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October 30, 2023
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How to Cultivate Hope When You Don’t Have Any

There’s a sense, once a whisper, that’s growing louder every day. Glaciers are melting; children are being slaughtered; hatred runs rampant. Sometimes it feels like the world’s approaching a nadir. Or like you are.

The antidote to any despair might be hope, experts say. It’s one of the most powerful—and essential—human mindsets, and possible to achieve even when it feels out of reach. “Hope is a way of thinking,” says Chan Hellman, a psychologist who’s the founding director of the Hope Research Center at the University of Oklahoma. “We know it can be taught; we know it can be nurtured. It’s not something you either have or don’t have.”

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Many people, he notes, don’t fully understand what hope is—and what it isn’t. Being hopeful doesn’t mean engaging in wishful thinking or blind optimism. Rather, it’s “the belief or the expectation that the future can be better, and that more importantly, we have the capacity to pursue that future,” Hellman says. The opposite of hope, therefore, is not pessimism, but rather apathy, with its loss of motivation. And while wishing is passive, hope is about taking action.

Being hopeful is associated with a wide array of health and life benefits. “Our capacity for hope is one of the strongest predictors of well-being,” Hellman says. Research suggests, for example, that people with more hope throughout their lives have fewer chronic health problems; are less likely to be depressed or anxious; have stronger social support; and tend to live longer. As Hellman points out, “Hope begets hope, and it has such a significant protective factor.”

We asked Hellman and other experts for strategies that can help cultivate hope—even when it feels unattainable.

1. First, give yourself permission to be hopeful.

Remember when you were a kid, and well-intentioned adults cautioned you not to get your hopes up? That mentality can linger, notes David Feldman, a professor of counseling psychology at Santa Clara University in California who studies hope. “The truth is, whether or not we allow ourselves to hope, at some point we’re going to be disappointed. I don’t think the solution is never allowing ourselves to feel hopeful or giving up on hope altogether.”

Feldman—who designed a widely used single-session “Hope Workshop”—thinks of hope as the psychological engine that drives progress in our lives. He worries that if we all give up on it, “we’re creating a self-fulfilling prophecy.” So go ahead and grant yourself permission to look toward the future with excitement and ambition.

2. Set at least one meaningful goal.

In the mid-1980s, the psychologist Charles Snyder set out to determine what qualities hopeful people had in common. He landed on three key factors that form the basis for Hope Theory, a model researchers still rely on today: First, in order to be hopeful, Snyder found, people must think in a goal-oriented way. (More on the other two elements, pathways and agency, in a moment.)

Make it a point to always be working toward at least one goal that’s intrinsically meaningful, Feldman advises. In other words, it shouldn’t be something you have to do—like crossing off your work to-do list—but something you want to do. “Goals can be anything that’s important to us,” he says.

Feldman recalls a friend who reached out to him in May 2020, newly furloughed from her job, scared about the pandemic, and feeling utterly hopeless. He asked her if she could set one goal that would allow her to use her talents and make her feel empowered. The woman, who enjoyed sewing, ended up pledging to turn scraps of fabric into face masks—and donated 200 to local nonprofits and charity groups. “When I caught up with her a month later, she was transformed—she felt so much more hopeful,” he says.

3. Brainstorm solutions.

Another key element of Snyder’s Hope Theory is “pathways.” Feldman describes this as “kind of a strange psychology term that means having the perception that there are plans or ways of getting you from where you are to your goals.” If you’ve set a goal that’s meaningful to you, but you can’t figure out a way to achieve it, you’ll probably feel pretty hopeless. People who are high in hope, meanwhile, tend to generate lots of pathways—so if one doesn’t work out, they have an alternative at the ready. If you’re struggling to make a plan, or you keep being blocked—by someone else, or an unfair system, or bad luck—Feldman suggests sitting down with a pen and paper and giving yourself an hour to brainstorm solutions.

4. Call your support team.

According to Snyder’s research, people who are hopeful tend to have a lot of “agency,” which means the motivation to actually achieve their goals. Getting a good night’s rest, following a healthy diet, and meditating can all promote agency, Feldman says. So can tapping into our own positive beliefs about ourselves; there’s a certain power to reminding yourself: “I got this.”

Sometimes, however, the strongest source of agency is other people. When Feldman is feeling low, he calls his father, who’s his biggest cheerleader. Having someone you care about tell you they believe in you “can give you a kick in the behind,” he says. Make a list of your biggest supporters, Feldman suggests, so when you’re feeling unmotivated, you know exactly who to call for a boost.

5. Seek out success stories.

Mary Beth Medvide has long been curious about the ways hope manifests in the lives of marginalized groups, like first-generation immigrants. So she set out to explore how low-income students of color experienced it in their daily lives.

In part, she found, they cultivated hope by seeking support from their parents and specific teachers. But they also got a lot out of meeting or learning about other people who had done well for themselves. “By seeing other people succeed—like maybe a senior, when they were a sophomore—they felt like they could succeed,” says Medvide, an assistant professor of psychology at Suffolk University in Boston. Indeed, research suggests that high levels of hope are associated with academic achievement and career exploration.

That’s something we can all apply to our own lives: Make it a point to read books about or even befriend people who have overcome adversity to achieve their goals, and you’ll likely feel more hopeful about your own future, Medvide says.

6. Tap into your imagination.

Hellman thinks of imagination as “the instrument of hope.” Let’s say you set a goal for the week, like applying for five jobs, helping your kid adjust to preschool, or volunteering for two hours. Spend a few minutes reflecting on or talking about what would happen if you achieved it. “How does it impact you, or how would it benefit others, and who are those other people?” he says. “You and I have this wonderful capacity to play a movie in our head. And when you can see yourself in the future, that is the very essence of hope.”

Hope is a way of thinking—and experts say it can be taught.

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Hope is a way of thinking—and experts say it can be taught.

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October 26, 2023
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How to Get RSV Vaccines to Those Who Need Them Most

The world is entering a new era of vaccines. Following the success of COVID-19 mRNA shots, scientists have a far greater capacity to tailor shots to a virus’s structure, putting a host of new vaccines on the horizon.

The most recent arrivals are several new immunizations against respiratory syncytial virus, or RSV.

These shots are welcome since RSV can be dangerous, even deadly, in the very old and very young. But the shots, produced by Pfizer and GlaxoSmithKline, are also expensive, costing about $300 for those directed at adults, and up to $1,000 for one of the shots, a monoclonal antibody rather than a traditional vaccine, intended for babies. Many older vaccines cost pennies.

And in part because of the high cost, there is a shortage of RSV shots for infants, leading the U.S. Centers for Disease Control and Prevention to issue a warning for doctors to prioritize the most vulnerable babies.

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The advent of these new drugs is forcing the U.S. to face anew questions it has long sidestepped: How much should an immunization cost that will possibly be given—maybe yearly—to millions of Americans? Also, given the U.S. is one of two countries that permit direct advertising to consumers: How can we ensure the shots get into the arms of people who will truly benefit and not those of people who seek it out as a result of scary marketing, at great expense?

Already, ads on television and the internet show active retirees playing pickleball or going to art galleries whose lives are “cut short by RSV.” This helps explain the lines for the shot at my local pharmacy.

The indiscriminate use of expensive shots could strain both public and private insurers’ already tight budgets.

The risk of RSV for infants

Other developed countries have deliberate strategies for deciding which vulnerable groups need a particular vaccine and how much to pay for it. The U.S. does not, and as specialized vaccines proliferate, public programs and private insurers will need to grapple with how to use and finance shots that can be hugely beneficial for some but will waste precious health dollars if taken by all.

A seasonal viral illness, RSV can cause hospitalization or, in rare cases, death in babies and in people ages 75 or older, as well as those with serious underlying medical conditions such as heart disease or cancer. For most people who get RSV, it plays out as a cold; you’ve likely had RSV many times without knowing it.

But RSV puts about 2% of babies under age 1 in the hospital and annually kills between 100 and 300 of those under 6 months, because their immune systems are immature and their airways too narrow to tolerate the inflammation. Merely having a bad case of RSV in young childhood increases the risk of long-term asthma.

That’s why Dr. Barney Graham, the scientist who spent decades at the government’s National Institutes for Health perfecting the basic science that led to the current shots, said “the most obvious use is in infants,” not adults.

That’s also why a consortium of European countries, trying to figure out how best to use these vaccines without breaking the bank, focused first on babies and determining a sensible price. Though more of the very old may die of RSV, the years of life lost are much greater for the very young. (Babies can get the monoclonal antibody shot directly or gain protection through a traditional vaccine given to the mother near the end of pregnancy, conferring immunity through the womb.)

Examining the cost-utility of the vaccine, a team of European researchers looked at scenarios where the price was what the team termed “very expensive” —which they put at above €75 (about $80) – or “cheapish” which they put at below €25(about $27), says Philippe Beutels, professor in health economics at the University of Antwerp, who led the group.

While the calculus varies somewhat from country to country, the group concluded generally that if the price was at the high end, it was not cost effective. That meant, he said, “we should not give either kind of shot and stick to current practice” of treating sick infants—who usually do fine—with supportive care.

The calculation will be used by countries such as Belgium, U.K., Denmark, Finland, and the Netherlands to negotiate a set price for the two infant shots, followed by decisions on which version should be offered. “If the monoclonal antibody is €100 and the vaccine €10, then the vaccine would be preferable,” Beutels says.

They have not yet considered how to distribute the vaccines to adults—considered less pressing—because studies show that RSV rarely causes severe disease in adults who live outside of care settings, such as a nursing home.

Letting the market decide who gets drugs

Why did the U.S. focus first on older adults, while Europe is more concerned about RSV in infants?

In the U.S., the drug makers had a financial incentive: Roughly 3.7 million babies are born each year, while there are about 75 million Americans ages 60 and older—the group for whom the two adult vaccines were approved. And about half of children get their vaccines through the Vaccines for Children program, which negotiates discounted prices.

Also, babies can get vaccinated only by their clinicians. Adults can walk into local drug stores for the shots, and pharmacies are only too happy to have the business.

But which older adults truly benefit from the shot? Studies presented by the manufacturers to the U.S. Food and Drug Administration for approval in a population of generally healthy people 60 and older, so that’s the group to whom they may be marketed. And marketed they are, even though the studies didn’t show the shots staved off hospitalization or death in people ages 60 to 75.

That led to what some have called a “narrow” endorsement from the CDC’s Advisory Committee on Immunization Practices (ACIP) for people 60 to 75: Patients in that age range could get the shot after “shared clinical decision-making” with a health provider.

In part because of this fuzzy, conditional endorsement, it is likely some Americans 60 and over with commercial insurance are finding that their insurers won’t cover it. Under Obamacare, insurers are generally required to cover at no cost vaccines that are recommended by the ACIP.

(In late September, the ACIP recommended immunization of all babies with either the antibody or the maternal vaccine. Insurers have a year to commence coverage and many have been dragging their feet because of the high price.)

A patchwork strategy

There are better and more equitable ways to steer the shots into the arms of those who need it, rather than simply administering it to those who have the “right” insurance or, swayed by advertising, can pay. For example, insurers, including Medicare, could be required to cover only those ages 60 to 75 who have a prescription from a doctor, indicating shared decision-making has occurred.

During the pandemic emergency, the federal government purchased all COVID-19 vaccines in bulk at a negotiated price, initially below $20 a shot, and distributed them nationally. If, to protect public health, we want vaccines to get into the arms of all who benefit, that’s a more cohesive strategy than the patchwork one used now.

Vaccines are miraculous, and it’s great news that they now exist to prevent serious illness and death from RSV. But using such novel vaccines wisely—directing them to the people who need them at a price they can afford—will be key. Otherwise, the cost to the health system, and to patients, could undermine this big medical win.

Drug companies are marketing RSV vaccines to US seniors, when it’s infants who need them the most.

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Drug companies are marketing RSV vaccines to US seniors, when it’s infants who need them the most.

Uncategorized
October 26, 2023
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6 minutes Read

Why Diagnosing Alzheimer’s Early Is So Important

Alzheimer’s patients now have more options than ever for treating their disease— two drugs are approved to treat the causes of Alzheimer’s, and the U.S. Food and Drug Administration is currently considering approving another, which could be available next year. Many researchers are starting to focus on how to get the most out of these treatments: how to identify people who will benefit the most, how long people need to be treated, and how to measure the effect of the drugs. They are also exploring whether these drugs could not only slow, but maybe even prevent some of the more damaging effects of the disease.

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At the annual Clinical Trials on Alzheimer’s Disease conference in Boston, Eisai and Biogen, makers of the most recently approved drug, lecanemab (Leqembi), as well as Eli Lilly, maker of donanemab, which the U.S. Food and Drug Administration (FDA) is currently reviewing for possible approval by the end of the year, reported on their latest studies. Eisai provided additional data on longer-term use of its drug, as well as on a new formulation that would make it easier for patients to take than the current hour-long IV infusion once every two weeks. Lilly shared new data from its final phase of testing that showed patients’ ability to execute daily tasks improved, as did their performance on memory, orientation, and judgment tests while taking the experimental drug, compared to those receiving a placebo.

The FDA approved lecanemab in January, based on data showing that IV infusions once every two weeks for a year and a half delayed cognitive decline by 27% in those receiving the drug compared to people getting a placebo. At the Boston conference this week, Eisai presented encouraging data on a new formulation of its drug—one that doctors or patients themselves can inject once a week rather than receive through an hour-long infusion once a month. In a group of 72 patients who received lecanemab for the first time as an injection, and 322 patients from the original study who switched from the IV infusion to the injections for six months, PET scans showed that the injections led to a 14% greater reduction in amyloid compared to those who had received IV infusions after six months. That, according to Eisai, may be because the injections result in a higher blood concentration of the drug by about 11% compared to the IV infusion. “We think the [injection] formulation will really help patients in terms of making it more convenient and not having to go to infusion centers,” says Dr. Michael Irizarry, senior vice president of clinical research at Eisai. He says the company plans to request that the FDA approve the injections by the end of March 2024.

