Your Weight

    15 Things to Say When Someone Comments on Your Weight

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    Figuring out what to say about someone’s weight gain or loss is really easy if you follow one of the golden rules of modern communication: Never comment on another person’s body. 

    Not everyone, however, gets the memo.

    Cherie Miller, an eating disorder and body image therapist in Southlake, Texas, hears often from clients on the receiving end of body talk. “It reinforces the idea that the way we look matters immensely, that we’re on display, and that, to some degree, our purpose is to be pleasing to others, which is really quite gross and harmful,” she says. “In our culture, we assume that weight gain is bad, and weight loss is good, and that’s just not always the case.”

    The person you’re talking to, she adds, might have lost weight because they’re sick. Or they might be depressed or recovering from an eating disorder. Maybe they packed on a few pounds because of the medication they’re taking for the condition they don’t want to disclose. The point, she stresses, is that it’s impossible to know, and none of your business.

    We asked experts as well as people who frequently experience unwanted weight-related comments to share their favorite ways to respond—and why those comebacks are effective.

    “I prefer people don’t comment on my body.”

    As a plus-size model who’s appeared on the covers of magazines like Cosmopolitan UK, Tess Holliday knows that people will have something to say about her body. Lots of that noise comes from internet strangers; some of it is from the people she passes on the street. Other comments fly out the mouths of her friends and family.

    When a loved one mentions Holliday’s weight—maybe trying to pay her a compliment, like “you’re looking healthy lately”—she generally assumes they have good intentions. “From their point of view, they’re trying to say something kind,” she says. That’s why she usually opts for a “nice, gentle” approach: a brief thanks, followed by a reminder that she doesn’t discuss her body.

    Read More: Here’s How Much Sleep You Need According to Your Age

    Other times, she’ll respond to a comment from a family member—“You look like you lost weight”—with something a little snappier: “Nope, still fat, but that’s OK.” She tells the person that she’s happy, and then changes the subject and moves on. The problem, she acknowledges, is that “some people aren’t even going to notice that you did that, and it’s going to roll right over their head.” If you feel up to it, firmly setting a boundary that you don’t talk about your body can provide a more surefire dose of the feedback your conversation partner needs, she says.

    “So funny, right?”

    During a recent trip to Italy with a plus-size travel group, Holliday encountered unusually brazen, fatphobic comments. “It was pretty jarring, even for me,” she says. One evening, as the group crossed the street, dressed up and excited to see a plus-size opera singer perform, they noticed a cluster of men laughing and pointing at them, egging their friends to “pick one.” “The whole mission is having these size-inclusive tours for people to feel comfortable and safe, but you can’t control the environment,” Holliday says. She had to say something. “I turned around and looked at them, and started laughing with them, and then I stopped, with a stone-cold look on my face, and said, ‘So funny, right?’” She continued staring at them for a few beats. The men quickly stopped laughing and joking, she says, and fell silent, with a look on their faces that indicated they knew they were in trouble.

    “My body is different, but my heart is fuller.”

    For a long time, thinness has been synonymous with happiness, Holliday stresses—and seeing someone thrive in a larger body can challenge people’s preconceptions. Yet it captures her truth. She’s recovering from an eating disorder and healing from an abusive relationship, she says, both of which took a toll on her health. “My body is bigger than maybe ever, but it’s just trying to make sure I survive,” she adds. “If it’s bigger right now or forever, that’s OK. I’m able to be happy and enjoy my life for probably the first time ever, and I’m able to be present.”

    “I’m so sorry you feel that way, but I am so loved and so blessed.”

    A couple years ago, Holliday made headlines for the way she responded to a woman who had body shamed her in a waiting room: “Ma’am, I am one of the most famous plus-size models in the world. I think I’m doing OK.” While we can’t all use her words verbatim, we can sub in what we’re most proud of: being a healthy mom of four, a hard-working business owner, a neuroscientist, a pickleball champ.

    Read More: How to Know if Your Friendship Is Toxic—and What to Do About It

    While Holliday still appreciates the occasional well-timed clapback, she increasingly aims to keep things light and move on with her day. That’s the way true change can happen, she believes: People are far more likely to reflect on their words if you “kill them with kindness,” rather than getting sassy. “It’s very easy to snap back with ‘hate’ when you’re being hated,” she says. “I’m definitely recovering from being a very defensive person, and trying to realize, maybe someone’s having a bad day. They might be commenting on my looks, but it usually has nothing to do with me and everything to do with them.”

    “Did you know that strawberries aren’t actually berries, but bananas are?”

    If someone makes a comment about your weight that makes you uncomfortable, you can simply change the subject, Miller says. She likes to keep a handful of fun facts in her back pocket—like this one about the scientific classification of popular fruit—and then pull them out when a conversation requires a 180° shift. “Some people aren’t going to be comfortable being very confrontational,” she says. “So redirecting the conversation is a great way to handle those situations.”

    “Oh, I didn’t realize we were sharing unsolicited opinions. Do you want mine next?”

    If you’re feeling provocative, a quip that maintains your dignity while putting the commenter in their place could be the way to go. “Sometimes, depending on your personality—or if directness isn’t really working—you’ve gotta step it up a notch to make your point,” Miller says. “Especially if it’s a person who said something really inappropriate or harmful, or if they’re a repeat offender.” Plus, she adds, “Some of us are just naturally spicy and want to go straight to level three.”

    “My body needed a little extra assistance to help with the weight loss.”

    Amy Kane has struggled with her weight for as long as she can remember. As a teen, she learned she had polycystic ovary syndrome, which can make it difficult to lose weight, and later, after having three kids, she was diagnosed with Type 2 diabetes. At her heaviest, she estimates she weighed 300 pounds and wore a size 4X.

    Read More: Does Text Therapy Really Work?

    Eventually, Kane’s endocrinologist suggested she try Mounjaro, a GLP-1 drug that can help people lose a significant amount of weight. She’s now down more than 160 pounds and says the drug saved her life physically and emotionally. Inevitably, she’s fielded plenty of questions—and judgment—about how she did it. Some people ask why she didn’t “just go to the gym.” Kane likes to respond: “I overhauled my diet and my lifestyle, and I had a tool that was helping me. Your body might not need that, but my body needed a little extra assistance to help with the weight loss.” If someone pushes back and tells her she “cheated” or took the easy way out—she’s heard it all—she emphasizes: “GLP-1s are not magic,” and she’s put a lot of work into achieving and maintaining her new body.

    “Wow. Do you normally comment on people’s weight like this? How do they usually respond when you say that to them?” 

    This is a terrific way to respond if someone tells you you’re fat or makes an otherwise offensive comment, says Kelli Rugless, a psychologist and eating disorder specialist in Los Angeles. “It takes the attention away from your weight and appearance and redirects it to the person making the comment or asking the question,” she says. Plus, it encourages them to reflect on their behavior. Rugless thinks of it as an opportunity to provide “honest feedback on how insulted or hurt the other person’s comment made you feel,” while hopefully spurring them to avoid such language in the future. She suggests delivering it with little emotion and steady eye contact. “In the same way they put you on the spot, you’re returning the favor,” she says, “and not attempting to relieve or rush through their discomfort.”

    “While I understand your curiosity, I promise you that how I lost weight is the least interesting thing about me. I’d rather talk about [fill in the blank].”

    This is another go-to when Rugless coaches her clients on how to respond to unsolicited comments about their appearance. “It communicates your boredom and disinterest in talking about weight, diets, and health trends,” she says, hopefully ensuring the person won’t bring them up again. Say it with a light, humorous tone of voice, she advises, and if you happen to have an audience, shift your eye contact to someone else. Doing so “reinforces the reality that you’ve moved on to not only a new topic, but a new individual,” she says.

    “I’ve been focusing on my overall health.”

    Kane documents her weight-loss journey on Instagram and TikTok, and she often hears from people who don’t want to tell their friends that they’re using a GLP-1 medication. She assures them that “it’s no one’s right to know.” When she first started taking Mounjaro, she didn’t tell many people, either. She recalls neighbors commenting on her weight loss and asking how she did it. “I didn’t lie, but I left out the part about medication,” she says. “I told them I changed my diet, and that since my kids were a little older, I had more time to focus on myself.” If you don’t feel comfortable disclosing your medical information, you could also say, “That’s between me and my doctor,” or “I’d rather not go into the details.”

    “I’ll take this loose skin for my physical and mental health to do a 180.”

    Being so candid on social media opens Kane up to, well, audience feedback. “The No. 1 thing I get asked about, or get nasty comments about, is my loose skin,” she says. Some people blame it on her medication; Kane responds that any weight loss can lead to loose skin. Others post mean-hearted remarks about what it looks like. “I have no shame—I’ll show it,” Kane says. “I think it empowers people. And I tell them that I’ll take this loose skin for the 180 my physical health has done, and the 180 my mental health has done.”

    Read More: Cuddling Might Help You Get Better Sleep

    “Yes, and?”

    Molly Day was a professional dancer throughout much of her 20s, but during the pandemic, complications related to an eye surgery led to her retirement. She gained about 50 pounds after that—weight that masked the six-pack she once had. She was floored by how many people felt entitled to comment on her new size. These days, Day, who’s now a body-neutral fitness instructor in New York, spares few words for those who make comments like, “Oh my God, you’ve gained weight.” She might reply: “Yes, and?” Trying to defend or deflect can bring more attention to the subject she wants to avoid, she’s found, whereas a terse response tends to shut down the conversation. “It takes a lot of inner work to be comfortable with your body shifting,” she says—but owning the change diminishes the other person’s ability to make her feel “less than.”

    “This is not the appropriate setting to be bringing this up.”

    In the early months after Day’s weight gain, friends brought it up under the guise of concern—”I care about your health”—during social gatherings and in public spaces. She didn’t appreciate the so-called good intentions. “If it was truly about my health, which we know it’s not because health is every size, this isn’t the situation to bring it up in,” she says. Day told her friends exactly that. She found that while some doubled down—to which she repeated her boundary—others immediately clocked themselves and apologized for the intrusive comments.

    “Can you repeat yourself?”

    People often express how they feel about others’ bodies by making sly “jokes,” Day has discovered. She doesn’t see the humor, so she’s started asking them to repeat themselves. Some do, to which she responds: “That’s what I thought you said.” “They want to just make it as a little jab and continue to move on,” she says. Making them repeat themselves—and then responding with silence, refusing to engage further—is a powerful way to call them out.

    “What a shame you felt the need to say that.”

    Day still recalls the time a colleague she hadn’t seen in years made a joke about her appearance. Her quick-witted retort: “What a shame you felt the need to say that.” “I could see it in their face—the disappointment,” she says. “It was one of those moments like when you’re a little kid, and your parent doesn’t yell at you, but they’re like, ‘I’m so disappointed,’ and it hits you so much harder.” She now keeps the phrase in her back pocket and has pulled it out in situations in which she might otherwise be at a loss for words. “We don’t have to appease people when they make these comments about our bodies,” she says. “Having a couple statements ready to go can really help you claim back your power.”

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    Angela Haupt

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  • These Are 4 of the Most Common Complications of Hypertrophic Cardiomyopathy

    These Are 4 of the Most Common Complications of Hypertrophic Cardiomyopathy

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    You could argue that the complications of a disease, rather than the disease itself, create most of the problems associated with that condition. Take hypertrophic cardiomyopathy, or HCM, a primarily genetic condition that results in a thickening of the walls of the heart—specifically its left ventricle, which is the chamber that pumps blood out of the heart and into the aorta. According to the Hypertrophic Cardiomyopathy Association, HCM is the most common genetic heart condition, affecting at least 1 in every 500 adults—possibly more, given that as many as half of all people with the disorder have no symptoms or ones that are so mild, they go unnoticed.

    The American Heart Association (AHA) reports that about two-thirds of those who have been diagnosed with HCM have so much thickening in their heart muscle that it obstructs blood flow out of the left ventricle and into the aorta. This is called, aptly, obstructive hypertrophic cardiomyopathy. This kind of obstruction is behind many of the more troublesome and life-threatening complications of HCM.

    In nonobstructive HCM, the thicker muscles may mean the ventricle is less able to pump the normal volume of blood, but the blood is able to move in and out of the ventricle unimpeded. Most people who have the nonobstructive version of the disease will have milder symptoms and lower risk of death than those with its obstructive relative. In other words, they’re likely to have fewer, though by no means zero, complications of their disease.

    With that in mind, here’s a look at what to know about four of the most common HCM complications—including how they manifest and how they’re treated.

    Atrial fibrillation (AFib)

    There are two main types of heart arrhythmias, and you’re probably already familiar with one of them: atrial fibrillation, or AFib. It describes a rapid and irregular heartbeat that can lead to blood clots within the heart, which, in turn, can increase the risk of stroke. “The longer a patient has the condition, the more likely atrial fibrillation is to occur,” says Dr. Steve Ommen, director of the Hypertrophic Cardiomyopathy Clinic at the Mayo Clinic in Rochester, Minn.

    AFib shows up in about a quarter of people with HCM. However, Dr. Milind Desai, director of the Hypertrophic Cardiomyopathy Center and vice chair of the Heart, Vascular and Thoracic Institute at the Cleveland Clinic, says that estimate may be too low. “I don’t believe we have accurate data,” he notes, “as many patients have short bursts of AFib that are asymptomatic.” In these instances, the heart beats irregularly, but the person feels none of the usual symptoms to warn them of the arrhythmia.

    Those who do experience symptoms might report heart palpitations or a sense of a rapidly pounding heart, shortness of breath, dizziness, or fainting. Treatment often focuses on the use of anticoagulant drugs, which prevent the formation of the blood clots that can lead to stroke. Cardiologists may also recommend drugs to restore a more normal heartbeat, including beta blockers or calcium channel blockers, which work by lowering the heart’s pumping rate and giving the cardiac muscles a bit of a biological break.

    When AFib recurs or doesn’t respond to medications, a minimally invasive procedure known as cardiac ablation may be considered. It involves using heat or cold to create very small scars in the heart tissue to interrupt the abnormal electrical signals that lead to the rapid or irregular heartbeat.

    Read More: What to Know About Hypertrophic Cardiomyopathy in Kids

    Ventricular tachycardia (VT)

    Ventricular tachycardia is another type of abnormal heart rhythm, in which an extremely fast heartbeat begins in the lower chambers of the heart. The rapidity of the beat prevents the ventricles from filling with enough blood before they contract again.

    The symptoms of ventricular tachycardia are similar to those of AFib and include palpitations, dizziness, shortness of breath, and fainting, but may also include neck tightness, chest pain, and even cardiac arrest. As with AFib, a cardiologist might prescribe beta blockers or calcium channel blockers to treat the symptoms and control the heart’s rhythm. When people don’t respond to medication, or if they have particularly advanced VT, they may need an implantable defibrillator. That’s “a special pacemaker-like device to monitor the heart for dangerous arrhythmias and deliver an electric shock to reset the heart to a normal rhythmif they occur,” says Dr. Michelle Kittleson, director of education in heart failure and transplantation and professor of medicine at the Smidt Heart Institute at Cedars-Sinai in Los Angeles.

    Compared to atrial fibrillation, VT packs a much bigger cardiac punch. “In terms of risk, ventricular tachycardia is the one we screen for annually in HCM,” Ommen says. “Ventricular tachycardia itself can make the squeezing function of the left ventricle ineffective; it can also degenerate into ventricular fibrillation.” While VT is about a rapid heartbeat, the problem in ventricular fibrillation, or VF, is that the ventricles contract in a sort of quivering and random beat. The AHA calls VF the “most serious abnormal heart rhythm,” and notes that, without treatment, it can lead to sudden cardiac death within minutes.

    Kittleson agrees. “Ventricular arrhythmias are more dangerous,” she says, “because they can cause sudden cardiac death, as the heart cannot pump efficiently and no blood gets to the body.” In fact, VT that becomes ventricular fibrillation is the most common cause of sudden cardiac death.

    Heart failure

    Another common HCM complication is heart failure, a broad term that means your heart isn’t able to pump enough blood out into your circulation to properly oxygenate the rest of your body. The heart fails, in other words, to effectively do its most essential job. Heart failure is not, however, the same thing as cardiac arrest, which is when the heart stops—arrests—its beating altogether.

    In HCM, heart failure is generally a result of the thickening and stiffening of the heart’s ventricles. In that sense, according to the Hypertrophic Cardiomyopathy Association, HCM is simply a form of heart failure. Specifically, people with HCM tend to develop a type of heart failure in which the left ventricle can’t fill with enough blood—because of its overly muscular walls—to then pump sufficient blood throughout the body. With less blood in the ventricle in the first place, even a perfectly pumping heart won’t be able to force as much blood out into the circulation as it’s meant to. And a heart with walls thickened by HCM is unlikely to be a perfectly pumping heart.

    Still, Desai notes, not all HCM patients experience heart failure. “Many HCM patients can be asymptomatic,” he says. “But if you have shortness of breath due to a cardiac problem, technically you have some element of heart failure.”

    In addition to an inadequate supply of oxygenated blood in the body, heart failure tends to lead to an accumulation of fluid in the body’s tissues, which is called congestive heart failure. In addition to the obvious physical signs of fluid accumulation, like swollen ankles, there are the more subtle and potentially dangerous ones. Fluid from the processes of heart failure is especially prone, for instance, to build up in the lungs; this can lead to coughing and shortness of breath, generalized symptoms that aren’t always as benign as they may initially seem.

    The treatment of heart failure itself—rather than the disease that causes heart failure, like HCM—tends to focus on the treatment of congestive heart failure, specifically. Cardiologists will likely prescribe diuretics, drugs meant to help the body’s kidneys process the extra fluid. Patients might be asked to limit both time on feet and fluid intake. The same beta blockers and calcium channel blockers used to treat arrhythmias can also be used to slow the heart enough to allow the left ventricle to fill to the best of its ability. For those with the most severe forms of heart failure, heart transplantation may be the best option.