Eisai also provided more detailed and extended data suggesting that lecanemab works best when it is used as early in the disease as possible, and that the benefits continued to 24 months, six months beyond the original study.

Experts believe that tau, which forms tangles that can compromise brain neurons, tends to accumulate after amyloid plaques have caused damage, so people with low levels of tau are still at the relatively early stages of disease. In Eisai’s latest study, researchers looked at a subset of the patients in the company’s original study who had very low levels of tau. In this group, 76% of those getting lecanemab showed no decline in tests of memory, orientation, or judgment; or in their engagement in social activities and hobbies; or in their personal care habits compared to 55% of those getting placebo. Even more encouraging, among these people with early disease, 60% of those getting the drug showed improvement in their test scores compared to 28% in the placebo group.

“This supports starting earlier in treatment for people who have symptomatic Alzheimer’s in order to maintain or improve their cognitive function,” says Irizarry.

Lilly saw similar benefits in early-stage patients who received its experimental drug, donanemab. In its study, all patients received tau PET scans, so the researchers could distinguish between those at earlier and later stages of disease. Among people with low-to-medium amounts of tau in the brain, 36% of those receiving the drug showed slowing of disease progression as measured by tests of memory, orientation, judgment, and measures of social engagement.

Delaying the onset of symptoms is essential—not just for patients, who can remain independent for longer, but for their caregivers as well. Lilly’s data showed that most patients in the study who were taking donanemab were able to remain at the same level of dependency at which they started the trial—for most that meant they needed some reminders about daily activities, such as taking their medicine or putting out the trash or other housekeeping tasks. But they didn’t progress quickly into more dependent stages in which they would need help getting dressed, remembering to eat, and executing other critical skills. In fact, about a quarter of the people taking the drug did not move on to becoming more dependent, compared to 50% of those taking placebo during the 18 month study.

Both Eisai’s and Lilly’s data confirm that starting treatment earlier gives the medications more opportunity to clear amyloid build up and prevent damage to brain neurons. That means it might even be possible to not only delay some of the more advanced symptoms of Alzheimer’s related to memory and cognition, but to also prevent them. Dr. John Sims, senior medical director at Lilly, says that the company anticipates that donanemab will not be a life-long prescription—but that patients could use it to either remove or reach an acceptable level of amyloid in the brain, which can then be monitored as they come off the drug for periods of time. “The hypothesis we are working on is that it’s much better to monitor the disease because it is a really slow process overall, and maybe some people may never need another treatment,” he says. If these results are supported by continued follow up, that would mean focusing even more on how best to diagnose patients at the earliest stages of disease, before memory or other cognitive symptoms appear. “The data show that the most optimal benefit occurs if people are treated as early as possible,” says Irizarry.

Experts in the field are already working on honing the criteria for diagnosing Alzheimer’s, and developing guidelines for even non-dementia experts such as primary care physicians to make it easier to distinguish when people have the condition, and which patients would benefit from treatment—as early as possible.

New data from Eli Lilly and Eisai show that their Alzheimer’s drugs are more effective when started earlier in the disease progression.

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New data from Eli Lilly and Eisai show that their Alzheimer’s drugs are more effective when started earlier in the disease progression.

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October 23, 2023
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5 minutes Read

Long COVID Research Is In Its ‘Most Hopeful’ Phase Yet

A phenomenal amount of research on Long COVID—the name for chronic symptoms following a case of COVID-19—has been published over the past three years. But scientific advances have yet to bring relief to people who are already sick, a group estimated to include about 5% of U.S. adults but hard to precisely quantify due to the difficulty of diagnosing people correctly.

Researchers are optimistic that breakthroughs are coming. The U.S. National Institutes of Health (NIH) has launched multiple clinical trials focused on potential therapies, and several recent studies have pointed to biomarkers that may help doctors accurately diagnose—and, hopefully, treat—people with Long COVID.

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“In the short history of studying this disease, this is probably the most hopeful moment we’ve ever had,” says Christoph Thaiss, an assistant professor of microbiology at the University of Pennsylvania’s Perelman School of Medicine who co-authored a recent study on Long COVID in Cell.

The search for biomarkers

Long COVID is currently a disease mostly defined by its symptoms, which range from brain fog and fatigue to headaches and nervous-system dysfunction. There is no single test that can diagnose it—although recent research points to a variety of potential testing methods, from full-body scans to eye exams.

A September study published in Nature was widely heralded as a step toward finally having a blood test to confirm Long COVID. Researchers analyzed blood samples from almost 300 people, some of whom had Long COVID, some of whom had never had COVID-19, and some of whom had it and fully recovered. Long COVID patients tended to have low levels of the stress hormone cortisol, and their blood also often suggested that virus lingered in their bodies—either remnants of the virus that causes COVID-19, or other viruses that had been dormant in the body after prior infections and become reactivated.

Co-author Akiko Iwasaki, an immunobiologist who directs Yale University School of Medicine’s Center for Infection and Immunity, says it’s unlikely there will ever be a single biomarker for Long COVID, since the disease can look very different from person to person. But when a machine-learning model was trained to pick up on all of those potential signals together, it was able to distinguish the blood of Long COVID patients from the blood of people without the condition with 96% accuracy.

“That doesn’t mean we’re going to have biomarkers next week,” Iwasaki says, “but I think we are moving forward in the right direction.”

Thaiss’ recent study in Cell found another potential biomarker in the blood of Long COVID patients: low levels of the neurotransmitter serotonin, which is largely produced in the gut and involved in numerous bodily functions. Using stool samples, Thaiss and his colleagues found genetic material from the SARS-CoV-2 virus in the gastrointestinal tracts of a subset of Long COVID patients, mirroring results from other studies. They then hypothesized, and used mice to demonstrate, that this stubborn viral material can trigger an immune response that leads to excess inflammation in the body, in turn hampering the gut’s production of serotonin. Inadequate serotonin seems to contribute to a number of neurological symptoms of Long COVID.

The study is important because it “gets us closer to understanding what’s happening” in the bodies of people with Long COVID, says Hannah Davis, one of the leaders of the Patient-Led Research Collaborative for Long COVID.

Low levels of cortisol or serotonin could be useful “signals” for assessing people with Long COVID, but—at least for now—they cannot serve as stand-alone diagnostics, says Dr. Adupa Rao, medical director of the COVID Recovery Clinic at the University of Southern California’s Keck School of Medicine. For one thing, the studies on potential Long COVID biomarkers have been fairly small and must be replicated in larger groups of patients, Rao says. Beyond that, there are plenty of reasons why someone would have low cortisol or serotonin, including non-COVID viral infections, he says.

Will biomarkers lead to treatments?

Still, Maayan Levy, who co-authored the Cell study and is also an assistant professor of microbiology at UPenn, believes serotonin may be a target for Long COVID treatment. Building on their findings in mice, her group is designing a clinical trial to test whether selective serotonin reuptake inhibitors (SSRIs)—a widely prescribed class of antidepressant, including fluoxetine (Prozac) and escitalopram (Lexapro), used to boost serotonin levels in the brain—are effective against Long COVID. She also plans to test whether supplementing tryptophan, an amino acid that the body uses to make serotonin, may be beneficial.

But Davis is skeptical. SSRIs are already so widely used, she says, that “if SSRIs worked, we would know.” And researchers working on ME/CFS, a condition similar enough to Long COVID that many long-haulers meet its diagnostic criteria, have previously warned that tryptophan supplementation may be dangerous for patients. “It would be good to not reinvent the wheel” by re-testing these ideas, Davis says, noting that there is plenty of research on ME/CFS treatment that could inform researchers working on Long COVID.

In her view, there are other, more promising possible treatments in the research pipeline, including antivirals (which could, in theory, destroy remnants of either reactivated viruses or the SARS-CoV-2 virus lingering in the body); drugs that interact with the immune system; and medications that prevent blood clotting.

Rao says he’s not sure any drug currently being studied will become a magic bullet, but he’s encouraged by the field’s progress. “My hope is, in the near future, we’ll be able to identify the cause [of Long COVID] and therefore provide more thorough treatment options, rather than treating just the symptoms,” Rao says.

In Davis’ view, testing treatments may achieve both goals: “Understanding what drugs help patients,” she says, “will also help us understand what’s actually happening in patient bodies.”

They’re getting closer to finding tests and treatments.

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They’re getting closer to finding tests and treatments.

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October 20, 2023
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Pig-Heart Transplant Recipient Is Doing Well After a Month

WASHINGTON (AP) — It’s been a month since a Maryland man became the second person to receive a transplanted heart from a pig—and hospital video released Friday shows he’s working hard to recover.

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Lawrence Faucette was dying from heart failure and ineligible for a traditional heart transplant when doctors at the University of Maryland School of Medicine offered the highly experimental surgery.

In the first glimpse of Faucette provided since the Sept. 20 transplant, hospital video shows physical therapist Chris Wells urging him to push through a pedaling exercise to regain his strength.

“That’s going to be tough but I’ll work it out,” Faucette, 58, replied, breathing heavily but giving a smile.

The Maryland team last year performed the world’s first transplant of a heart from a genetically altered pig into another dying man. David Bennett survived just two months before that heart failed, for reasons that aren’t completely clear although signs of a pig virus later were found inside the organ. Lessons from that first experiment led to changes before this second try, including better virus testing.

Attempts at animal-to-human organ transplants—called xenotransplants—have failed for decades, as people’s immune systems immediately destroyed the foreign tissue. Now scientists are trying again using pigs genetically modified to make their organs more humanlike.

In Friday’s hospital video, Faucette’s doctors said the pig heart has shown no sign of rejection.

“His heart is doing everything on its own,” said Dr. Muhammad Mohiuddin, the Maryland team’s cardiac xenotransplantation chief.

A hospital spokeswoman said Faucette has been able to stand and physical therapists are helping him gain strength needed to attempt walking.

Many scientists hope xenotransplants one day could compensate for the huge shortage of human organ donations. More than 100,000 people are on the nation’s list for a transplant, most awaiting kidneys, and thousands will die waiting.

A handful of scientific teams have tested pig kidneys and hearts in monkeys and in donated human bodies, hoping to learn enough for the Food and Drug Administration to allow formal xenotransplant studies.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

A month ago, Laurence Faucette became the second person to receive a transplanted heart from a pig. Today, he’s doing physical therapy.

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A month ago, Laurence Faucette became the second person to receive a transplanted heart from a pig. Today, he’s doing physical therapy.

Uncategorized
October 20, 2023
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6 minutes Read

Don’t Fall for the Marketing. ‘Toddler Milk’ Is Not Good for Your Child

All parents want the best for their children, so they could be forgiven for thinking that infant nutrition brands prioritize the same. But then there’s toddler formula.

Toddler formulas, or toddler milks, are beverages often sold in the same product lines as infant formulas, framed as a sort of natural nutritional continuation for the 9-to-12-month-old being weaned off traditional infant formula or breast milk. Unlike infant formulas, however, toddler milk is unregulated in the U.S., and as a result is not required to meet the same nutritional standards. For years, it’s been an open secret among pediatric health experts that the toddler milk market has run wild with deceptive marketing and less-than-healthy formulations, but with sales growing, the American Academy of Pediatrics (AAP) has released a formal call for regulatory action. The physician’s organization is hoping that their report, published on Oct. 20, will at minimum provide more education for caregivers.

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Understanding toddler milk’s role in the market today, says Jennifer Pomeranz, an associate professor of public health policy and management at New York University, means looking back at the policies that laid the groundwork for its popularity. Since its invention, infant formula has been a good alternative for mothers who can’t breastfeed, though “there’s zero question that breast milk is better for an infant,” says Pomeranz, especially in terms of nutrition and immune development. This deficiency has made formula a bit political, and never more so than in the run-up to the 1980s. For a few decades, it was a hot alternative to breastfeeding that mothers saw everywhere they looked; pitched in the pages of magazines and given out in sample packets by pediatricians. Between the late 1930s and late 1960s, the proportion of U.S. babies who were breastfed dropped from around 77% to 25%. But the formula boom came with dangers, since companies didn’t always provide guidance on how to use it correctly. Soon enough, “infants were dying,” says Pomeranz, due to malnutrition in lower-income countries and communities, where formula was being watered down or otherwise prepared improperly.

In 1981, the World Health Organization (WHO) stepped in, writing up a set of guidelines that asked countries to bar all direct-to-consumer and some industry marketing of infant formulas, and to clarify nutrition labels and hazards of use. In response, many countries passed laws reflecting the WHO’s recommendations. In the U.S., where the Food and Drug Administration (FDA) had already begun to regulate the products more heavily a year prior in 1980, additional marketing restrictions were never adopted.

Confronted with the potential revenue loss of restricted marketing worldwide, manufacturers began to push a product just different enough to avoid the now-established rules. So-called ”toddler milk” allowed brands to print ads with their logos and packaging, while simultaneously selling an additional product on the back of the public’s trust in infant formulas.

The strategy worked. When infant formula sales decreased by 7% from 2006 to 2015, the sales of toddler milks increased by 158%—and have continued growing, says George Fuchs, vice chair of clinical affairs for the pediatrics department at the University of Kentucky and an author of the AAP’s new report.