    Read More: 9 Weird Symptoms Cardiologists Say You Should Never Ignore

    Sudden cardiac death

    Sometimes the first—and, sadly, last—sign of HCM is also its most feared complication. Sudden cardiac death, which is also known as sudden cardiac arrest, occurs when the heart stops beating or beats so irregularly or weakly that it can no longer provide enough oxygen to the body to sustain life. A death falls under the sudden cardiac death label if it occurs within an hour of the onset of symptoms such as feeling faint, dizzy, or noticing the feeling of an irregular heartbeat—in other words, the signs of ventricular fibrillation. If the heart actually stops beating, however, death will occur within minutes, unless emergency measures are taken.

    Experts stress that sudden cardiac death—which, in HCM, occurs when the heart’s electrical system misfires, resulting in ventricular tachycardia or ventricular fibrillation—is not the same as a heart attack, in which a blocked artery prevents blood from getting to the heart, killing off the heart’s muscles.

    HCM is one of the most common identifiable causes of sudden cardiac death in athletes under 35. And although it is by no means a common outcome for those with HCM, sudden cardiac death occurs in approximately 0.8% of affected individuals each year, says Ommen. “Assessing each individual’s risk is thus an important part of regular checkups,” he notes.

    The cascade to sudden cardiac death can be treated, if caught immediately after its onset, using CPR to keep blood flowing through the body, an external defibrillator to reset the heart rhythm, and medications to restore the heart’s normal rhythms.

    Read More: How to Talk to Your Family About Their Heart Health History

    Better still, cardiologists say, is to treat the arrhythmias and other electrical-impulse issues that can arise in an individual with HCM—or to treat the HCM itself—sand thereby stave off sudden cardiac death altogether.

    Overall, says Kittleson, it’s important to remember that “HCM is not a death sentence. With current methods of diagnosis, evaluation, and treatment, survival is comparable to that of the general population. With proper management, patients can live full and healthy lives.”

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    Lori Oliwenstein

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  • What It’s Like to Take an Adult Gymnastics Class—with Zero Experience

    What It’s Like to Take an Adult Gymnastics Class—with Zero Experience

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    Every four years, I become a gymnastics fan. It’s the only summer Olympic sport I reliably seek out, gawking from my couch as the athletes perform tricks that seem to defy the laws of physics and human capability. Since my own gymnastics career ended around the time I entered elementary school—in other words, around the time classes began to involve more than diving into a pit filled with foam blocks—I assumed this occasional experience was as close as I’d ever get to the sport in my adult life.

    Until a recent Monday evening, when I joined about 20 other people for an all-levels adult gymnastics class at the Chelsea Piers Field House in Brooklyn, New York. Even though the summer Olympics had already ended, enthusiasm for gymnastics hadn’t died down. I was lucky to get into the class, as I overheard multiple people saying the waitlist had been filling up fast lately. And apparently, a similar trend is playing out across the country.

    “So many classes are waitlist-only right now, and that rarely happened before this past Olympics,” says Gina Paulhus, who keeps a list of adult gymnastics classes on her website. That list has grown dramatically over the years, from 231 gyms offering adult classes in 2015 to 590 this year, Paulhus says. She also runs a Facebook group for adult gymnasts that has grown from 300 members in 2014 to almost 14,000 a decade later.

    Read More: Green Tea Is Even Better For You Than You Think

    Why are so many adults suddenly trying to become gymnasts? It could be that people simply want fun, community-oriented ways to work out, Paulhus says. Or it could be because some of the U.S. team’s stars, like 27-year-old Simone Biles and 25-year-old Stephen “the Pommel Horse Guy” Nedoroscik, are proving that grown adults can succeed in a sport once dominated by teens, she says. Former Olympic gymnast Chellsie Memmel also made national news a few years ago when she un-retired from competitive gymnastics in her 30s.

    If Memmel could do that, surely this 30-something could attempt a cartwheel for the first time in decades.

    As I nervously waited for my class to begin, I chatted up a couple people idling outside, trying to get a sense for what brought them out to flip and tumble—and whether I was about to be humiliated by my lack of experience. The first person I spoke with was a newbie with zero gymnastics background who signed up just because the class sounded fun, which made me feel better. The second was a professional dancer, which did not.

    “Is the class hard?” I asked the dancer, who said she’d taken it a few times before.

    “No,” she replied—before adding that some of the warmup exercises would “make you realize how weak you are.” Great! 

    Her assessment turned out to be correct. The warmup started out like a high school sports practice—high knees, butt kicks, lunges—before moving into a series of humbling strength exercises, like scooting across the floor in plank position with my feet on a glider disc. I was fully sweating by the end of warmups, at which point we began stretching. As we did, the pair of instructors asked if anyone was brand new. My hand, along with a few others, went up. Was anyone a former gymnast? Only a few hesitant hands. Okay, I thought, maybe I can do this after all.

    Read More: Does Text Therapy Really Work?

    After stretching, we split up into two roughly equal-sized groups: beginners and advanced students. While the advanced group worked on tricks like handsprings and flips, we beginners tried to master basics like handstands, cartwheels, and roundoffs.

    Here, I will let you in on my delusion. Despite a) not being very flexible or having particularly good upper-body strength and b) not having done gymnastics for 25 years, a tiny part of me hoped that I would be surprisingly good at it. Not Simone Biles good, obviously, but passable. Maybe all those Pilates and yoga classes over the years would somehow translate and I would stun everyone with my grace and skill!

    Those hopes came crashing down during our second exercise: backward somersaults. When the instructor demonstrated the move, he rolled over smoothly and popped up into a standing position like it was nothing. When I tried it, I got stuck with my feet over my head, like a turtle flipped onto its back. Medal-worthy, this was not.

    Despite my devastating lack of hidden talent, I enjoyed the rest of class. The instructors were unfailingly patient and supportive, and none of my fellow beginners seemed to take anything too seriously. I’ve taken plenty of group fitness classes that felt silent and serious, but in this one, students complimented each other and chatted between exercises. We were all in it together, maybe because we were pretty far outside our comfort zones.

    Were my handstands perfectly straight or my cartwheels smooth by the end of the hour? Not at all. But it was fun to give it a shot and try exercises totally different from what I normally do at the gym, with each marginal improvement feeling like a victory. Who cares that I needed to brace myself against a wall to hold a handstand for longer than a second? I was still upside down. I felt a little bit like a kid again, in a good way. 

    At least, until I realized I’d tweaked a muscle in my leg doing a cartwheel. Then, I remembered I’m in my 30s.

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    Jamie Ducharme

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  • Green Tea Is Even Better For You Than You Think

    Green Tea Is Even Better For You Than You Think

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    Other than water, tea is the most consumed beverage worldwide. And for good reason: tea is great for you, particularly the green variety.

    Several benefits of green tea are supported by solid research. Others, much less so. For example, influencers sometimes gush about green tea being “nature’s Ozempic,” suggesting it’s as effective as obesity medication. If this claim sounds exaggerated, that’s because it is, researchers say.

    Below, they explain what the science shows about green tea’s role in countering obesity and diabetes, boosting heart and brain health, and fighting cancer.

    Green tea, a nutrition unicorn

    Tea leaves are unique because they have more catechins than any other drink or food. These compounds protect cells from damage as we get older.

    Green tea may be especially healthy compared to other teas, partly because it undergoes little processing on the way to our cups. Black and oolong teas are fermented, a process that reduces their catechins, although fermentation does yield other kinds of healthy compounds.

    Green tea contains a few types of catechins, but one called EGCG is the most powerful for safeguarding the cells and fighting inflammation. “That’s what makes green tea so special,” says Laura Acosta, an instructional associate professor of nutrition at the University of Florida who researches green tea.

    How to drink it

    When green tea is freshly brewed, it packs more EGCG than ready-to-mix or ground green tea powders, which range widely in their EGCG content, from 2 to 200 mg per serving, Acosta says. If you do go the powder route, look for packages that state their EGCG content, she adds, and try to consume them quickly after buying. Sitting on pantry shelves for six months, powders lose 30-50% of their catechins, Acosta says, meaning fewer health benefits.

    Read More: 6 Health Myths About Oils

    Aim for 2 to 4 cups of green tea per day, says Jeffrey Blumberg, a research professor of nutrition science at Tufts University, depending on your sensitivity to caffeine. “Data suggest there are diminishing returns for health after five cups,” says Marilyn Cornelis, associate professor of preventive medicine at Northwestern University. “More isn’t necessarily adverse,” but the benefits start to plateau.

    You’ll want to maintain this intake for a while—years, not days. “Over time, it will have a cumulative effect,” Acosta says.

    Managing obesity 

    So, are TikTokers right that you can swap obesity medications like Ozempic for a tall cup of tea? 

    Don’t count on it. The research isn’t as clear as social media suggests. For example, an influencer dietitian TikTok post in March analyzed one clinical trial on whether green tea acts like obesity medications by triggering the hormone GLP-1, which promotes feelings of fullness and lower blood sugar. According to her, the outcome of the trial was that green tea did elevate GLP-1—but the actual result “isn’t what she implied,” Blumberg says. In truth, the researchers found no significant difference between the group that got the green tea, and the group that didn’t.

    A 2017 research review found no evidence that green tea affects blood glucose levels. However, Cornelis thinks it could “inhibit the absorption of carbohydrates, which may reduce glucose levels.” Other studies found that green tea’s catechins contributed to feelings of fullness and drove weight loss. “In theory, it could help with managing obesity or diabetes, but we need a lot more data to support it,” says Dr. Sara Ghoneim, a gastroenterologist at Massachusetts General Hospital and spokesperson for the American Gastroenterological Association.

    Read More: What’s So Great About Cottage Cheese?

    Clinical research on green tea typically involves very high doses of EGCG, using pills instead of the drink. These “green tea extract” pills are available online, packing as many as 800 mg of EGCG. The drink won’t provide that much unless you dust off your beer hat from college and slurp it all day. 

    Very high doses may damage the liver if taken regularly over many years, but research suggests that only about 5% of people are particularly vulnerable to these effects. “Basic research in animals suggests that high doses can harm the liver,” but perhaps only while fasting from food, when the liver is more vulnerable, Blumberg says.

    However, the extract may leave out some of the beneficial properties of tea. “I encourage the whole beverage,” Cornelis says. Excess green tea consumption may also cause nausea or acid reflux, Ghoneim notes, especially for those who are sensitive to tea. “It’s really individual dependent,” she says. “Start with a couple of cups and see how you do.”

    The effects of drinking a few cups per day would be very gradual, like a single pound lost over 12 weeks. “Eating tea plants is not like a drug. It won’t have an overwhelming effect,” says Carol Johnston, professor of nutrition at Arizona State University. But that’s no reason to put down your cup, she adds. “A slow, moderate weight loss is the healthiest kind of weight loss. Don’t expect to lose 10 pounds in two weeks. This is a lifelong process.” 

    Preventing heart disease 

    Regularly drinking green tea supports heart health, partly by decreasing blood pressure, according to a recent meta-analysis. Other research, co-authored by Acosta, showed a similar effect in postmenopausal women. 

    It could lower cholesterol as well, Cornelis found. “It reduced bad cholesterol and increased good cholesterol,” she says. “That may underlie the beneficial impact on cardiovascular disease.”

    Animal studies point to similar benefits, though Johnston notes that most research in humans suggests that only 5% of green tea’s catechins actually get into the blood system. “It’s poorly absorbed,” she says. But there’s a potential solution: mix green tea with sources of vitamin C, like lemon juice or blended strawberries, which act synergistically with the tea. “Vitamin C can enhance some of the absorption,” Johnston says. 

    Protecting brain health

    Drinking green tea is associated with a lower risk of Alzheimer’s and Parkinson’s disease. Brain health is one of the “best established health benefits” of green tea, Acosta says.

    The caffeine in tea may be especially helpful in keeping the mind sharp. Plenty of research shows that caffeine boosts cognition in the short term, which may translate into long-term protection for frequent quaffers, Cornelis says. Caffeine blocks certain receptors in the brain that affect dopamine, which is involved in Parkinson’s, she adds.

    Read More: Are Dates Actually That Good for You?

    Now, a sensitive topic: green tea vs. coffee. Both drinks have their passionate defenders, but it’s tough to pick a clear winner. Coffee has twice as much caffeine as tea, but green tea has more L-theanine, a building block of protein that has a calming effect and improves focus and attention, Blumberg says. At least one study has found that green tea, but not coffee, was associated with better cognition as people age.

    Detoxing  

    Another theory popping up on the internet is that green tea “detoxifies” the body. This idea isn’t accurate, Acosta says, because EGCG can actually become a toxin in its own right. After EGCG spurs healthy adaptations, the body works to transform and eliminate this compound to avoid being harmed by it. “Green tea is a powerful antioxidant,” Acosta says, “but detoxification is completely different.”

    Fighting cancer

    People on social media have made bold statements about green tea’s ability to combat cancer. What does the research actually show?

    In 2021, a large review found little evidence for green tea’s role in preventing cancer. However, lab research suggests that EGCG blocks pathways involved in tumor formation, says Dr. James Segars, a cancer researcher and head of the reproductive endocrinology unit at Johns Hopkins.

    Other research shows an association between green tea and a lower risk of certain cancers such as breast, ovarian, prostate, and neck. “It might be protective,” Acosta says, as part of a healthy overall lifestyle. Segars studies cells to see how green tea could reduce the size of fibroids, abnormal masses of tissue that may develop into uterine cancer. He tells patients with a family history of fibroids to take two tablets of 400 mg of green tea extract, daily.

    Read More: 8 Eating Habits That Actually Improve Your Sleep

    In theory, green tea may even help with treating cancer, partly because high doses seem to promote the death of cancerous cells. More research is needed on these effects, Segars says.  Dr. Mary E. Money, an internal medicine physician, was diagnosed with advanced ovarian cancer in 2012. Several years later, she was impressed by studies on green tea and cancer, and began sipping 6 to 8 mugs of the beverage throughout the day, instead of taking extract pills—without changing the rest of her regimen. Her cancer biomarkers improved significantly, she says. Money continues to receive chemotherapy when needed; green tea may act synergistically with chemotherapy in some cases, research suggests. 

    However, the evidence is mixed, with other studies showing that antioxidants, including those found in tea, might interfere with certain cancer treatments, such as chemotherapy and radiation therapy. 

    Money notes that her experience is just that: one anecdote. She could be a super responder, while others’ responses depend on numerous factors, including their specific diagnosis, treatment strategy, and overall nutrition. “There are so many variables,” she says. What’s clear is that—big picture—green tea is a healthy choice.

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    Matt Fuchs

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  • Is Friendship Therapy the Next Big Thing in Mental Health?

    Is Friendship Therapy the Next Big Thing in Mental Health?

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    Years ago, Aminatou Sow and Ann Friedman hit a rocky patch in their friendship. For reasons they couldn’t fully articulate, they weren’t communicating or clicking like they once did. Things just felt off.

    Sow and Friedman are serious about friendship—they co-wrote the book Big Friendship: How We Keep Each Other Close—so they tried something a bit unconventional: friendship therapy. Just like in traditional couples counseling, a therapist helped them understand their relationship dynamics, where they’d gone wrong, and how they could move forward together.

    “The structure was everything, because in a less-structured way, all you’re doing is talking about surface-level stuff. You’re not seeing the patterns,” Sow says. “It was really nice to have someone who doesn’t know us ask us these questions.” 

    When Sow and Friedman sought friendship therapy in 2016, the concept was somewhat fringe. They struggled to find a therapist who worked with friends, rather than business or romantic partners, and had to fire one clinician who got hung up on the idea that they actually were romantically attracted to each other. But now, the idea of friendship therapy is becoming more popular, as people wake up to the reality that friendship is intimately connected to well-being and happiness—and that, particularly post-pandemic, many people don’t have as many strong connections as they’d like.

    “The way that we view friendship in society—that is changing,” says Miriam Kirmayer, a clinical psychologist and friendship expert based in Canada.

    Read More: What to Do When Health Insurance Denies Care You Really Need

    Barbie Atkinson, who offers friendship therapy at Catalyst Counseling in Houston, is seeing the effect of that shift in her practice. Years ago, she says, she’d get calls from people who wanted to go to therapy with a friend but weren’t sure if that was “allowed.” Today, about 25% of her clients are pairs, or even groups, of friends in therapy together.

    Friends come to Atkinson for all sorts of reasons, like reconciling political differences, processing shared grief, or working through tricky life transitions—like one friend having a baby or moving away for a new job. “It’s normal human stuff,” she says.

    The process isn’t so different from what a romantic couple would do in therapy, except that friend sessions typically don’t revolve around discussions of sex, romance, or co-parenting, Atkinson says. Just as she would with spouses, she helps her friendship-therapy clients understand their attachment styles, define how they relate to and communicate with one another (and where those dynamics could be improved), and set goals for their relationship. “You’re just seeing two people that want to reconnect—who are sad at the way their relationship has gone and are so actively trying to fix it,” Atkinson says.

    Unless a friendship has turned truly toxic or abusive, to the point that friends no longer feel physically or psychologically safe together, most conflicts or impasses can be worked out collaboratively, says Victoria Kress, a professor of psychological sciences and counseling at Youngstown State University in Ohio. She used to work with friends all the time when she was a college counselor, mediating everything from roommate struggles to the aftermath of fights between close friends. There’s no reason full-grown adults can’t seek therapy for their own problems, she says.

    “I spend most of my career working with people who have been hurt in relationships, trying to help them be healthy in relationships,” Kress says. “Friendship counseling is such a great way to promote growth and healing that will transfer into all relationships across a person’s life.”

    Read More: How to Know if Your Friendship Is Toxic—and What to Do About It

    Improving friendships can be transformative. Research increasingly suggests that close friendships, perhaps even more so than familial bonds, are important for well-being, and Americans seem to be getting the message. As of 2023, 61% of U.S. adults said having close friendships is vital to living a fulfilling life, whereas only around a quarter said the same for being married or having children. And as more people forgo those traditional milestones, some are leaning more heavily on platonic partnerships for support, companionship, and care—which sometimes means nurturing those bonds with the help of a therapist.