Fuchs and his colleagues agree that there’s no functional role for toddler milks in a young child’s diet. Toddler milks don’t just lack nutritional value, they eschew it— their primary ingredients are powdered milk, high-calorie sweeteners, and vegetable oil. One study from earlier this year found that 60% of toddler milks had excess sugar, while many were higher in sodium and lower in protein than cow’s milk, the pediatrician-recommended option for tots. And then there’s corn syrup, a common ingredient that definitely isn’t in cow’s milk. And because of poor regulation, these products can get away with false marketing: at least one product the study looked at had branding suggesting it was iron-fortified, but had less iron than the FDA requires in similarly-branded infant formula.

Toddler milk as a whole is “just junk,” says Pomeranz. “It’s unnecessary and not needed.” She previously found that 60% of caregivers believed that toddler milks contained essential nutrients that their kids couldn’t get elsewhere.

“So many of them have undesirable attributes that could have consequences for health,” Fuchs says of the products. In particular, he worries about toddler milks potentially hijacking the sensitive period in early childhood where taste preferences are programmed. There’s a lot of evidence that high sugar intake during infancy is a key contributor to childhood obesity; there’s also a well-documented link between early excess sodium intake and poor cardiovascular health later in life.

What concerns experts the most is that toddler milks are often found on store shelves right alongside, or even mixed in with, the infant formulas. They also often have packaging that makes them look like only slight variations of reliable products. This makes them incredibly easy to confuse, particularly if parents don’t know, for instance, that the FDA has a special format of nutrition label used exclusively for infant formulas. Sometimes the word “toddler” appears, but there are various other terms used interchangeably for these products, such as “follow-up,” “transition,” or “weaning” formulas, or “growing-up milk.” In her research, Pomeranz has learned that even physicians sometimes aren’t sure of the differences between these products and well-regulated infant formula.

There are many simple solutions that regulators could easily implement. The AAP’s suggestions include mandating more distinct branding on toddler milks, banning the use of the word “formula” on their labels, and requiring that they be stocked on shelves separately from infant formulas. Pomeranz would like to see a required warning label on all toddler milks explicitly stating that they’re not for infant use.

Fuchs, who has worked with the FDA before, is skeptical that any real regulatory change will come out of the AAP’s recommendations anytime soon, particularly because of what he describes as Congress’s “opposition to anything that places restrictions on business.” But with enough pressure from parents and physicians, he thinks manufacturers could be convinced to take some of these changes on themselves.

The high-selling ‘follow-on’ formulas are nutritionally empty compared to the infant formulas they’re often tied to, experts say.

Uncategorized, healthscienceclimate

Health – TIME

The high-selling ‘follow-on’ formulas are nutritionally empty compared to the infant formulas they’re often tied to, experts say.

Uncategorized
October 19, 2023
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5 minutes Read

There’s Almost No Research on the Health Impact of Plastic Chemicals in the Global South

This story was produced in partnership with the Pulitzer Center’s Ocean Reporting Network.

Some 13,000 chemicals are associated with plastic production, of which only 7,000 or so have been investigated for their health and environmental impacts. Nearly half of those studied have elements deemed hazardous to human health, but the research—spanning 50 years, multiple languages, thousands of publications, and an alphabet soup’s worth of acronyms, synonyms, and chemical compounds—is difficult to navigate. Yet doing so has become increasingly important as plastic production ramps up, along with its potential for causing serious threats to human health.

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A new research map brings order to the chaos, indexing the existing research by chemical compound, health outcomes, affected population groups, and geography. There are hundreds of thousands of studies about chemicals in plastics. So far, the map only covers some 3,500 human health-related peer-reviewed studies—a third of which demonstrate impacts on human endocrine, nutritional, and metabolic systems—but it provides valuable insight into what we already know about plastic’s role in human health, and what remains to be known.

The Plastic Health Map, produced by Australia’s Minderoo Foundation, a philanthropic organization with a strong focus on reducing plastic pollution, brings welcome transparency to a historically opaque industry, says Jorge A. Emmanuel, an adjunct professor studying plastics and the environment at Silliman University’s Institute of Environmental and Marine Sciences in the Philippines.

The map will be a vital tool for negotiators gathering in Nairobi next month to hammer out a legally binding United Nations treaty governing the global production and disposal of plastic. Human health advocates, industry leaders, NGOs, and national representatives can easily draw upon the existing research to support, or suppress, proposals on plastic production limits, manufacturing processes, chemical regulation, disposal options, and the use of alternatives. “It’s overwhelming trying to keep up with all the new papers coming out,” says Emmanuel, who was not involved in creating the map. “Having the material synthesized, searchable, and with all the references, will be very helpful.”

Plastic production is on track to triple by 2060, and with it a potentially damaging influx of toxic and hazardous chemicals such as PCBs, phthalates, BPA, PFAS, and their analogues, that have been consistently linked to a wide range of adverse health effects in human studies. In March 2023, the Minderoo-Monaco Commission on Plastics and Human Health—a global consortium of scientists, policy analysts, and health care workers convened with support from the Minderoo Foundation—published a comprehensive study in The Annals of Global Health laying out the health risks of plastic’s rise. The report estimated that the health-related costs of plastic production exceeded $250 billion globally in 2015, and that in the United States alone the health costs of disease and disability caused by the plastic-associated chemicals PBDE, BPA, and DEHP (which are not exclusively found in plastic products) exceeded $920 billion. Yet many of the other chemicals used in plastic production remain largely unnoticed, unregulated, and unresearched.

It was this uneven coverage that sparked neuroscientist Sarah Dunlop’s quest to understand the full range of research into plastic’s health impacts. As the head of plastics and human health at the Minderoo Foundation, she says she was at first overwhelmed by the number of chemicals and related research papers that she needed to work through. Her first search of the existing literature referencing chemicals in plastics came up with more than 846,000 published papers. “That’s why we needed to create a map so that we could navigate our way through it quickly.”

It took Dunlop’s team three and a half years to index the first tranche of 3,500 peer-reviewed studies, painting an overwhelming case for stronger regulations. But the most significant finding, she says, is what they didn’t find: papers examining micro and nano plastic exposure in humans, for example, or studies on the health impacts of alternative chemicals used to replace the ones, such as Bisphenol A, that have already been deemed dangerous. Not surprisingly, she says, “most of the work has been done in rich countries. But the countries which are being exposed the most”—low-income countries with poor waste management infrastructure, for example—“have hardly any research.”

The blank areas on the database’s geographic index of research hotspots are a clear call for more scientific attention, says Bhedita Jaya Seewoo, a biomedical researcher at Minderoo who helped develop the map. So too is the long list of chemicals used in everyday plastics whose impact on human health hasn’t been studied at all, or which only started seeing scientific scrutiny after raising red flags with regulators.

“Ideally, you would want the chemicals to be rigorously tested before being introduced into consumer products,” and then monitored afterwards to ensure their safety, she says. Of course, it would be unethical to test chemical compounds on human subjects—Seewoo and her colleagues are talking about laboratory trials. But when most plastic producers are adding chemicals into consumer products without reviewing their broader health implications first, it essentially amounts to human trials on a massive scale. “How can you know what’s safe?” asks Dunlop. Mapping what we know, and more importantly, what we don’t know, is a good place to start.

Scientists mapped thousands of studies on the health impacts of plastic chemicals. Their findings will be critical to better regulation.

Uncategorized, climate change, Climate Is Everything

Health – TIME

Scientists mapped thousands of studies on the health impacts of plastic chemicals. Their findings will be critical to better regulation.

Uncategorized
October 18, 2023
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4 minutes Read

How AI Can Make Cancer Treatment More Equitable

Many are aware of the Cancer Moonshot—an ambitious and hopeful initiative of the U.S. government to reduce cancer-related death rates by 50% by the year 2047. It will take an army to achieve this goal, composed of the brightest minds and biggest hearts in healthcare, science, and technology. Many parties will be involved—the federal government, healthcare providers, researchers, patients, caregivers, and advocates, among others in both the public and private sectors. One of the most pivotal tools that can help propel us toward this lofty goal is artificial intelligence (AI), which is poised to revolutionize cancer treatment.

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The moonshot plan identifies five priority areas, all of which AI has the potential to enhance. Two areas in particular lend themselves to AI: the call to “deliver the latest cancer innovations to patients and communities” and the aim of enhancing “the oncology model to place cancer patients at the center of decision-making.”

The history of cancer care has been a continual process of refining treatments through innovative processes and solutions. Consider, for instance, the evolution of prostate cancer treatments. Initially, surgery was the primary treatment for late-stage cases. In the 1940s, hormone therapy emerged as a treatment option. Then, in the 1960s and ‘70s, we saw the development of Gleason scoring for better cancer characterization, and the 1990s brought further refinement in risk classification. Eventually, genetic testing that identifies likely pathogenic variants of the primary tumor became a valuable tool in cancer care in the late 1990s and gained prominence in the 2010s.

A constantly improving technology

While these advancements represented significant strides toward personalizing cancer care, it has been a slow and historically inequitable process, with minority populations not having as much access to advanced diagnosis or care tools. AI has many distinct advantages over prior technologies. It continuously improves when trained on enormous datasets, making it both more accurate than prior methods and enabling it to distinguish subtleties across demographics, age, race, etc. It is relatively low-cost to deploy, runs instantly, and can be made accessible via cloud computing, which is now available in all populated continents. These advantages make AI a scalable solution that can uniquely optimize patients’ treatment plans across the globe, delivering efficient and personalized cancer care to a substantially larger population than prior technology.

One of the most promising developments is the rise of AI-enabled tests that can simultaneously prognosticate how tumors will progress and predict treatment benefits. These tests use unique deep-learning algorithms that assess digital images from patient biopsies and couple them with the patient’s clinical data. Clinicians can then take this information and build a personalized treatment plan; in some cases, this even means avoiding unnecessary treatments where the side effects outweigh the benefits for the patient.

The Moonshot initiative to “deliver innovation to patients and communities” is intended for all patients, not a select few. The generalizability of AI relies on the amount and variety of data that is used to build it. When AI is trained on datasets that properly represent diverse patient populations, it has the potential to provide greater insights for all, including historically underrepresented populations.

In addition to helping bridge the gap in health disparities, AI can also serve as a conduit for increased communication between patients and clinicians by positioning patients at the center of decision making about their care. How? By providing patients with more information about their illness, and therefore increasing confidence in their treatment plan. This confidence is a cornerstone of effective cancer treatment.

Centering patients

Patients must live with treatment decisions, both physically and mentally. Studies show that one key to treating cancer is for clinicians to create a patient-centered plan that incorporates multifaceted aspects of a person’s life. With AI-enabled tests, the patient and clinician can review the data together to align on whether the therapy selected is worth the adverse effects that could influence the patient’s lifestyle. In contrast, a lack of understanding of the options and benefits of the therapy can leave patients overwhelmed and under-committed to the treatment. This can decrease adherence to treatments and have detrimental effects on survival rates.

AI can significantly advance our progress towards the objectives of the Cancer Moonshot initiative by delivering exceptionally precise and comprehensive information on disease progression and therapeutic benefits at an unprecedented scale. While the objectives outlined by the initiative are extraordinarily ambitious, each day we witness tangible progress—and we have only scratched the surface of AI’s role in cancer care.

Investors in Artera, the AI company where Esteva is CEO, include TIME owners and co-chairs Marc and Lynne Benioff.

Harnessing AI will be a key component to achieving the goals of the Cancer Moonshot, according to an AI health pioneer.

Uncategorized, Innovation

Health – TIME

Harnessing AI will be a key component to achieving the goals of the Cancer Moonshot, according to an AI health pioneer.

Uncategorized
October 18, 2023
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8 minutes Read

6 Ways to Set Boundaries at Work—Even When It’s Uncomfortable

Setting boundaries at work—in this economy—might seem like a pipe dream. Not be available 24/7? Not smile and accept every new assignment? Not push back when a colleague tries to steal your time?

It could be your best career (and mental health) move: Establishing expectations for what you will and will not tolerate is key to increasing productivity and wellbeing, experts agree. “Boundaries are limits or personal rules that protect your time and energy and allow you to perform at your best,” says Melody Wilding, a licensed social worker and author of Trust Yourself: Stop Overthinking and Channel Your Emotions for Success at Work. “Everyone likes certainty and clarity, and that’s what boundaries provide.”

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Sticking up for yourself is particularly essential, she adds, when you consider how many people are burned out or plain old fed up at work. According to the American Psychological Association’s latest Work in America survey, 19% of employees say their workplace is very or somewhat toxic, and 22% believe that work has harmed their mental health. Workers describe feeling emotionally exhausted, ineffective, and unmotivated, and admit to being irritable with their coworkers or customers. Meanwhile, only 40% report that time off is respected, 35% say their workplace culture encourages breaks, and 29% note that their managers encourage employees to take care of their mental health.

Enter boundaries. Setting them can be hard, acknowledges Amy Cooper Hakim, an industrial-organizational psychology practitioner and author of Working With Difficult People. That’s why it’s essential to remove emotion from the equation: “When we can be a bit more pragmatic, we can clearly state to our boss, ‘In order for me to be most productive, I need this; in order for me to accomplish this task, I need that,’” she says. “Everyone is so afraid of stepping on someone’s toes or making them feel uncomfortable. It’s best to focus on being professional and courteous and clear with what we expect of others, and to treat people the way they want to be treated, but to give ourselves that same level of respect.”

With that in mind, we asked experts how to set boundaries around six common work scenarios:

If your boss routinely Slacks you at 10 p.m.

The line between work and home is so blurred it’s practically indecipherable. (Maybe someone spilled their stale office coffee on it?) “We shouldn’t have to tell our boss, ‘Hey, I’m happy to work at work, but please don’t bother me after hours,’” Hakim says. “But work-life balance is almost like a work-life merge, because things blend into each other instead of having very clear demarcations.”