    There’s little official data on the popularity of friendship therapy, perhaps because it is not technically a specialty; there’s not a separate certification process or degree required to offer it. At its core, friendship therapy is just “systemic therapy”—which examines how an individual’s relationships affect their well-being, and which often forms the backbone of couples therapy—applied to a platonic pair, says Paul Hokemeyer, a Colorado-based marriage and family therapist.

    Hokemeyer says he’s not aware of many clinicians who focus on friendship therapy, but he has noticed rising patient demand for the service. He’s even worked with friends himself, including one duo struggling to navigate the college-to-adulthood transition while keeping their relationship intact.

    Hokemeyer says friendship therapy seems to be particularly popular among millennials, who tend to be comfortable turning to therapy and who place a high value on friendship. “There’s a real hunger for human connection and human relationships,” he says. “Millennials, in particular, value connections, they value experiences, and they value their mental health.”

    Kirmayer says she’s noticed a clear uptick in interest, too. In recent years, in fact, she started getting so many requests for friendship therapy from all over the place—which, because of licensing requirements, she wasn’t able to provide to people outside her province—that she decided to pivot to creating friendship-focused workshops for people who live anywhere. “This is something that so many of us are facing,” she says.

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    Jamie Ducharme

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  • How to Appeal Health Insurance Denials

    How to Appeal Health Insurance Denials

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    If there’s anything worse than being sick, it’s being sick while dealing with insurance issues. But unfortunately, that situation is all too common. Recent research from the Commonwealth Fund, a private foundation that researches health care issues, finds that 17% of U.S. adults have in the past year had their insurance company deny doctor-recommended care, with denials happening about as frequently for people on both commercial and government insurance plans.

    Denials can occur either before you’ve gotten a test, procedure, or treatment—when a provider submits a request for prior authorization, for example—or after you’ve already received care. The insurer may argue the service isn’t one it covers or is medically unnecessary for you, or it may deny care on logistical grounds, like a claim having incorrect information or coming from an out-of-network provider.

    Receiving a denial letter can be discouraging, but you can take certain steps to fight back. Here’s what to do.

    Read your denial letter in full

    It’s easy to let your eyes glaze over when faced with a letter full of jargon, but it’s important to read it carefully, says Jeremy Gurewitz, CEO of Solace, a company that connects consumers with advocates who help them navigate the health care system. Your letter should spell out exactly why you were denied coverage—and that reason is important to know, Gurewitz says, because it determines your next steps. Your issue may have a fairly straightforward fix, like providing additional paperwork or re-submitting a claim with different information. Or, it may require putting together an appeal to argue that your doctor’s treatment plan is, in fact, medically necessary. Gurewitz recommends starting with a call to your insurer’s customer service line, as some issues can be worked out on the phone.

    Read More: Does Text Therapy Really Work?

    Insurance companies also make mistakes “all the time,” Gurewitz says, so don’t assume that your denial letter is correct and give up right away. Consult your policy documents to verify that what the insurer is claiming is true, and ask them to correct any errors you find. 

    Appeal

    Even if your denial can’t be easily reversed—such as when the company argues a service isn’t medically necessary, or you accidentally saw an out-of-network provider—you still have options.

    “Never take ‘no’ as a final answer, ever,” says Wendell Potter, a former Cigna executive who became a whistleblower and advocate for health care reform after leaving the company in 2008. “Insurance companies are expecting the people enrolled in their health plans to just accept whatever they decide to do because [pushing back] is complicated. It’s a burden. It’s a chore.”

    People who do take the time to appeal, however, often get good results. The Commonwealth Fund’s recent report found that half of people who challenged an insurance denial ultimately got at least partial approval, or approval for a similar service. (The same is true for medical bills, by the way. Recent research suggests more than 60% of people who try to negotiate their health bills successfully get a price adjustment.)

    Putting together a good appeal does require doing some homework, though. First, refer back to your denial letter, which should include information about how to file an appeal and, potentially, specific instructions about what to include and in what format, Gurewitz says. This information should also be available on your insurer’s website.

    If you’ve been denied on medical necessity grounds, your goal is to make a clear, compelling case for why you need a treatment, procedure, or medication. If you can, get your doctor involved, recommends Diane Spicer, supervising attorney at Community Health Advocates (CHA), a group that helps people in New York use the health care system. This can be tricky, as providers aren’t always willing or able to make the time, she says. But if your doctor makes a detailed argument for medical need, augmented by medical records and clinical notes, it significantly strengthens your case, she says.

    A doctor may choose to write a letter themselves or they may provide you with a statement to include in your own letter. You can also search for a strong template letter online and send it to your doctor as an example.

    Read More: How to Make a Long-Distance Friendship Work

    You’re also entitled to ask for the criteria your insurer used to make its decision, Spicer says. The best way to get this, as well as other records related to your case, is to ask for your “claim file.” You can compare the insurer’s decision-making criteria with national standards of care for your condition; if your insurer is trying to enforce a more stringent standard than is typical, you can include that information in your appeal letter.

    To find these national standards, Spicer recommends using a search term like, “Guidelines for the diagnosis, management, and treatment of [insert name of condition, being as specific as possible].” Search results will typically lead you to reports or guidelines from national health organizations. You can also search UpToDate, a database that compiles information about evidence-based health care practices, but that requires paying a fee.

    If you’ve been denied because you were treated by an out-of-network provider, you may also be able to appeal, Spicer says. The No Surprises Act protects consumers in a variety of circumstances, such as if you’re treated by an out-of-network clinician during an emergency or a provider is mistakenly listed as in-network on an insurer’s database.

    Insurers often ask for appeals to be submitted by mail. If so, it’s “super important” to send yours by certified mail so you can track delivery, Gurewitz says. “You need to have a paper trail,” he says.

    Escalate

    If your appeal is denied, that’s still not the end of the road. If the company continues standing by its original decision, you can request an external review in which a third party assesses the case.

    You also don’t have to stop at filing an appeal through official channels, Potter says. Consider alerting executives at the insurance company, regulatory boards, local politicians, or the media to turn up the pressure. This works best, Potter admits, if you have an especially sympathetic or dramatic story—if the company’s denial has forced you to delay critical care or caused significant financial hardship, for example. If you don’t want to go quite so nuclear, you can always call out the company on social media, Potter says.

    “Being a squeaky wheel is important,” Potter says. When he worked at Cigna, he says, the company had a system for dealing with “high-profile” cases, like those that had attracted the attention of a journalist. “Before too long,” he says, “that denial would be overturned.” 

    Get help

    If all of this sounds overwhelming, call in the experts. Health advocates can help put together a strong appeal, as they know the ins and outs of the system and what’s worked with specific insurers in the past. 

    Consumers can work with health advocates, whose services are often free, through private companies like Solace, charities like the Patient Advocate Foundation, or state-specific organizations like CHA. Sometimes, employers even offer health advocacy services as an employee benefit. The soon-to-launch startup Claimable also promises to use artificial intelligence to sort through medical research, information about your insurance plan and health history, and data from past appeals to craft one with a better shot at working.

    Whatever avenue you take, it’s important to remember there are people who can help, Gurewitz says. “When you or your loved one is dealing with a serious illness,” he says, “the last thing you want to be doing is scouring the paperwork.”

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    Jamie Ducharme

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  • How to Fix the Global System for Distributing Mpox Shots

    How to Fix the Global System for Distributing Mpox Shots

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    From its epicenter in the Democratic Republic of the Congo, Africa’s mpox epidemic is spreading fast, reaching a dozen other African nations so far. The single most important tool for extinguishing the fire is mpox vaccination, which prevents infection and illness. Until yesterday, not a single dose of mpox vaccine was available in Congo. Few shots are available anywhere on the continent.

    Congo’s health minister Samuel-Roger Kamba says his country urgently needs 3.5 million doses to stop its outbreak, while 10 million doses are needed for the whole African continent. Without these shots, mpox will continue to spread.

    And here’s the kicker. While adults and children in 13 African nations are getting infected, sick, and in some cases dying, several rich nations are sitting on large stockpiles. The U.S., for example, is believed to have stockpiled 7 million doses by mid-2023, while Spain has 2.5 million doses. If a rich country were to become affected, it could immediately launch a vaccination campaign to protect its own citizens—as we saw during the 2022 U.S. mpox outbreak, when the government mounted a robust vaccine campaign, distributing more than one million shots by the end of the year.

    The return of “vaccine apartheid”

    It is painful to watch history repeating itself. During the COVID-19 pandemic, we witnessed what Winnie Byanyima, executive director of the Joint United Nations Programme on HIV and AIDS, called “a global vaccine apartheid”—a profound injustice in which rich countries were the first to get vaccines and boosters, while low- and middle-income nations were left behind. Now we are witnessing mpox vaccine apartheid.

    Beyond being unfair and causing preventable illness and deaths in the 13 affected nations and counting, this vaccine inequity also hurts rich nations in two important ways. First, an adage in public health is that an outbreak anywhere can become an outbreak everywhere. In other words, if the outbreak is not contained, it will continue to spread, including to rich nations.

    Read More: What It’s Like to Respond to Mpox in Africa Right Now

    We’re already seeing this happen. The outbreak centered in Congo is of an mpox strain targeting adults and children called clade I, which is thought to cause a more severe illness than clade II, the strain that caused a multi-country mpox outbreak in 2022-2023. Cases of clade I mpox have recently been identified as far away as Sweden and Thailand, in people who had traveled to African countries.

    Second, when vaccine apartheid causes a pandemic to smolder, it hurts the entire global economy by disrupting supply chains, imports, and exports. It is not just low- and middle-income countries that suffer this economic pain. During the COVID-19 pandemic, for example, one study estimated that about half of the global economic losses caused by vaccine apartheid were borne by rich nations, mostly through suppressed exports.

    Mounting an urgent mpox vaccination campaign in the countries affected in the African region is in the whole world’s interest. Why is it not yet happening? Understanding the reasons is critical—not just to control Africa’s current mpox epidemic, but to ensure we do not make the same grave mistakes again.

    Mpox shots are made in rich nations and must “trickle down” to low-income countries

    At its heart, the reason for mpox vaccine inequity is that the shots are made by companies in rich nations—Denmark’s Bavarian Nordic and Japan’s KM Biologics—and their high costs (around $200-$400 per course) means they are largely unaffordable to low-income nations like Congo. The affected countries in the African region that are unable to afford the high prices are therefore left to rely on charitable donations of shots from rich nations’ current stockpiles. Even if an affected African nation had enough cash in hand now, vaccine makers are likely to sell doses to the highest bidders first. That’s exactly what’s happening: rich countries are now buying up mpox doses, and low-income countries are at the back of the queue.

    A laboratory specialist takes a sample from a patient suspected of being infected with mpox at the Kavumu hospital in Kabare territory, South Kivu region, Democratic Republic of Congo, on Sept. 3, 2024. Arlette Bashizi—Bloomberg/Getty Images

    This is topsy turvy. In the middle of a devastating epidemic in Africa, why on earth is the region dependent on mpox vaccines “trickling down” from the rich world? Instead, there should be capacity built within the region to manufacture mpox shots locally and have them close to those most affected. Affected countries in Africa should also be making investments to ensure they are better prepared to respond to future mpox outbreaks with a well-trained workforce and the right tools: vaccines, medicines, and diagnostic tests.

    Read More: What to Know About Mpox in 2024

    Since the World Health Organization (WHO) has declared Africa’s mpox epidemic to be a global emergency (what it calls a “public health emergency of international concern”), there’s a powerful case for waiving the intellectual property rights on mpox vaccines to allow any company worldwide to make the shots. Sadly, there is no indication that a waiver is on the table. But at the very least, Bavarian Nordic and KM Biologics should share the technology with African manufacturers and support them to scale up manufacturing as soon as possible. Even if these manufacturers do not produce mpox vaccine doses immediately, such technology transfer would ensure that lasting capacity is built on the continent for this endemic disease.

    In the long run, as we discuss in our recently published “roadmap” on improving the development of medicines, vaccines, and diagnostics worldwide, a concerted global effort is needed to build vaccine manufacturing capacity in all regions of the world. If there’s a new infectious disease epidemic in Africa, Latin America, the Asia Pacific, or any other region, the fastest and most affordable way to get shots in arms is to make doses locally. No more going hat in hand begging for doses from the rich world.

    The system for approving pandemic vaccines isn’t fit for mpox

    Since it looks like mpox vaccine manufacturing won’t be up and running in the African region in the coming days, weeks, or perhaps even months, in the short term, the only feasible avenue for beating the epidemic is a well-structured donation program. Yet even on this front, the international community can’t get its act together.

    The only realistic avenue for a large vaccination campaign is one led by Gavi, the Vaccine Alliance and UNICEF. Because of their existing relationships with manufacturers, and their positioning as the two major agencies that buy and deliver vaccine shots at large scale to low- and middle-income countries, they are best placed to strike a deal the quickest. But right now, they are paralyzed.

    UNICEF and Gavi’s rules mean they are only allowed to buy vaccines that have been approved by WHO—yet while the U.S., Europe, and a few African nations have approved them, the WHO has still not approved mpox vaccines. Sania Nishtar, Gavi’s Chief Executive Officer, told The Lancet in late August that “we are still weeks away from any vaccine being approved for emergency use by WHO and even then, it will take time for manufacturers to supply doses in large quantities.”

    Read More: A New Era of Special Education Begins with Inclusive AI

    It is hard to believe we are in this situation. The U.S. Food and Drug Administration approved an mpox vaccine in September 2019. The European Medicines Agency approved an mpox vaccine in July 2022. Bavarian Nordic says it met with WHO in August 2022 to discuss approval of its vaccine, Jynneos. But here we are, two years on, and WHO still has not given the green light through its approval system known as pre-qualification.

    Doctor Robert Musole, medical director of the Kavumu hospital, visits patients recovering from mpox in the village of Kavumu, in eastern Democratic Republic of Congo on Aug. 24, 2024.
    Doctor Robert Musole, medical director of the Kavumu hospital, visits patients recovering from mpox in the village of Kavumu, in eastern Democratic Republic of Congo on Aug. 24, 2024. Glody Murhabazi—AFP/Getty Images

    While WHO pre-qualification is important in helping ensure the safety and effectiveness of medicines and vaccines, the delay in approving mpox vaccines indicates that the system is too slow, risk averse, and inflexible.

    With UNICEF and Gavi hampered by these bureaucratic hurdles, a handful of rich-country governments have stepped in to pledge doses, although others won’t release any of their stockpile. For example, last week the U.S. donated 10,000 doses to Nigeria—the first shots to arrive anywhere on the continent—and yesterday 100,000 doses arrived in Congo, donated by the European Union, but other rich countries have not committed to release any of their stockpiles.

    But there’s another sorry twist to the tale. The regulatory agencies in Congo and Nigeria have both approved the mpox vaccine, so these countries can start vaccination as soon as doses arrive. But many affected African nations have not yet approved it, so even if shots were to be donated, they can’t go into arms immediately. In a situation in which a country has not approved it, it relies on WHO approval, which, as we have seen, comes with its own challenges. Regulatory agencies in low-income nations must work together to jointly assess not just mpox vaccines but all medicines and vaccines, reducing dependence on WHO approval as the only avenue.

    History will keep repeating itself unless we act now

    Each time there’s a new epidemic or pandemic, the international community pledges to “make it the last.” But this is a pipe dream unless we see a concerted, coordinated effort to invest in building a global system of vaccine development, manufacturing, and distribution that benefits everyone.

    In addition to urgently streamlining the WHO prequalification process, over the long run, the regulatory agencies in low- and middle-income countries that assess and approve vaccines and other medicines should continue to build local capacity and expertise. Richer countries should provide technical and financial support to national and regional regulatory agencies, such as the newly formed African Medicines Agency, to ensure that these agencies can effectively perform core regulatory functions. Equally, African nations should invest in health systems strengthening and ensure that national budgets meet the annual financial commitments made in declarations such as the Abuja Declaration committing 15% of annual budgets to health. Cross-collaboration between regulatory authorities within the region, as well as with those abroad, will also be critical to build this capacity.

    With strengthened national and regional regulation, increased research and development, and scaled-up local manufacturing, we can start to see meaningful progress towards the end of vaccine apartheid.

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    Gavin Yamey, Marco Schäferhoff and Shingai Machingaidze

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  • What It’s Like to Respond to Mpox in Africa Right Now

    What It’s Like to Respond to Mpox in Africa Right Now

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    It was early morning in Burundi when one of our patients set out for the hospital, her baby strapped to her back and her sick four-year-old son cradled in her arms. When her little boy’s itchy sores started to weep and he would not stop crying, she knew she had to get him there as quickly as possible. They trekked for miles up a dusty red path, passing palm groves and rice fields as they made their way. When she finally arrived, the doctors told her they’d have to move her son to a separate building. “He has mpox,” they said.

    Scenes like this are playing out daily all over Burundi—and in other Central African countries—as thousands of people are falling sick with a new strain of mpox that is ravaging the region. On Aug. 14, 2024, the World Health Organization (WHO) declared that the multiple mpox outbreaks occurring on the African continent were a Public Health Emergency of International Concern. Although mpox has been around for decades, a new strain known as clade Ib has led to thousands of infections and hundreds of deaths in countries such as the Democratic Republic of Congo (DRC), Burundi, Rwanda, and the Central African Republic.

    The WHO declaration was meant to spur an international response. But what has this looked like on the ground? As doctors who have treated dozens of mpox patients in Burundi over the past four weeks, take it from us: the response has been passive at best. People are in desperate need of both medical care and basic resources.

    Read More: What to Know About Mpox in 2024

    The limited funding is largely being directed toward improving mpox diagnosis and surveillance. Almost nothing is left over to care for the sick or prevent the continued spread of mpox in communities most at risk. This is especially heartbreaking since this outbreak seems to preferentially strike vulnerable groups, including women, children, people with HIV, and those who face food insecurity. This gap in mpox prevention and care is especially acute in countries like Burundi, where the health system is already strained after decades of civil war and where diseases like cholera, measles, malaria, and malnutrition are all too common.