If your manager repeatedly pings you after you’ve logged off for the day, Hakim suggests communicating a boundary like this: “I’ll be fully present at work, but I need to know that I’m also permitted to fully commit to my home life.” If that’s not practical in your industry, and you’ll need to be at least somewhat available, you can still set a boundary. For example, you might say: “When I step out the door, I’m going to be with my family. However, I appreciate that urgent things happen, so I’ll check my email once a night at 9 p.m.” If something pops up after that time? It’ll be addressed the next morning.

If your time off is interrupted

You’d probably prefer not to take your colleagues along on vacation—but a stubborn few might insist on showing up in electronic form. Even if the nature of your job makes it impossible to go totally offline, you can still set boundaries around disconnecting during paid time off. It’s essential to prepare in advance, Hakim says: Let your team know who to reach out to if they have a question about a project you oversee, for example—and name a backup for the backup. Include this information in your email auto response, too.

If you suspect your direct supervisor will hound you anyway, send her a note and say: “I’m offline from X to Y. If you need me urgently and can’t reach this person, this person, or this person, give me a call and I will commit to responding within 24 hours.” That way, you won’t be leaving your employer high and dry—but you also won’t feel pressure to respond immediately. If you still feel guilty, or worried that you’ll look bad, Hakim suggests repeating this mantra: “I respect myself enough to grant myself this opportunity to take a break. I deserve it.”

If your boss piles on—and on and on

Part of you is probably pleased to be your boss’s go-to; it means they recognize and appreciate your skills. But you also want a reasonable workload—research suggests that having too much to do can trigger burnout. There are a couple ways to set boundaries in this scenario, says Alison Green, who runs the work-advice blog Ask a Manager. You might approach the conversation from a big-picture angle, perhaps during a weekly check-in: “Hey, my workload is really high,” she suggests saying. “Can we talk about how to prioritize? I’m going to need to say no to new things that come up, or take some existing things away.”

Or, you could wait until the next time your boss comes to you with a new assignment, and have an in-the-moment discussion. When they ask if you can take on a project, respond by saying: “I’m really interested in doing that, but my plate is full right now. I don’t think I can make room for it without compromising the work I’m doing on X, Y, and Z,” Green advises. That ensures you won’t get overloaded—and opens the door for your employer to figure out the best use of your time.

If you need to say no after already committing

Wilding’s clients often ask her how to say no to an assignment they already accepted. The best way to handle this situation, she says, is to have a second conversation with your boss—focusing on what you can do. “You might say, ‘When I committed to this, I thought I had the bandwidth, but looking at my calendar, it’s not possible,’” Wilding suggests. “‘However, I can attend the first strategy meeting and help you come up with an initial plan.’” With that, you’ve set a boundary around your workload—but you’re also not leaving your team totally in the lurch.

If your chatty coworker won’t let you work

It’s 2 p.m., you’re slammed, and Rick from accounting has been leaning against your cubicle for 20 minutes. Don’t be afraid to be direct, Green advises: Tell your colleague you have something you need to get done by 3. You could also communicate a boundary silently, through actions—perhaps by looking at your watch or standing up. “Physically give the cue that you’re leaving your workspace,” she says.

Or, perhaps you’re struggling with any overly nosy coworker—a problem Green sees a lot. Maybe a coworker keeps asking what you’re planning to do over the weekend, even after you’ve tried to brush them off. Or your officemate’s curiosity might be piqued by the sick days you just took, or the doctor’s appointment that caused you to miss the morning meeting. “You don’t need to share your private medical information at work,” she says. It’s often easiest to make it clear that you don’t wish to divulge personal details by adopting a breezy attitude. If someone asks what’s going on, Green suggests responding in a cheerful tone: “Oh, just some medical stuff I had to take care of. Nothing to worry about.” That, she says, signals the conversation is over.

If you crave a different style of feedback

Ideally, your manager will make it a point to ask what type of feedback you need to succeed. But maybe that hasn’t happened—and your boss’s gruff, blunt style is getting to you. It’s a tricky situation, Green acknowledges, since boundaries are about you, and you can’t change someone else’s behavior. “But I do think there’s room to have that conversation and say, ‘Hey, I really appreciate that you’re giving me all this constructive feedback to help me grow. I also need to know where I’m doing well. What should I keep doing?’”

Eventually, with overly critical bosses—who make you feel like you never do anything right—the boundary might become quitting, Green adds. She suggests asking yourself: “Is there a way to change my mental positioning and let it roll off me, or is it going to make me come home unhappy every day?” If it’s the latter, it may be time to start looking for other opportunities.

Yes, even in this economy.

Uncategorized, healthscienceclimate

Health – TIME

Yes, even in this economy.

Uncategorized
October 18, 2023
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7 minutes Read

3 Ways Anxiety Can Actually Help You

“Anxiety.” The very word evokes discomfort. Its effects—shortness of breath, pounding heart, muscle tension—are outright distressing. And there’s more of it than ever. According to the U.S. Census Bureau, half of young American adults have significant symptoms. It’s no wonder that the anxiety epidemic is causing us much consternation and concern.

But, as a clinician and researcher, I see a much bigger problem. In our society’s quest to be anxiety-free, we tend to miss out on many valuable opportunities presented by this normal human emotion.

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In and of itself, anxiety is not deadly, and it certainly is not a disease or pathology. Quite the contrary: being able to feel anxious shows that our fight-or-flight system is operational, which is an indicator of brain and sensory health. Once we accept that anxious arousal is a normal, albeit uncomfortable, part of life, we can use it to thrive.

Here are three ways anxiety can help you:

It can build your emotional strength and resilience

Working out at the gym is supposed to be hard. By its very nature, a “good workout” is uncomfortable, since it involves pushing our physical strength and aerobic capacity past what you can easily do. Yes, you can overdo it in the gym and push too hard, but the sweet spot of exercise is always a somewhat strenuous experience.

Similarly, if you want to build emotional strength and resilience, you need to face some degree of mental adversity. Of course, traumatic events and abuse tend to cause more harm than good, but the experience of—and perseverance through—occasional anxiety, stress, and tension substantially increases your emotional fortitude.

For example, one of the most effective treatments for anxiety is exposure therapy, which involves systematically confronting one’s fears, head-on, in reasonable and increasing doses, over time. With the help of a therapist, individuals with phobias to anything from snakes or spiders, to heights or medical procedures, gradually encounter that which makes them anxious. As they exercise their emotional strength—voluntarily and courageously—they become desensitized to their anxiety, and its effects decrease.

In my clinical practice, I have treated hundreds of patients with exposure therapy, and in many instances, individuals emerge not only less phobically anxious, but also with greater resilience in general. In one particularly memorable case, I helped a young woman overcome a severe case of hypochondriasis (anxiety fixated on her health) with this method. Years later, when her newborn child had a serious health complication requiring life-saving surgery, she handled the situation with incredible fortitude and calm. Anxiety can provide opportunities to flex our neural and emotional muscles, developing greater mental capacity to face day-to-day stressors more effectively.

It can increase your emotional intimacy and connection

Humans are social creatures. The number one predictor of happiness and flourishing in late life is not great genes, financial success, or fame. It’s the quality of our relationships. In this same way, clinical science has identified that sharing our anxieties with our loved ones is one of the most effective strategies to build connection. When my patients learn to open up and share their anxieties with their partners, they almost always report a greater sense of emotional intimacy.

Again, anxiety is a normal human emotion, and if you’re lucky enough to find yourself in a relationship that matters enough, you will feel anxious at some point! Even in the most secure relationships, we naturally feel some anxiety from time-to-time about whether the love we receive is truly unconditional. As international relationship expert Sue Johnson teaches, when we embrace and express our need for connection during challenging moments (e.g., “I’m having a hard time right now and could really use your support”) it begets greater connection and turns our anxiety into love.

Recently, a young married couple (let’s call them Marty and Sheryl) came to me in distress over a significant financial dispute. Sheryl was anxious about Marty’s spending relative to their bank balance, and Marty saw Sheryl as being overly frugal. Months of mutual blame and recrimination had eroded trust and connection, without any change in monetary behaviors or financial status.

I encouraged the couple to express the roots of their fears to one another. Marty opened up that he was terrified of Sheryl losing interest in their relationship if they weren’t materially comfortable. Sheryl, in turn, shared that she had seen her own parents almost divorce due to financial strain. It took several months, but the financial dispute eventually became less of an issue, since Marty and Sheryl both realized their respective behaviors were coming from a place of love: They simply had different ways of trying to preserve their connection. By recognizing and expressing their anxieties, they were able to strengthen their emotional bond and deepen their connection.

It can help you recalibrate and rebalance

From time to time, all of us find ourselves at the end of our rope. Our responsibilities pile up, our resources break down, and we just don’t have enough time to get everything done. We feel uncomfortably anxious most, if not all, of the time.

In such cases, what we’re experiencing is called stress. Simply put, the demands placed upon us outweigh our available resources. Just like a set of scales going out of balance, dealing with stress is almost mathematical: We either need to decrease our demands, or increase our resources (or both). There are no other solutions.

Many times, when my patients are overwhelmed they tend to take on more demands. Ironically, they take on additional projects at work, volunteer for community service, and provide additional support to their friends. This happens because it’s hard to acknowledge when we are struggling, and easier to avoid thinking about how overwhelmed we feel—and pretend that everything is ok—when we’re focused on work.

Unfortunately, this can lead to disastrous consequences since, at some point the scales cannot stand being out of balance and they break. Working harder, faster, and longer hours when one is already ragged can create chronic stress, which has been associated with heart disease, cancer, and stroke, as well as numerous less severe medical conditions.

Medicating away symptoms of stress may help us to function day-to-day for a while, but this tends to make things worse in the long run. Again, the only real solutions to stress are to decrease our demands or increase our resources.

Therefore, when we feel genuinely overwhelmed and anxious because of stress, it’s our body’s way of telling us to recalibrate and rebalance. Ultimately, we are all finite creatures in a massive world, and nobody is truly limitless. When we heed our internal cues and acknowledge our fallibility, we emerge more focused and healthier overall—and also less stressed and anxious.

Anxiety can be a healthy, helpful emotion that is a constructive aspect of human life. Acute anxiety can strengthen our emotional capacity when we face our fears. Anxiety can foster emotional connection when we convey our vulnerable feelings to others. And in the form of stress, anxiety can serve as an internal barometer to remain balanced and healthy. It’s about time we start to put it to good use.

Anxiety is a normal human emotion. Let’s use it to our advantage, writes David H. Rosmarin.

Uncategorized, freelance

Health – TIME

Anxiety is a normal human emotion. Let’s use it to our advantage, writes David H. Rosmarin.

Uncategorized
October 17, 2023
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6 minutes Read

One Year Later, Where’s All the Adderall?

The U.S. is facing a mystery of missing Adderall—one for which nobody has an answer.

Oct. 12 marked one year since the U.S. Food and Drug Administration’s formal announcement that pharmaceutical companies were unable to produce enough Adderall, one of the common amphetamine-based medications for attention-deficit/hyperactivity disorder (ADHD). As a result, many of the 41 million ADHD patients nationwide who rely on the drug daily to stay focused and reduce impulsive behavior have faced refill delays and empty inventories at their pharmacies.

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Eight drug manufacturers have reported shortages of Adderall, which also means other major ADHD medications are now in short supply after psychiatrists turned to other treatment options for patients. In a year with the highest rate of drug shortages reported since 2014, “this one really baffles me,” says Marta Wosińsk, a senior fellow and health care economist at the Brookings Institute. The scarcity of Adderall remains uniquely confusing, she says, not only because there is no plan to remedy it, but because the major players involved in making and regulating the drug have provided little explanation, choosing instead to point fingers at one another while the public is left to speculate.

Experts say the FDA bears some responsibility for the ongoing shortage, as its lax reporting standards for manufacturers are the primary reason why there are still only theories about the shortage’s cause, rather than answers. These potential causes, which include increased prescription rates and the U.S. Drug Enforcement Administration’s tight control of critical ingredients, are impossible to investigate because of how little information the parties are required to provide to the public and one another.

Increased ADHD diagnoses

For months, the primary culprit for the shortage was believed to be an ongoing increase in prescription rates and ADHD diagnoses, which spiked between 2020 and 2021. Adderall’s active ingredient is a controlled amphetamine salt, and its production requires communication between the FDA, drug companies, and the DEA, which sets an annual cap on the amount of highly-controlled amphetamines that manufacturers can use.

Recently, however, it’s become more and more clear that something else is also going on—and that nobody wants to be responsible for figuring out what it is. In a joint letter to the public released on Aug. 1, the FDA commissioner and the DEA administrator stated that although they plan to re-evaluate quotas, manufacturers only sold 70% of the prescription stimulants they were permitted to in 2022, with 2023 rates on track to match. The implication was that the shortage has nothing to do with the amount of drugs released by the DEA, but is instead a result of how private companies are handling them further down the line. Following this finger-pointing at manufacturers, the government implemented a stopgap measure last month when the FDA approved the first generic versions of the ADHD medication Vyvanse, in essence making an Adderall alternative cheaper and more accessible to the public.

That nearly a third of the DEA-allocated allowance of a highly profitable prescription drug appears to be missing is massively confusing, says Wosińsk. “A lot of people in the industry have told me that this number seems way too high, that this just doesn’t seem right,” she says, “but there’s no information.” Knowing which manufacturers are actually contributing to that discrepancy would be hugely helpful, she says, but the FDA hasn’t released that information.

Some of the shortage could even stem from concerns about potential overprescription. There’s growing suspicion among experts that the increasing prescription rates can’t possibly all represent legitimate cases of ADHD, given the known abuse of stimulants as a concentration tool and the ease of acquiring prescriptions from telehealth companies. Though no one is ready to make any real allegations, some of Wosińsk’s colleagues have theorized that the missing medication could be sitting quietly in the hands of wholesalers, distributors, and pharmacies who fear future blame if the widespread prevalence of stimulants is someday condemned as a public-health issue. Then again, she adds, the 30% could just as easily reflect data-tracking or reporting errors. All anyone really knows, says Wosińsk, is that the DEA is unlikely to release extra medication as long as a large portion of what it’s already allocating remains unaccounted for.

Frustrated lawmakers

Lawmakers aren’t satisfied with the statement from agency leadership, who they say should take on the responsibility of fixing the problem rather than merely shifting the blame. “I understand that with an increase in prescriptions, the supply chain wasn’t immediately ready to contend with that,” says Representative Abigail Spanberger, a Democrat from Virginia, “But a year later, it isn’t enough for the DEA to say, ‘You know, actually, manufacturers weren’t utilizing their allotted quotas.’” Spanberger has led colleagues in calling for the DEA to investigate and resolve the shortage multiple times since it began, most recently in an Oct. 12 letter responding to the joint statement from the agencies.

“People say, well with the pandemic, and telehealth, a lot more people got diagnosed, and there’s a little bit of blaming the patient in that, which I absolutely am a little bit resentful of,” she says. Spanberger believes that part of why the shortage has lasted so long is because of a widespread assumption that many diagnosed Americans don’t actually need ADHD medication. The DEA’s quota system is in place in large part to prevent the abuse of Adderall, a concern that Spanberger says should be more carefully balanced against the needs of actual ADHD patients who may be at risk without their medication, including via a growing online amphetamine black market.

Wosińsk feels a little differently, and sees the ongoing shortage as an opportunity for the medical community to rethink the prescription of stimulants for ADHD, particularly in adults, for whom the long-term effects of taking them isn’t well known. “There’s really a concern that we are at the beginning of another wave of controlled substance abuse,” Wosińsk says. Eventually, she’d like to see leaders “paying attention more to demand, and thinking hard about who really needs it and how much is appropriate use.”

But first, like Spanberger, she wants to know where the missing Adderall is.

The ongoing shortage of the ADHD medication has revealed a communication breakdown between regulators and manufacturers.

Uncategorized, healthscienceclimate

Health – TIME

The ongoing shortage of the ADHD medication has revealed a communication breakdown between regulators and manufacturers.

Uncategorized
October 16, 2023
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5 minutes Read

Why Do Infants Seem to Avoid Severe COVID-19?

With COVID-19 rates rising around the country, and an updated vaccine now available, researchers are still trying to understand how immunity to COVID-19 works, and the best ways to build and sustain it.

One of the possibly richest areas of research might be infections among the very young, who tend to be spared from more serious COVID-19 disease. Hospitalization rates for infants four years old or under dropped to under 1 per 100,000 earlier this year, and have recently inched up slightly to 2 per 100,000 in the middle of September, compared to rates for people over 65 years old, which hit a low of 6 per 100,000 earlier this year and climbed up to 17.6 in September.

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In a study published recently in the journal Cell, researchers led by Bali Pulendran, a professor of pathology, microbiology, and immunology at Stanford University School of Medicine, report some key differences in how infants and adults experience COVID-19 infections, which could lead to new ways of generating stronger and more durable immunity in the future.

Pulendran and his team took advantage of samples collected from children at Cincinnati Children’s Hospital in 2020, before COVID-19 vaccines were available. Doctors took weekly nasal samples from the infants, who ranged in age from one month to nearly four years old, and some developed COVID-19 infections, so the researchers captured immune cell activity in the nasal passages before, during, and after infection. They found that unlike in adults, infants, especially the youngest babies, produce strong antibody responses against SARS-CoV-2, and these antibodies remained at relatively high levels throughout the study period of nearly a year.

“In the case of COVID-19, this is certainly unique and new,” says Pulendran. “We hadn’t expected to see this in infants. When adults get infected, they see an increase in the antibody response in the months following the infection, and then a sharp decay in that level. But in the babies, we didn’t see that happening. In fact, in some babies, the antibodies kept rising, and in others they plateaued, but they did not decline.”

The scientists also discovered another key difference in the way babies responded to the COVID-19 virus. While adults develop a strong inflammatory response in the blood soon after infection, as the virus triggers a flood of cytokines and other compounds that can cause complications associated with serious COVID-19 disease, infants did not develop this same reaction in the blood. In fact, in their blood, levels of these inflammatory markers did not increase appreciably.

However, these factors were abundant in the nasal passages of the babies, suggesting that for them, the battle between the immune system and the virus was occurring primarily in the mucosal tissues of the nose and upper respiratory tract, and not throughout the body in the bloodstream. The mucous membranes of these babies were flooded with interferon in particular, which is a potent immune hormone that can control how much a virus replicates. “It’s as if in infants the virus infects the upper respiratory tract but this infection is nipped in the bud there,” says Pulendran.

The reason that the antibodies generated by babies last so much longer than those generated by adults isn’t clear, but could have to do with the fact that infants may be relying on a type of immune response known as the innate response. It’s a first line of defense, and doesn’t involve educating immune cells like antibodies and T cells by exposing them to pathogens first. Because the immune systems in babies are still developing, it’s possible that they are more reliant on this more rudimentary, innate immune response and that could explain the longer lasting protection they have. But, says Pulendran, “it’s one of the great mysteries in immunology why in some cases like measles and chickenpox, you only need to have one infection during childhood and you are protected for your entire life, because the half life of the antibodies against them lasts years and years, but with other infections like flu and COVID-19, the half life of antibodies is more on the order of a few hundred days.”

There are tradeoffs to the infants’ immune responses, however. The scientists found that the antibodies the babies generated, while abundant and durable, were more specifically targeted to the virus that had caused their infections, meaning that if they were infected with another variant, these antibodies might not be as potent. In addition, the babies’ T cell responses, which in adults is responsible for protecting against serious disease, was somewhat muted as well. It’s not clear yet whether the other advantages of the infants’ response is enough to offset these other limitations.

Still, the results of the study point to some intriguing new strategies for generating stronger, and longer-lasting immune responses to the COVID-19 virus. Scientists are currently developing nasal vaccines, for example, which rely on generating mucosal immunity, and in the case of COVID-19, that may produce more durable immunity than injected vaccines. “These infants may be teaching us a lesson that certain pathways to immunity can be triggered by nasal vaccines that mimic the response we see in babies,” says Pulendran. “If only we can make a vaccine that mimics these same pathways, then we might be onto something.”

They aren’t immune, but serious illness is rarer among very young infants than among adults.

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Health – TIME

They aren’t immune, but serious illness is rarer among very young infants than among adults.

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October 16, 2023
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Rite Aid Files For Bankruptcy While Dealing With Opioid-Related Lawsuits

Rite Aid has filed for bankruptcy protection and plans to sell part of its business as it attempts to restructure while dealing with losses and opioid-related lawsuits.

The company said Rite Aid stores will continue to fill prescriptions, and customers will still be able to visit its locations or shop online while it goes through its voluntary Chapter 11 process. But that process also will allow it to speed up its plan to close underperforming stores.

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Going through Chapter 11 will help “significantly reduce the company’s debt” while helping to “resolve litigation claims in an equitable manner,” Rite Aid late Sunday.

Rite Aid Corp. runs more than 2,100 stores in the United States, mostly on the East and West Coasts, and has posted annual losses for several years.

The Philadelphia company, which is marking its 60th birthday this year, has been cutting costs and closing some stores as it has dealt with long-standing financial challenges.

The company, like its rivals, also faces financial risk from lawsuits over opioid prescriptions. Rite Aid already has reached several settlements, including one announced last year with the state of West Virginia for up to $30 million.

In March, the U.S. Justice Department intervened in a whistleblower lawsuit brought by former employees under the False Claims Act. Federal officials said in a statement that the drugstore chain filled “at least hundreds of thousands” of illegal prescriptions for drugs including opioids.

Rite Aid called the government’s claims “hyperbolic” in a subsequent motion to dismiss. The company said facts alleged in the case actually showed it exceeded regulatory requirements for diversion control.

Drugstores also have been dealing with several issues that frustrate customers. They’ve handled prescription drug shortages, and they have struggled to fill their stores with enough pharmacists and technicians to run the pharmacies. Rivals CVS and Walgreens both have dealt with walkouts by pharmacy employees concerned about their growing workloads and lack of help.

The stores also have had to weather tight prescription reimbursement and waning COVID-19 vaccine and testing business in recent quarters. But Rite Aid’s larger competitors have moved more aggressively into health care, opening clinics and adding other sources of revenue.

Walgreens and CVS Health each run about 9,000 locations or more in the U.S.

Deutsche Bank analyst George Hill said in an August note that Rite Aid operates on a much thinner profit margin than its competitors and while it can pay costs to service its debt, it won’t be able to cover principal payments “based on the current trajectory of the business.”

Rite Aid said Sunday that it had reached an agreement with some key creditors on a financial restructuring plan to cut its debt. The company also said it obtained $3.45 billion in fresh financing from some of its lenders, which will help support the company through the Chapter 11 process.

The company also said it reached a deal to sell its small pharmacy benefits manager, Elixir, to MedImpact Healthcare Systems. Elixir runs prescription drug coverage and a specialty pharmacy among other services.

Rite Aid said MedImpact will serve as the “stalking horse bidder” in a court-supervised sale process.

Rite Aid says it does not know yet which stores it will close, but it will make “every effort” to ensure that customers have access to health services either at another Rite Aid location or another nearby pharmacy.

The company also said Sunday that Jeffrey Stein, who heads a financial advisory firm, was named CEO, replacing interim leader Elizabeth Burr, who remains on Rite Aid’s board. She had replaced Heyward Donigan, who left in January.

Rite Aid said Stein has experience working with companies that are undergoing financial restructuring.

The company earlier reported that its revenue fell to $5.7 billion in the fiscal quarter that ended June 3, down from $6.0 billion a year earlier, logging a net loss of $306.7 million.

A few years ago, Rite Aid propped up its share price with a 1-for-20 reverse stock split that took more than a billion shares off the market. But the share price has slid for most of this year and tumbled back below $1 in August. The stock last traded at roughly 65 cents.

Earlier this month, Rite Aid notified the New York Stock Exchange that it was not in compliance with listing standards. During a grace period, the company’s stock continues to be listed and traded.

Walgreens attempted to buy Rite Aid for about $9.4 billion in a deal announced in 2015. But the larger drugstore chain scaled back its ambition a couple years later and bought only a chunk of Rite Aid, around 1,900 stores, to get the deal past antitrust regulators.

In 2018, Rite Aid shares plunged after the company called off a separate merger with the grocer Albertsons, which is currently trying to merge with another grocer, Kroger.

Murphy reported from Indianapolis. Kurtenbach reported from Bangkok.

The pharmacy giant Rite Aid has filed for bankruptcy as it tries to restructure while dealing with losses and opioid-related lawsuits.

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The pharmacy giant Rite Aid has filed for bankruptcy as it tries to restructure while dealing with losses and opioid-related lawsuits.

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October 13, 2023
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19 minutes Read

6 Stories Show the Human Toll of Poland’s Strict Abortion Laws

This project was supported by the Pulitzer Center

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Krzysztof Sowinski has cried every day since his wife Marta, who was five months pregnant, died of sepsis in 2022; he believes doctors put Marta’s life in danger by not giving them the option to terminate the pregnancy while the fetus’ heart was still beating. Janusz Kucharski also lost his partner Justyna to sepsis in the fifth month of a pregnancy. She left behind two boys.

It is likely, reproductive-rights advocates say, that these women would be alive if not for Poland’s increasingly restrictive abortion laws. Abortion has been illegal in the country since 1993, but a 2020 ruling by Poland’s Constitutional Tribunal, which went into effect the next year, removed one of the exceptions to the law—fetal abnormalities—and imposed a near-total ban on abortion. Now women can terminate a pregnancy only if the women’s life or health is at risk (including mental health risks with a psychiatric diagnosis) or if there is reasonable suspicion that the pregnancy resulted from rape or incest.

Yet as examples from across the country indicate, what the law allows is not actually what is happening in practice. The consequences of the reproductive-rights rollback have been dire. Women who have abortions are not prosecuted under the law, but doctors and others who help women terminate pregnancies, up to the point of viability, may face up to three years in prison. If an abortion takes place beyond the point of viability, then the person who aided in the abortion may face up to eight years in prison. This creates what many consider a “chilling effect,” as doctors scared of running afoul of the law hesitate to take lifesaving steps for pregnant patients. “Patients are powerless and doctors are increasingly fearful,” says Professor Marzena Debska, a gynecologist at Debski Clinic in Warsaw.

The concerns are similar to those raised in the U.S., where the 2022 overturning of Roe v. Wade allowed states to enact severe restrictions on abortion. Women in Texas, Tennessee, Idaho, and Oklahoma have sued their states, claiming a lack of clarity in the laws is preventing doctors from performing abortions on women with serious pregnancy complications. Over the last 30 years, 60 countries have liberalized abortion law, with only four rolling back its legality: the U.S., Nicaragua, El Salvador, and Poland.