    Health workers speak with patients inside a ward for women infected with mpox at the Kamenge University Hospital’s Mpox treatment center in Bujumbura, Burundi, on Aug. 22, 2024. Tchandrou Nitanga—AFP/Getty Images

    One of our other patients came to the hospital with her newborn whom she was breastfeeding. She had walked for hours to reach us, seeking help for the numerous painful lesions that now covered most of her skin. She was diagnosed with mpox, and we recommended that she stop breastfeeding to avoid the skin-to-skin contact by which mpox spreads. Having no other way to nourish her child, she became distraught at being asked to choose between the baby going hungry or the baby developing mpox. There were no vaccines to protect the baby and no other resources available to provide a safe feeding alternative for this family.

    Read More: It’s Time to Start Taking Mpox and Bird Flu Seriously

    This lack of care-focused resources for people with mpox is not a failure of science. Mpox is not a new disease, and there are vaccines and medications that can greatly alter its course. But these tools are not available in the hospitals and health centers that are tasked with caring for a growing number of people with mpox every day. A scant 250,000 courses of the only effective vaccine have been earmarked for DRC, when tens of millions of doses are actually needed to curb mpox’s spread. And smaller counties like Burundi have no access at all. By contrast, when one patient with the clade Ib strain was diagnosed in Sweden, the European Centers for Disease Control decided to recommend that travelers to Africa now consult their physicians about receiving shots.

    Governments in the region are trying valiantly to respond to the mpox crisis. In Burundi, the government has developed a comprehensive national plan for managing mpox. But they should not have to shoulder the burden alone—and these regions desperately need partners who can immediately step up and provide:

    1. Dignified services to those already sick with mpox, including care in the community for people who are stable and at the hospital for those who have severe disease or who are at high risk for it. Such care would include access to proven strategies for decreasing the sickness and suffering associated with mpox, such as antivirals, antibiotics, and anti-inflammatory eye drops to prevent the blindness sometimes seen when mpox affects the eye. It would also address the socioeconomic needs of families: hunger, housing, childcare, and management of common comorbidities, including HIV.
    2. Localized, preventive care. This works best when it originates within the community and could include adapting standard health-education messaging so that it is relevant for those most at risk. Epidemics exploit fractures in society and can escalate pre-existing tensions. Mpox mitigation measures should be paired with activities meant to foster collaboration and address other community needs.
    3. Immediate vaccination in places where the epidemic is concentrated. Because most impacted regions face challenges with overcrowding and limited access to water, other preventive measures will be less effective. Releasing existing vaccines for use in Central Africa and making sure they can be imported, stored, and administered safely should be a priority.
    4. Investment in strengthening health systems, since infectious diseases will always prey upon people whose health is most precarious. Instead of providing the bare minimum necessary to respond to mpox, donors should see this outbreak as a call for backing solid and lasting investments in building resilient health systems.

    Models of mpox care that embrace these pillars have been developed in countries like Burundi. When the first patients with mpox began appearing in the rural areas, our team at Village Health Works—an organization founded by a Burundian to provide high-quality health care to those with limited access—launched a holistic response program called Halting the Mpox Outbreak with Equity (HOME). We stand ready to support the government regionally and nationally but need to mobilize resources to do so effectively.

    Dr. Robert Musole, medical director of the Kavumu hospital (right), consults an infant suffering from a severe form of mpox at the Kavumu hospital in Democratic Republic of Congo, Aug. 24, 2024.
    Dr. Robert Musole, medical director of the Kavumu hospital (right), consults an infant suffering from a severe form of mpox at the Kavumu hospital in eastern Democratic Republic of Congo, Aug. 24, 2024. Glody Murhabazi—AFP/Getty Images

    There is a global sense of fatigue when it comes to outbreaks, and mpox is no exception. What is happening to families in Central Africa can seem very far away. People reaching for their smartphones or laptops to Google where countries like Burundi are located should realize, however, that they already have a connection to Central Africa. The minerals that power these technologies have been extracted from the area by companies that have reaped billions of dollars in profit. Very little of this capital has been reinvested for the betterment of people living there.

    The weak mpox response on the ground shows that governments and their international collaborations are impotent in the face of an outbreak like this. And really, it shouldn’t just be their responsibility: companies that get rich by taking materials out of this region of the world should have to reinvest in building sustainable health systems.

    We are used to hearing the word “outbreak” in conjunction with the spread of an infectious disease. But an alternative meaning of the term is “a sudden increase in activity.” We urgently need an outbreak of solidarity and resource mobilization to end mpox in Central Africa.

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    Jennifer Furin, Nesar Hamraz and Eddy Jonas

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  • Do At-Home COVID-19 Tests Still Work?

    Do At-Home COVID-19 Tests Still Work?

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    These days, many people use at-home COVID-19 tests when they feel ill, rather than going out to get tested by a professional. (That’s when they bother to test at all.) But for all their convenience, the antigen tests commonly used at home have never been as accurate as PCR tests done in a lab—and the continued mutation of the virus raises additional concerns about their performance.

    Rapid COVID-19 tests have never been perfect. How are they holding up as new variants emerge?

    The U.S. Food and Drug Administration (FDA) continues to monitor the efficacy of the diagnostics it regulates—and as of August 2023, the FDA said none of the antigen tests on the market were expected to have reduced performance against Omicron or its subvariants. (All of the variants that have emerged since late 2021, including recent ones like KP.3.1.1, are relatives of the original Omicron strain.)

    The FDA has also collaborated with a U.S. National Institutes of Health task force set up to monitor how variants affect tests. In 2022, well into Omicron’s dominant era, that team concluded that DIY diagnostics continued to work well. Task force member Richard Creager wrote in an email to TIME that the tests still seem able to catch the Omicron spinoffs that are circulating now. “The rapid tests are having no issue detecting the variants,” he wrote, noting that the protein that antigen tests look for has remained fairly stable as the virus changes.

    Read More: Does Text Therapy Really Work?

    Even if tests have remained constant, our immune systems haven’t. Early in the pandemic, an infected person’s “viral load”—the amount of virus in their system—tended to peak around the time their symptoms began. So if someone self-tested on the first or second day they felt sick, they likely had enough virus in their body for a rapid test to detect it.

    Now that most everyone has prior immunity from multiple vaccines or infections, the timeline seems to be extended. Viral load now tends to peak around day four or five of symptoms, according to a study published in early 2024. That’s likely because the immune system is primed for action by its previous encounters with the virus, so it responds faster, even before lots of virus has built up in the body. A quicker immune response may mean a faster onset of symptoms.

    “If your body has seen the virus before, you’re going to react to it and have an immune response more quickly,” explains study co-author Dr. Nira Pollock, co-director of the Infectious Diseases Diagnostic Laboratory at Boston Children’s Hospital. “That immune response can show up as symptoms.”

    From an immune perspective, that’s a good thing. But it can complicate testing, because it means someone may not test positive for COVID-19 until they’ve already been feeling sick for days. In their recent study, Pollock and her co-authors estimated that a COVID-19 antigen test is somewhere between 30% and 60% accurate at detecting an infection on someone’s first day of symptoms, but up to 93% accurate on day four.

    Based on such findings, Pollock and other researchers cautioned in a recent review article that people who are symptomatic shouldn’t assume they’re COVID-free based on a single negative antigen test result. Although it’s a hard sell for people who no longer take precautions, the ideal scenario is for someone to stay isolated—or at least wear a mask when around other people—and test again around day four of symptoms.

    Read More: The 1 Heart-Health Habit You Should Start When You’re Young

    “The instructions for these tests are to do serial testing,” Pollock says. “If you’re symptomatic, you should test early. But if you’re negative, you need to repeat it, because the amount of virus in your nose may not be high enough yet to detect.”

    One other factor to consider: tests don’t last forever. Many people stockpiled tests when they were previously available for free through government programs and insurance, and those kits may have since expired. (You’ll soon be able to order four more free tests through the government.) The FDA’s website provides up-to-date guidance on determining how long your kits last.

    Expired tests can still work, says Dr. Zishan Siddiqui, an assistant professor at the Johns Hopkins University School of Medicine. He co-authored a 2023 study on Abbott’s popular BinaxNOW tests, which found no major accuracy differences between unexpired tests and those that were five months past expiration. (Siddiqui’s other research suggests unexpired BinaxNOW tests accurately detect COVID-19 cases more than 80% of the time.)

    But, although Siddiqui says he isn’t too worried about using expired tests, it’s good to remember that their performance can suffer if they’re long past their recommended use dates. If the control line on your test strip doesn’t show up or looks distorted, that’s a good indication that it’s too old to use, he says. Even in Siddiqui’s study, which found that expired tests still work, the lines on the old tests showed up more faintly than on fresh tests, making them harder to read.

    Whether your tests are old or brand new, it’s good to use some healthy skepticism when interpreting their results. “I trust these tests,” even as the virus evolves, Siddiqui says—but a single result doesn’t always tell the whole story. If you have COVID-like symptoms but test negative, it’s best to be cautious and retest in a few days.

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    Jamie Ducharme

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  • What 5 Doctors Are Excited About in Kidney Cancer Research

    What 5 Doctors Are Excited About in Kidney Cancer Research

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    With multiple game-changing developments over the past two decades, kidney cancer patients are now living longer and better.