Officially in 2020, there were seven maternal deaths in Poland. In 2021, there were nine. Such low figures have persisted for more than a decade, but experts say the data is unreliable. “Every year we estimate that there are almost three times as many deaths as appear in the statistics. If a patient dies in the intensive care unit, for example, and not in the gynecology and obstetrics department, nothing in the certificate will link her death to the pregnancy,” says Dr. Katarzyna Szamotulska, head of the epidemiology and biostatistics department at the Mother and Child Institute in Warsaw. (Poland’s Ministry of Health declined to answer multiple requests for comment about the reliability of the statistics.) With doctors reluctant to intervene, infant mortality rates have also risen, says Dr. Gizela Jagielska, the deputy director of the public hospital in Olesnica and a gynecologist who performs many of the few legal abortions that still take place in Poland.

Jagielska says the anti-abortion movement calls her a “baby killer” but she is undeterred. “I act according to the law, using the premise of saving a woman’s life. I will continue to work no matter what, because who else will help these women?” she says. “I get threats, I am called the butcher of Olesnica. I’m not afraid. I only feel sorry for the couples who come to me for consultation. These are the most traumatic moments in their lives, and they have to hear that they are murderers.”

Because Poland’s ruling right-wing Law and Justice Party (PiS) supports the restrictions, many are looking to the Oct. 15 parliamentary elections to produce change. Others are looking to the courts. Attorney Jolanta Budzowska is representing families in criminal-negligence cases against doctors in relation to pregnant women who died and suffered harm in hospitals. She has also filed a complaint to the European Court of Human Rights against the Polish government on behalf of some of the families. “I think there are more such cases. And even more where women are survivors, but they have gone through a trauma and want to forget about it,” Budzowska says.

In 2019, even before the latest restrictions, the U.N. Committee Against Torture concluded that denying access to legal abortion in certain circumstances involves such intense physical and mental suffering as to constitute torture, and called on Poland to act. “A year ago, I helped another pregnant woman who was told by doctors to wait four days until the fetus died,” Budzowska says. “She got sepsis. She paid for it with depression.” In an opinion for the Office for Patients’ Rights, Professor Krzysztof Preis of the Medical University of Gdansk wrote that “the action prolonging the patient’s mental suffering was inhumane and cruel treatment, completely unjustified medically.”

To grasp the human consequences of Poland’s abortion restrictions, TIME interviewed the families of pregnant women who arrived at hospital with second-trimester pregnancy complications and later died, as well as one woman who terminated her pregnancy and another who delivered a boy with severe health complications (the child died days later). Below are their stories.

Marta Sowinska

For more than five years, Marta, 36, and Krzysztof Sowinski, 40, tried everything to have a baby, including in vitro fertilization. Marta miscarried twice, in 2019 and 2020. On Dec. 31, 2021, she discovered she was pregnant again. “I loved our baby from the first line on the pregnancy test,” Krzysztof told TIME in July 2023, as he began to cry. On April 15, 2022, at 20 weeks, Marta started having contractions so Krzysztof drove her to the hospital in the southern Polish city of Katowice.

The next morning Marta did not feel well, but the fetus’s heart was still beating so she hoped for the best, Krzysztof says. “Later she called me, shivering with cold: ‘Something is wrong with me. Maybe it’s some inflammation.’” She developed a 100°F fever, leukocytosis, and a fast pulse. The doctor gave her hydroxyzine, an antihistamine with a sedative effect; paracetamol, a medication used to reduce fever; and an antibiotic, according to medical records obtained by Krzysztof and reviewed by TIME. At 1 a.m., Marta started bleeding from her birth canal. The fetus’s heart had stopped beating but the doctors moved her into the delivery room anyway. “I joined her at 3:40 a.m. and held her hand the whole time,” Krzysztof says, visibly shaking. Medical records note that Marta was “rude, abusive, and undermines the midwives’ decisions.”

Marta’s bloodwork from the hospital’s laboratory time-stamped 3:51 a.m. showed a procalcitonin (PCT) test reading of 14.4—when a reading above 2 indicates a very high risk of sepsis. (The hospital told TIME in a statement that doctors only became aware of the PCT reading hours later; the hospital did not respond to inquiries as to why this delay occurred.) She delivered a stillborn boy at 5:19 a.m. “I said goodbye to the boy two hours later. We already knew that we would give him a funeral. I cried for hours in the waiting room, so Marta couldn’t hear me,” Krzysztof says.

The hospital wrote to TIME in a statement that “the patient wanted wholeheartedly to save the pregnancy and even after finding out that the fetus had no heartbeat she did not consent to the proposed medical action (inducing a miscarriage).” Krzysztof tells it differently: “She wanted a baby but didn’t want to die for it. At first she did not consent, but after 40 minutes, she said OK. If they had explained to us 12 hours earlier that Marta’s life was in danger, and the pregnancy had to be terminated to save her, neither of us would have given it a second thought. Abortion was not a taboo subject for us. We trusted them. Who am I to check the doctor’s every step?”

Marta’s condition continued to deteriorate into the morning. By mid-afternoon, doctors raised the prospect of removing her uterus.

But it was too late. “Marta fell into a coma after the procedure and doctors told me to go home, saying she could remain in this state for many days. A few hours later, I received a call that Marta had died,” Krzysztof says. (Medical records do not mention a coma.) “She was my only friend,” he adds. “The day she died, she said I could do whatever I want with our three embryos, frozen in a fertility clinic. Sometimes I think about surrogacy outside of Poland, but then I realize the whole point of having children is to raise them together. But maybe it is a way to make a part of her alive again?”

Justyna Szymura

Before Justyna Szymura’s death in December 2020 at age 34, Janusz Kucharski, 42, never cried. Now he tells their 4-year-old son, Dawid, that a man also has the right to grieve. He says he will not forgive the doctor who patted him on the back and told him that “nothing could be done” just after Justyna died.

While Justyna lay dying, the largest protests in the nation since the fall of the communist rule in 1989 filled the Polish streets. Following the Constitutional Court ruling in October 2020 to further restrict abortion access, more than 1,000 demonstrations were organized, with over 1 million people participating.

Justyna was 18 weeks pregnant when she started bleeding from her birth canal and went to the hospital in Wodzislaw Slaski on Dec. 9. Bloodwork results at 9:08 p.m. showed a high C-reactive protein (CRP) test, which indicated inflammation in her body, according to an opinion issued by Professor Miroslaw Wielgos, an expert witness for Poland’s Office for Patients’ Rights, on Justyna’s care. Wieglos’ opinion states that she was given an antibiotic and apparently left alone for 12 hours.

Professor Wielgos wrote in his opinion that the antibiotic could not have worked because “two weeks earlier, a culture from the genital tract showed the presence of a bacteria resistant to its action.” He also criticized the hospital’s decision to leave Justyna alone for 12 hours: “The consequence [of high leukocytosis and CRP] should be the monitoring of the effectiveness of the treatment by repeating the tests after a maximum of 4-6 hours.”

The next morning, Justyna texted Janusz: “I fainted in the bathroom. I’m vomiting since 5 a.m. and I have diarrhea.”

Doctors began inducing a miscarriage at 9:20 a.m on Dec. 10. “Perhaps it would have been undertaken several hours earlier, if the inflammatory parameters had been properly monitored,” wrote Professor Wielgos. Laboratory test results soon showed a further increase in CRP, and there was a sharp increase in PCT as well as more vomiting, the appearance of chills and a fever, wrote Professor Wielgos in his opinion. He wrote that doctors needed to ” immediately intensify action and proceed with instrumental emptying of the uterine cavity,” but instead they proceeded with the induction of the miscarriage. By 11:30 a.m., no fetal heart function was detected. Justyna gave birth to a stillborn boy at 1:30 p.m. She named him Antoni. Due to persistent hemorrhage, a decision was made to surgically remove the uterus to which Justyna gave her consent. After being transferred to ICU, she died of sepsis the next day, at 1:30 p.m. on Dec. 11.

In the death certificate, the hospital wrote that the cause of death was “multiple organ failure.” In an email statement on Sept. 22 to TIME, they said that the “patient was given due care by the medical staff adequate to her condition.” The hospital said in a subsequent statement that “the immediate cause of death was hemorrhagic shock with blood clotting abnormalities and associated multi-organ lesions. The hemorrhage, on the other hand, was caused by uterine cancer. Thus, the cause of death was not related to pregnancy, much less to childbirth, but to cancer.” According to Budzowska, who is representing Janusz and Dawid, an exam confirmed a placental site tumor, but Budzowska says, “Our main allegation is that the inflammation was poorly treated, and the patient was not supervised, which led to the development of sepsis and septic shock. If Szymura had survived and the placental site tumor had been detected, she would have undergone chemotherapy and had about an 85% chance of survival.”

According to Poland’s Central Statistical Office, not a single woman in the Silesian province, where Wodzislaw Slaski is located, died that year due to obstetric complications.

Izabela Sajbor

Izabela Sajbor, 30, was 22 weeks pregnant when her water broke in the early morning of Sept. 21, 2021, and she went to the Joannitas hospital in Pszczyna, in southern Poland.

By the evening of Sept. 21, Izabela was shaking from a fever. Bloodwork earlier in the day had indicated elevated CRP levels, according to medical records reviewed by TIME. “Thanks to super PiS they’ll wait until it’s dead. If not, great, I can expect sepsis!” Izabela messaged her mother Barbara Zientek, who lived in Cwiklice, a 15-minute drive from Pszczyna, but was unable to visit her daughter in hospital because of pandemic-related restrictions. Prenatal testing earlier in Izabela’s pregnancy indicated that the fetus might have Edwards syndrome—a congenital syndrome due to an extra copy of the 18th chromosome that is usually fatal; about 90% of babies with this condition do not survive the first year—though Skrobol says Izabela had shared this information only with her husband. Izabela never had amniocentesis to confirm a diagnosis.

“They can’t do anything, because someone could think they did it on purpose,” she texted her mother. “My life is at risk. And I have to wait. Kisses mommy,” she also wrote. (TIME has reviewed the messages.)

Doctors had administered fentanyl and Diazepam, according to TIME’s review of the medical records. That evening, “Izabela was crying for help,” Skrobol says. “She was heard by other patients. ‘I have someone to live for!’ she yelled, thinking about her 8-year-old daughter, Maja.” Izabela died at 7:35 a.m the next morning, less than 24 hours after she was admitted.

According to Budzowka, three doctors have been charged with endangering life and health, and one of them has been charged with causing death. All three doctors pleaded not guilty. The hospital in Pszczyna has not replied to multiple requests for comment.

Dorota Lalik

Dorota Lalik, 33, was 20 weeks pregnant when her water broke on May 20, 2023. She and her husband, Marcin Lalik, 27, were visiting family in Nowy Targ at the time, so he took her to the hospital named after Pope John Paul II in the southern Polish town. Doctors performed an ultrasound that showed the fetus still had a heartbeat.

Dorota had a headache on May 22, and bloodwork indicated her CRP was rising, according to Budzowka’s review of the medical documentation. (Budzowka, who is representing Dorota’s family, declined to share the documentation with TIME citing an ongoing investigation.) On the 23rd, she began vomiting, and her headache worsened. “No one informed us that the chances of saving our baby were close to zero, and sepsis was almost inevitable,” Marcin says.

“Usually women want to fight for their child. The most important thing is to honestly explain to them what their situation is. And observe them carefully, because the threat of sepsis can be, though not always, caught at an early stage,” said Dr. Krzysztof Preis, a gynecology consultant for the Ministry of Health for the Pomeranian region. Professor Preis said he would decide whether to terminate a pregnancy as soon as the first signs of an infection appeared, but for years, doctors in the region “hid behind the ‘conscience clause,” and declined to perform an abortion if it conflicted with their beliefs. “But for me,” he said, “to put a woman’s life at risk contradicts the Bible.”

Dorota had been jotting down a few words daily with a pencil in her prayer book, but by that night, she no longer had the strength to write. She spoke to her husband for the last time at 9 p.m. and told him she loved him. As a devout Catholic Dorota opposed abortion, but Marcin says it is hard to say what she would have chosen if given the option to terminate the pregnancy. “But for sure it is better to save one life than to lose two,” he tells TIME.

On May 24, doctors ordered a second ultrasound and found the fetus’ heart had stopped beating. Three hours later, and after discussion with a regional consultant, doctors decided to remove the fetus as well as Dorota’s uterus. Dorota died at 9:34 a.m. from sepsis despite 90 minutes of attempted resuscitation.

In June a patients’ rights ombudsman Bartlomiej Chmielowiec stated that “the investigation revealed a number of irregularities that occurred during the patient’s stay in the hospital. No additional measures were taken in view of the rising CRP; adequate antibiotic therapy was not implemented in time and the patient was not offered induction of miscarriage on May 22 (the day after admission to the hospital) in view of the rising CRP. The supervision of the pregnant woman was not carried out in accordance with due diligence and in accordance with current medical knowledge.” In August, Marek Wierzba, the head of the hospital, sent a letter expressing condolences and “deep regret for the death of Mrs. Lalik and her unborn child” to Marcin Lalik. “The management of the hospital in Nowy Targ apologizes for the violation of the rights of Mrs. Dorota Lalik to health services corresponding to the requirements of current medical knowledge, immediate provision of health services in case of danger to health and life, health services related to childbirth, health services provided with due diligence and to information about her health condition,” Director Wierzba wrote.

“The death of a pregnant patient is a huge tragedy not only for the relatives of the deceased or the public, but also for the management and staff of the Hospital,” the hospital said in a statement to TIME. “The patient was kept informed of her and the baby’s condition. Both the patient and the family received support from a psychologist.

“To the best of our knowledge, neither in 2005 nor thereafter has there been any official declaration from the hospital that pregnancy terminations will not be performed at our facility. We have not reached any document or record that confirms this. The same goes for invoking the conscience clause. We are committed to ensuring that a similar situation does not occur again.”

The hospital then outlined steps it had taken to ensure “a similar situation does not occur again,” including someone to restructure the gynecology-obstetrics department and conducting training sessions. “Out of respect for the family and relatives of the deceased, as well as the applicable laws (confidentiality of medical records), the Hospital Director maintains his position and will not comment on the entire case until it is clarified by the relevant authorities.”

Joanna

Joanna and Marek, 26 and 32, learned in May 2023, about four months into Joanna’s pregnancy, that the fetus had a diaphragmatic hernia, a birth defect in which there is an opening in the diaphragm that allows abdominal organs to move into the chest. (TIME is using pseudonyms for Joanna and Marek because of privacy concerns.) They consulted a doctor who told them the child had about a 50-50 chance of surviving birth. “The doctor was not sure if he would have legs and could be missing other organs,” Marek told TIME from Olesnica hospital in August. The doctor told them he could operate to move the organs to the right place and sew up the diaphragm once the child was born but it would be expensive. Given the political landscape, the couple was afraid to ask about terminating the pregnancy.

“I am chronically ill and I thought it was all my fault. I was told by a doctor to stop crying and deal with it,” Joanna says. “I was afraid that something would happen to me or the baby. At 21 weeks, I ordered pills online to induce an abortion at home, but the package came empty. I was going out of my mind and I ended up in the ER with a panic attack.”

It is then that Joanna and Marek decided to take action. The Foundation for Women and Family Planning (FEDERA), a Polish nonprofit that fights for reproductive rights, referred them to Dr. Jagielska. On Aug. 1, when Joanna was 27 weeks pregnant, they traveled 250 miles from their home in northern Poland to the hospital in Olesnica. A few hours after arriving, Dr. Jagielska administered a fetal intracardiac potassium chloride injection to the fetus’s heart to terminate the pregnancy. They decided not to see the baby afterward.

“The fetus had almost no lung tissue. It would have died immediately or a few hours after birth,” Jagielska recalls.

Maria

While Joanna and Marek were waiting for the abortion, in another room at Jagielska’s hospital in Olesnica, Maria, 25, a Ukrainian refugee who came to Poland following Russia’s full-scale invasion of her country, gave birth to a boy on Aug. 1, 2023. (TIME is using a pseudonym for privacy concerns.)

Test results earlier in Marta’s pregnancy indicated the baby had hydrocephalus, a build-up of fluid in the brain, which Dr. Jagielska says is likely because Maria had toxoplasmosis, a common infection caused by a parasite. But according to Jagielska, medical records from a previous physician did not mention any treatment. “How can you not notice that there is water instead of a brain?” asks Jagielska. “Unfortunately such things are on the rise. A few days ago I had a patient with a fetus missing half of the heart. These doctors just don’t want to take responsibility for what happens next.”

Dr. Jagielska, along with 11 other doctors, paramedics, and nurses tried to save Maria’s son who, after several hours, was taken to a specialized hospital in Wroclaw, in southwestern Poland. Maria was in shock and, due to the language barrier, barely understood what was happening. A month later, by the decision of a neonatology consultant in the Lower Silesia region, the baby’s life support was switched off. “I don’t know how I’d feel if I knew about the malformations from the beginning,” Maria told TIME in Olesnica hospital the day she gave birth on Aug. 1, “but I would like to have been given a choice.”—With reporting by Kasia Strek

The rollback of reproductive rights has created dire conditions in Poland. Many are looking to the Oct. 15 parliamentary elections to produce change.

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Health – TIME

The rollback of reproductive rights has created dire conditions in Poland. Many are looking to the Oct. 15 parliamentary elections to produce change.

Uncategorized
October 12, 2023
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12 minutes Read

How COVID-19 Changed Life for People Terrified of Needles

From the moment COVID-19 reached pandemic designation, Joe McDougall had nightmares. Not, like others, about the potential path of the virus, but about the seemingly inevitable moment at which he’d be asked—or held down and forced—to receive a vaccine. McDougall, now 39, is terrified of needles and a global pandemic meant that for the first time since adolescence, he might not be able to avoid them.

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Of all of the challenges facing mass COVID-19 vaccination, fear of needles is one of the least acknowledged by public-health campaigns. Even what we know about it is limited. It’s likely that at least 16% of adults worldwide have skipped some medical treatment—mainly annual flu vaccines)—due to concerns about needles. For an estimated quarter or more of those people, the level of anxiety and terror caused by needles coalesces into a legitimate phobia, formally called trypanophobia, that governs elements of their life and interferes with normal functioning.

The exact number of people living with this phobia is nearly impossible to know, primarily because many of them steer clear of medical care entirely, choosing instead to risk missing screening and diagnosis. This avoidance can be far-reaching. People may choose to avoid everyday activities for fear of being injured and requiring needle-related medical care. Some young women have chosen to postpone or even forgo desired motherhood simply because of the health care that pregnancy and delivery requires, according to online support groups.

Fear of needles isn’t about pain

“The fear of needles is greater than the fear of the consequences,” McDougall says. “It’s not about the pain, either.” When he needed to check his HIV status a few years back, he says, he simply couldn’t bear the thought of using the small auto-lancet that came with his at-home testing kit to prick his finger. So, he opted for a mind-easing solution that many would consider far worse—slicing his hand with a box cutter to get the requisite few drops of blood.

McDougall has a difficult time explaining where his fear comes from, but describes it as a sort of existential issue with needle insertion “and seeing that it’s in there.”

Being able to break down a fear of needles requires understanding each and every element of interacting with them that can make a person feel uncomfortable. “People’s triggers are quite specific, and they can differ,” says Jocelyn Sze, a clinical psychologist in Oakland with years of experience treating phobias. “For some people, it’s really the puncture and moving into the skin. For others, it’s this idea of a foreign substance entering their body. It could even be the smell of rubbing alcohol, or the fear of fainting.” Some people, including trypanophobes who work in health care, of which Sze says there are plenty, are truly only fearful of being injected themselves, and have no reaction to seeing or even using needles on others.

But after decades of avoidance and resignation, McDougall and many others like him are now confronting their phobia. To them, the COVID-19 vaccine is that unstoppable force. In the trypanophobia forum on Reddit, where self-identified needle avoiders gather, conversations about treatments, both professional and self-guided, increased multifold starting in mid-2021, many centered around a general desire or need to be vaccinated against COVID. For some, the sudden frequency with which distressing images of needles appeared on their TV screens or social-media feeds alongside COVID news stories was also overwhelming enough to make them rethink treatment. McDougall says he even wrote a letter that spring to his local TV station in Fife, Scotland, begging them to consider using other images, though it went unaddressed.

During the pandemic, “the motivation for folks really increased,” says Sze. “Folks that hadn’t interacted with the medical system in 20-plus years in any way, shape, or form were slowly coming out of the woodwork to get support.” This chance to get to better understand a hidden patient population has allowed experts like Sze to begin reimagining what the experience of routine needle-based care can look like.

Reshaping life-long attitudes about healthcare

It’s not uncommon for children to be apprehensive about needles, and interactions early in life with the health care system can easily set the tone for lifelong attitudes toward medicine. In many cases, says Sze, trypanophobia begins with a key incident in youth. “When you look into peoples’ history with needle phobia,” she says, “most people can remember vividly where they had a moment at a young age where they felt very out of control and their autonomic nervous system kicks in.” This fight-or-flight response, she adds, can become deeply ingrained over time, in some cases remaining long past the initial memory of the incident that caused it. In some cases, the fear is learned simply from watching an ill family member undergo treatment.

Studies show that the numbers of people suffering from the remnants of childhood needle-based trauma could be increasing. A 2017 study showed a strong correlation between the number of childhood vaccines given on the same day and later preadolescent needle fear around age 10. The standard number of vaccines given to children increased throughout the 1980s and ‘90s with the development of reliable Hepatitis B and Varicella, or chickenpox, treatments among others. “Getting four shots in a row at age two versus before, having to get only one or two shots per visit can increase that experience of distress,” for infants and toddlers, says Sze.

For Alex Coyne, a 45-year-old code enforcement officer in Pittsburgh, the phobia began around age 11, when he walked into a fire escape and had to get stitches near his eyelid. In a common feature of many inciting incidents, Coyne remembers the practitioner having little patience for his apprehension, instead telling him to “just suck it up,” he says. Today, his resistance feels like “a control thing,” he explains. “I’m a grown man, and you’re not going to do this to me again.”

Just being in a doctor’s office makes Coyne nervous. “I don’t trust them. I want to, and a lot of them mean well, but to me, they don’t care,” he says. “Intellectually, rationally, I know that they do. But that’s where that 11-year old brain kicks-in. And it says, ‘they’re going to toss you around, and they are going to hurt the hell out of you and not care.’“

For some, this need for control leads to an expert-level understanding of needle and injection types. Trypanophobes explain it as a sort of know-thine-enemy approach to coping with an otherwise frighteningly ambiguous fear. As a result, online spaces dedicated to trypanophobia often contain encyclopedic levels of information about which procedures require which width implements and how deep into the skin or muscle different needles need to go to deliver medication.

To Sze, needle phobias are a public health issue, a perspective she’s been encouraging clinicians to embrace since the start of the pandemic. “In the psychotherapy world, we’re often using this one-on-one treatment model approach, and to me that felt very insufficient to meet the demands of what was happening globally,” she says.

With the help of colleagues, Sze started the I Don’t Like Needles project, designed to offer free treatment referrals and resources to those struggling with needle phobia. From October to April of 2022, the project offered free counseling sessions to those hoping to get vaccinated. Today, Sze and fellow psychologist Julie Lustig are working with Sutter Health’s California-based sensory vaccination clinic, where specialized care can be given to individuals, many with autism, who are unable to be vaccinated in a normal clinical setting. They are piloting best practices and principles they hope to share with health care providers more broadly. “Because this has been a pretty silent population that has avoided a lot of medical care, there hasn’t been enough advocacy around what their needs are,” she says.

The fear is gradually being talked about more. In 2022, the U.S. Centers for Disease Control added a few pages about needle fears and phobias to their website, including guidance for both adults and the parents of young children.

The test clinic that Sze works with uses a wide variety of interventions. “There’s some simple stuff like being able to use ice or vibration to block the pain signal or letting the person know that they don’t have to watch what’s going on—you can watch a YouTube video if you’d like, or listen to music,” Sze says of the test clinic. “You can have the option of a chair that kind of lies flat so you can lie down if you have a history of fainting.” The key, she says, “is just working in that patient advocacy role—checking in and not assuming that this person doesn’t have needle phobia when you are vaccinating them.”

COVID forces the issue

McDougall and Coyne both sought out therapists in 2021 with the goal of being able to receive COVID vaccines. For Coyne, whose wife is immunocompromised, it felt like he had no real choice in the matter. “It was like, look, you’re gonna have to face this,” he says.

He sought out a therapist in his area, and found one who agreed to help him, suggesting that they try eye movement desensitization and reprocessing (EMDR) therapy, a newer technique commonly used to treat traumas that’s also gaining traction in the treatment of phobias. Coyne’s specific memories attached to his fear made him a good candidate for EMDR. Once he made the decision to seek help, he says, he’d have tried just about anything. “I can handle a lot,” he says, “And it’s ridiculous to me that I can’t rewire my own brain to not be afraid.” His children, he says, are fully vaccinated and have no issues with needles.

Coyne says his roughly half a dozen sessions with the therapist didn’t help much, but he was determined. That August, armed with a Valium prescription from an understanding primary care physician, his wife for support, and headphones playing his favorite songs from Finnish metal band Nightwish, he went to his local pharmacy and got a Pfizer mRNA shot.

“Before it got done. I couldn’t imagine life after it,” Coyne says of the apprehension he felt. “To me, life wasn’t going to be the same after this was done. And I knew how ridiculous that was. but it was such a monumental event.” The second dose, three months later, was so much easier, he says, that he didn’t even bring anyone to the pharmacy with him. But he refused a flu shot offered by the same pharmacist. For Coyne, any injection other than Pfizer’s COVID shot felt, and still feels, like an entirely different beast. “It doesn’t make any sense,” he acknowledges.

When McDougall called the U.K.’s COVID helpline to ask about vaccination accommodations for his phobia, he says he was passed from supervisor to supervisor and talked to “like a freak.” Eventually, he decided to look outside the National Health Service and found a therapist who specialized in exposure therapy. Exposure therapy is by far the most empirically effective treatment for needle phobias, and involves making a thorough list of an individual’s triggers from least to most severe before eliminating them one by one through desensitization exercises. For McDougall, this meant repeatedly watching videos of specific injections—as well as ordering a full set of commonly used needles from a medical supplier to touch and look at.

Thanks to a friend who worked at a local vaccination clinic,McDougall was able to make an appointment to be vaccinated alone in a side room at the clinic rather than having to sit and wait where he’d have to watch others get shots before him. Without that accommodation and his own preparations, it’s almost certain that he’d never even have made it through the clinic door. “Before exposure therapy, I’d driven up to a vaccination center, had a panic attack in my car, and come home,” he says. Like Coyne, McDougall found that going back for the second dose was much easier.

Coyne, McDougall, and others who received COVID vaccines after decades of avoiding the health care system have found themselves grappling now with a decision: Continue the grueling work to break down their fear even more, or celebrate the victory and retreat back to an avoidance of non-acute care? McDougall returned to exposure therapy six months ago, and though Coyne still hasn’t tried the approach, he’s toyed with the idea. “I do think about getting older,” he says. “My wife wants me around and I want to live a very long life with her.”

Coyne and others understand that the doctor’s office is inevitable—and they hold out hope that better accommodations will exist by the time they get there.

COVID-19 forced many adults to confront their fear of needles. Now, medicine has an important opportunity to earn their trust back.