    A big part of the reason is that many are being diagnosed at earlier stages of the disease, when it can often be more easily treated and sometimes cured. Even when cancers are caught later, advances in medications and in methods of targeting cancer cells are significantly extending survival.

    “When I started two decades ago, the average survival for patients with advanced kidney cancer was one year,” says Dr. Brian Rini, a professor of medicine at the Vanderbilt University Medical Center in Nashville. “Now, the median survival is between five and six years. It’s amazing.”

    The growing use of scanning technologies in medicine overall has been one of the most important changes over the last couple of decades: Tumors are being detected during scans for non-cancerous conditions.

    “Most kidney cancers are found by accident quite early, because people get scans for unrelated reasons,” says Dr. William Huang, a professor of urology and radiology at the NYU Grossman School of Medicine and a urologic oncologist at NYU Langone’s Perlmutter Cancer Center in New York City. “People get scanned for almost everything now: heartburn, back pain, car accidents. Eight out of 10 newly diagnosed patients who come to see me were scanned for something completely different.”

    Because these cancers are caught early, they may be “completely curable, and sometimes so early that nothing needs to be done,” Huang says. “We can just keep an eye on them, and unless they change, we don’t need to do any intervention.” Advances in imaging have also led to novel ways of determining whether a tumor is benign or malignant. Scanners allow doctors to see growths in much greater detail nowadays, which allows for diagnosis in some cases without a biopsy. For example, scans using radioactive tracers can detect fat, which can be a signal that a growth is benign, Huang says.

    Here’s a look at additional kidney cancer advances that doctors are excited to see come down the pipeline.

    Killing cancer without surgery

    Surgeons used to remove the entire kidney when a tumor was found. “Now you can remove just part of the kidney,” Huang says. Some methods of eliminating tumors don’t even involve cutting. “You can ablate a tumor with heat or you can freeze it,” says Huang. “Right now we are involved in a clinical trial that uses a method that is completely non-invasive. There is no incision, no radiation, no needles. We just ablate the tumor using ultrasound waves, which rupture the cancer cells.”

    Read More: Coping With the Side Effects of Kidney-Cancer Treatment

    Radiation by itself can eliminate tumors, too

    For patients who aren’t good candidates for surgery because of underlying health issues, there’s another option that will eradicate the main tumor and some metastases. “This is something that has been evolving, and it’s very, very exciting,” says Dr. Catherine Spina, a kidney cancer specialist and an assistant professor of radiation oncology at Columbia University’s Vagelos College of Physicians and Surgeons in New York City. “Traditionally, radiation has been given over long courses in small doses.”

    Over the years, however, specialists have discovered they could give much higher doses of radiation over a much shorter period of time, so long as the radiation was tightly targeted to hit the cancerous tissue, while giving a very low dose to the surrounding areas.

    The result is that patients with a moderate-sized main tumor and cancer that has metastasized to just a few other sites can completely avoid surgery, with their cancer treated after just five or fewer radiation treatments. The technique is mostly limited to 8-centimeter main tumors, though some clinicians are also using it in tumors that are as large as 11 centimeters, Spina says.

    When surgery is needed

    Some patients prefer to have surgery or won’t qualify for non-invasive therapies because their cancer is too advanced. Surgical breakthroughs over the past decade or so have allowed these procedures to be more targeted and less invasive. 

    Many operations are now done with robotic instruments that are inserted into the body through tiny incisions, while surgeons sitting at consoles view the operation and remotely control the instruments, says Dr. George Schade, an associate professor in urology at the University of Washington and a physician with the Fred Hutchinson Cancer Center in Seattle.

    Robotic surgeries are a big advance over the original minimally invasive laparoscopic operations, in which tools at the end of stiff rods were inserted through small incisions with the surgeon standing over the patient and viewing the procedure on a computer screen. The new robotic instruments, by contrast, use a jointed probe rather than a straight one, offering more mobility. “They are like tiny arms inside of the patient with wrists and fingers,” Huang says.

    Fluorescent dyes can help surgeons tell the difference between healthy tissue and cancer, as well as shine a light on the location of blood vessels feeding tumors. And in what may be another big step, some specialists are using robotic equipment that allows them to have depth perception. As the surgeons peer into a patient’s body, they see a 3D image overlaying the area that they’re operating on. “This is not in wide use yet, but there are several groups working on improving the technology to bring it to the mainstream,” Schade says.

    Looking forward, as high-speed internet access spreads around the country and throughout the world, it’s possible that the surgeon controlling the robot in the operating room might not even be at the same hospital. “I don’t see that as too far in the future,” Huang says.

    Read More: How to Manage Anxiety and Depression When You Have Kidney Cancer

    Targeted medications 

    It wasn’t that long ago that specialists had little to offer cancer patients after surgery, outside of chemotherapy, which wasn’t very effective against kidney cancer. But in the past two decades, there’s been an explosion of new cancer medications. Some pump up a patient’s immune response, while others target a variety of pathways to slow or stop cancer growth and development.

    Drugs known as checkpoint inhibitors stop the immune system from being fooled into quitting before the cancer is conquered, says Dr. Bobby Liaw, clinical director of genitourinary oncology for the Mount Sinai Health System and an assistant professor of medicine, hematology, and medical oncology at the Icahn School of Medicine at Mount Sinai.

    Checkpoints are the part of a normally functioning immune system that act as a set of brakes to turn down the system’s response once an infection or other pathology such as cancer has been defeated. That way the immune system doesn’t start turning its attack on healthy cells.

    By blocking the action of a checkpoint, these medications keep the immune system on target. There can be immune system side effects—such as skin inflammation, and less commonly, autoimmune-like effects on certain organs, as well as endocrine disturbances—from cutting one of the immune system’s brake lines.

    “Any time we plan to initiate any kind of new therapy for any cancer patient, there needs to be consideration for the benefits versus the risks,” Liaw says. 

    In the case of serious side effects, particularly the immune system attacking healthy cells, the checkpoint inhibitor is stopped and the patient is given corticosteroids, says Dr. Toni Choueiri, director of the Lank Center for Genitourinary Cancer at the Dana Farber Cancer Institute in Boston. 

    A study published in April in the New England Journal of Medicine that followed patients for nearly five years showed that the checkpoint inhibitor pembrolizumab, when given after surgery, reduced the risk of death by 38%.

    Read More: These Factors Increase the Risk of Kidney Cancer

    “Prior to the approval of pembrolizumab, there was no wide-spread accepted standard of care for patients with [the most common form of kidney cancer] after treatment with surgery,” says Choueiri, the lead author of the study. The next step, he says, is to study whether combining it with another therapy, like belzutifan, will reduce the risk of death even further.

    Other drugs take aim at blood vessel formation. “Tumors are more dependent on the growth of new blood vessels than organs are,” Rini explains. “These medications choke off the blood supply to the tumor.” 

    One other type of drug, called a tyrosine kinase inhibitor, blocks an enzyme that’s needed for tumor cells to grow and divide. There are currently numerous tyrosine kinase inhibitors approved by the U.S. Food and Drug Administration (FDA).

    At the end of 2023, kidney cancer specialists got yet another arrow to add to their quivers: The FDA approved the drug belzutifan, a medication that effectively suffocates tumors by blocking a protein involved in regulating oxygen levels.

    Doctors have traditionally liked to give one cancer drug at a time, but that’s changing. Specialists believe that cancers may have a harder time surviving when multiple medications are taken at once.

    A number of ongoing clinical trials are looking at the impact of this strategy and exploring which combinations work the best. “There’s absolutely an additive effect of giving more drugs at the same time,” Rini says.

    A kidney cancer vaccine? 

    The mRNA technology that was used to create a vaccine to combat COVID-19 was initially developed as a potential way to battle cancer. Only recently has that research started to pan out.

    Once a patient’s tumor has been removed, doctors identify proteins that are specific to cells in the tumor but not found anywhere else in the patient’s body. Then they determine which of those proteins are likely to be able to call the immune system’s attention to the cancer. Those proteins become the targets for the patient’s personalized mRNA vaccine.

    There have already been promising results using mRNA technology to create personalized vaccines to help treat advanced melanoma. In a phase 2 trial that ended in mid-2023, researchers compared the checkpoint inhibitor pembrolizumab plus personalized vaccines to pembrolizumab alone. They found that the vaccine reduced the risk of recurrence by nearly a half. 

    The same strategy is being tested in a phase 2 trial that will soon be recruiting patients with advanced kidney cancer, says Choueiri, co-lead investigator of the trial.

    Read More: 7 Myths About Kidney Cancer, Debunked

    The results of the phase 1 trial, which was testing just for safety, found “the vaccine to be well tolerated,” Choueiri says. “We and many others have been trying to do vaccines for several decades now.” The goal is to find the specific proteins in the vaccine that will be “the ones that elicit the most intense immune response that will lead to killing the cancer.”

    Experts like Choueiri have high hopes for mRNA cancer vaccines. And with numerous other therapies being developed by pharmaceutical companies at the same time as others are making their way through clinical trials, the future for kidney cancer patients is getting brighter with each passing year.

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    Linda Carroll

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