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Health – TIME

COVID-19 forced many adults to confront their fear of needles. Now, medicine has an important opportunity to earn their trust back.

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October 12, 2023
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5 minutes Read

I Wrote the Book On Juul in 2021. Here’s What’s Happened to the Vaping Industry Since

The problem with writing a book about current events is events don’t stay current for long. I finished writing my book, Big Vape: The Incendiary Rise of Juul, in January 2021, at a time when the future of both mega-popular vaping brand Juul Labs and the entire U.S. e-cigarette industry were in flux. Each time news broke after the draft was done, I wished I could go back and update it—but of course that wasn’t possible.

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I got some closure when my book was adapted into a Netflix docuseries, Big Vape: The Rise and Fall of Juul, which premiered Oct. 11. The series’ producers worked on it long after my book came out, allowing them to weave in big developments that hadn’t happened when I finished writing—but even still, the story of Juul and vaping is ongoing, and no one knows how it will end.

Here’s what has changed since Big Vape was published, and what I view as the biggest question marks about the vaping industry.

Regulators banned Juul…then back-tracked

The U.S. Food and Drug Administration (FDA) has long played catch up when it comes to regulating the vaping industry. Brands including Juul were already widely available nationwide when, in 2016, the agency finalized a process for assessing their health effects. That meant e-cigarette companies already in business had to retroactively prepare paperwork to prove that their products were beneficial for public health; if they couldn’t convince the FDA, regulators could order them to stop selling their vapes in the U.S.

When I finished writing Big Vape, Juul had submitted its application but the FDA hadn’t reached a verdict yet. Then, in a dramatic decision in June 2022, the FDA said Juul had not provided adequate toxicology data for its products and ordered them off the market.

Then, following an appeal from Juul, the FDA began a secondary review of its data, which is still in progress. Meanwhile, Juul devices remain on the market. It’s already been more than a year since that all happened, and the FDA has given little public indication about what it will ultimately decide.

Juul has also submitted an application for a new product: a Bluetooth-enabled “next-generation” device that’s meant to lock out underage users and reject counterfeit pods, but it’s anyone’s guess whether the FDA will authorize it.

Tobacco giant Altria broke up with Juul

At the end of 2018, the tobacco giant Altria (which owns the company that makes Marlboro cigarettes) paid almost $13 billion for 35% of Juul. But as scrutiny on Juul grew and the FDA cracked down on its marketing and sales practices, Altria valued its investment lower and lower—down to just $250 million by the end of 2022. In March 2023, Altria announced it would exchange its minority ownership stake for the right to license some of Juul’s intellectual property, a signal that Juul’s business had suffered enough that the Big Tobacco company wanted to move on. Altria also purchased NJOY, a different e-cigarette maker.

That’s only one element of Juul’s financial struggles. Juul has been sued by everyone from school districts to state attorneys general for its role in the teen vaping epidemic, and over the past couple years, it has agreed to pay nearly $3 billion in legal settlements. Juul’s revenue is also significantly down from its peak, and the company has been through multiple rounds of layoffs.

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Teens have largely moved on from Juul

Juul became notorious for being the e-cigarette teens used in school bathrooms and on Snapchat. But these days, federal data suggest underage users have mostly moved on to single-use vaporizers that—unlike Juul, which is now only available in tobacco and menthol varieties—come in tons of flavors. Among the roughly 10% of U.S. teens who regularly vape, more than half now use disposable e-cigarettes, according to the FDA. My anecdotal research backs this up. When I’m walking around my neighborhood in Brooklyn, I see tons of teenagers with vapes made by brands like Elf Bar and Air Bar, and hardly any hitting Juuls.

For the record, most disposable vapes are not supposed to be sold to anyone, underage or not, because they haven’t gotten authorization from the FDA. But it’s proven so difficult for the agency to keep up with regulating a large and ever-changing market that many continue to be widely available.

There is (still) a lot of debate about the risks and benefits of vaping

This was true when I began covering vaping in 2018 and it’s still the case now. Some researchers believe vaping can help adults stop smoking cigarettes and transition to a less-dangerous form of nicotine. Meanwhile, other studies find that vaping is not an effective way to stop smoking and may come with significant health risks of its own, including increased chances of developing lung and heart diseases. The big caveat to the whole debate is that e-cigarettes only became widely used and studied within the past couple decades, which is not all that long in the world of health research. More health risks—or benefits—could come to light as vapers are studied for years to come.

One thing, however, remains clear: the safest choice is not to use any tobacco product at all.

The Netflix series “Big Vape” tells the story of the once-dominant Juul Labs—but it and the the U.S. vaping industry remains in flux.

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Health – TIME

The Netflix series “Big Vape” tells the story of the once-dominant Juul Labs—but it and the the U.S. vaping industry remains in flux.

Uncategorized
October 12, 2023
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11 minutes Read

She Sued Tennessee For Denying Her an Abortion. Now She’s Running For Office.

Allie Phillips never wanted to be a politician, but she had always wanted to be a mom of two. Whenever Phillips asked her 5-year-old daughter, Adalie, what she wanted to be when she grew up, Adalie would say, “A big sister.” So when Phillips found out she was pregnant again in Nov. 2022, Adalie was thrilled. “Her eyes got big and her jaw just dropped open,” Phillips recalled. “Every night after that, she sang Twinkle Twinkle, Little Star to my belly. She’d kiss my belly every night before bed.” Phillips and her husband planned to name the new baby Miley Rose.

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But at a routine anatomy scan when she was around 19 weeks pregnant, doctors told Phillips that the fetus had significant problems with its kidney, stomach, bladder, heart, lungs, and brain. These conditions were “not compatible with life outside the womb,” a doctor told Phillips. Miley Rose would likely die before birth, and the longer Phillips stayed pregnant, the worse her own health could become.

But Phillips, who lives in north Tennessee, could not get an abortion in her home state. After the Supreme Court overturned Roe v. Wade, Tennessee enacted one of the strictest abortion bans in the nation, leaving only the most narrow exception for emergency medical situations. In February, Phillips and her husband had to travel almost 1,000 miles to get an abortion in New York City.

Shortly after she returned, Phillips was approached by the Center for Reproductive Rights, which is representing patients in multiple states who were denied medically necessary abortions. The lawsuit seeks to ensure that pregnant patients can access abortion when their own health is at risk, and to give doctors clarity on which “medical emergencies” are exempted from state abortion bans.

Phillips also met with her state representative, Republican Jeff Burkhart, to tell him her story. She wanted to ask for his help writing Miley’s Law, which she hoped would expand abortion options for parents when a fetus is diagnosed with severe anomalies. When Phillips told him about her pregnancy loss and mentioned her older daughter, “He said, ‘I thought women could only have a miscarriage in their first pregnancy,’” Phillips recalls. “The lack of knowledge, the lack of education, is astounding.”

That’s when she began to think about running for his seat.

Phillips is a bubbly 28-year old with a halo of golden curls and a TikTok account dedicated to her journey with pregnancy, pregnancy loss, and abortion-rights advocacy. She became a single mom to Adalie when she was 22. Three years later, she married her husband, Bryan Lynch, an old high-school flame. She runs a daycare center out of her home. “Being a single parent, daycares were expensive and hard to find,” she explains. “I wanted to help other moms in my community by not charging as much.”

Phillips and her husband planned to try for another baby as soon as they could afford a bigger home. In the summer of 2022, it was finally time. “We got married, we got our house, and we were about to expand our family,” Phillips says. The pregnancy seemed to be progressing smoothly until the anatomy scan. Adalie wanted to see her baby sister, so the couple decided to make the routine scan in February a “family affair,” Phillips recalls.

As soon as the ultrasound began, Phillips could sense that “the emotion in the room was kind of off.” About five minutes in, the technician stopped the exam and told Phillips that she needed to talk to her doctor.

“Is everything okay?” Phillips asked.

“I saw some things that are concerning,” the technician replied. Phillips’s stomach dropped.

The doctor came in and told the family that the scan had detected multiple fetal abnormalities. The doctor urged Phillips to see a high-risk maternal-fetal medicine specialist. Four days later, after a second ultrasound, that specialist told Phillips that Miley Rose’s kidneys, stomach, and bladder weren’t functioning. Her heart had only two working chambers, and her lungs had not developed at all. Worst of all, the fetus’s brain had semilobar holoprosencephaly, which meant the brain had not properly split into two hemispheres.

“While she was talking about everything that was wrong, I was thinking, ‘She could get a heart transplant, she could get a kidney transplant, this is fixable,’” Phillips recalls. “But then she got to the brain and I thought, ‘Oh no.’”

The doctor informed the family that Miley Rose was highly likely to die in utero. If she did make it to birth—fetuses with semilobar holoprocencephily have only a 3% chance of making it to delivery—she would die shortly after. The doctor also told Phillips that the longer she stayed pregnant, the higher her own risk of health complications, especially because her condition was already delicate because of a gastric sleeve that had been installed before her pregnancy.

But by that point, in Feb. 2023, abortion was outlawed in Tennessee. Doctors who performed abortions had to provide “affirmative defense,” meaning that the burden was on the physician to prove that the abortion was necessary to save the patient’s life. Phillips had two options: she could continue her pregnancy and put her own health at significant risk, or she could travel out of state to terminate it.

Phillips explained to Adalie that she wouldn’t get to meet her little sister. She went to a 3D ultrasound clinic, and got Miley Rose’s heartbeat recorded in a little teddy bear. Then she and her mom started looking up out-of-state clinics where she could get an abortion.

The cheapest option was in New York City. The procedure cost $1,100, the flights cost $650, and hotels were expensive. But Phillips, who had shared the details of her pregnancy and then the news of the fetal abnormalities on TikTok, received an outpouring of support from her followers, who raised money for her procedure and offered her a place to stay in the city. “I’ve always wanted to go to NYC,” she says. “But I didn’t want to go for this reason.”

After she arrived at the clinic, Phillips underwent another ultrasound. That’s when she was told that Miley Rose’s heartbeat had already stopped. Phillips went into the hallway, sat down on the floor by the elevators, and cried.

When she was called back in to see the doctor, he explained that since the last recorded fetal heartbeat was over a week earlier, she was at serious risk of blood clots, infections, or sepsis. They had planned to do the abortion the following day, but it was too risky to wait. “It happened so fast, I didn’t have a moment to breathe,” Phillips says.

After she woke up from the procedure, a nurse asked her if she was okay. “I said, ‘So I’m not pregnant anymore?’” Phillips recalls. “And she said, ‘Ma’am, you’re not.’”

Losing Miley Rose was hard enough. But the more Phillips thought about it, the more enraged she became. Not at the loss of her daughter, but at the Tennessee abortion restrictions that forced her to travel out of state for a procedure she needed to protect her own health.

Phillips’ story had gone viral on social media as she shared details about her ordeal. In late March, the Center for Reproductive Rights reached out to her over Instagram, asking if she would join a multi-state lawsuit challenging state bans that prohibit medically necessary abortions. “It felt like a no-brainer,” Phillips recalls. “The whole point of me sharing my story was to open new doors, and this was a door.”

In March, the Center for Reproductive Rights filed suit against the state of Texas. In September they filed additional lawsuits against Tennessee and Idaho. The suits were brought on behalf of 20 women denied abortion care across all three states, as well as doctors and medical associations. The goal, says the plaintiffs, is to clarify the “medical emergency” exceptions to abortion bans in order to protect patients’ access to abortion during dangerous medical situations, and to ensure that the law allows doctors to treat their patients without fear of prosecution.

In April, Tennessee changed its abortion law to allow doctors to use “reasonable medical judgement” to provide abortions to prevent “death… or to prevent serious risk of substantial and irreversible impairment of a major bodily function.” But the Center for Reproductive Rights argues that the way the law is currently written is “not a meaningful exception,” says Linda Goldstein, senior counsel at the Center for Reproductive Rights and the lead attorney on the Tennessee case.

“Using ‘reasonable medical judgement’ means that the doctors can be second-guessed. If the prosecutor brings a case and hires a medical expert, the medical expert could say ‘Oh, that wasn’t reasonable,’” says Goldstein. “Doctors are at risk of going to jail and losing their license.” Abortion remains a felony in the state, with doctors at risk of being sentenced to three to 15 years in prison if convicted.

In Tennessee, the Center for Reproductive Rights is asking a court to clarify that the state’s medical exception must permit doctors to use their “good faith judgement” to provide abortions when pregnancy poses a risk to the patient’s health, including their future fertility, or when the fetus is unlikely to survive. The suit also asks the court to affirm that pregnant patients have a right to life and health under the state constitution, and that the equal protection clause guarantees the right to an abortion when the pregnant person has a medical condition that poses a risk to their health. The goal, says Goldstein, is to “to clarify that women don’t forfeit their right to life or health when they get pregnant.”

As Phillips was in the process of joining the lawsuit, she asked for a meeting with her state representative, Burkhart. She visited him in June and asked for his help writing Miley’s Law. Phillips asked Burkhart if he had a daughter. “If she called you and told you she had a fetus incompatible with life, and her life were at risk, what would you tell her to do?’” she recalls asking him. “He said, ‘The way I grew up, I’d tell her to continue the pregnancy.’”

Phillips says that Burkhart spend the majority of their meeting arguing with her about how “high risk” she would have to be to need an abortion. (Burkhart did not respond to multiple requests for comment; his office declined to comment on Phillips’ recollection of their conversation, and did not respond to a detailed list of questions.)

Phillips knew that Burkhart, who is in his first term representing a new state House district in north Tennessee, had run unopposed in 2022. “I thought, ‘Somebody needs to step up,’” she says. Her mother suggested she run for the seat. Then two friends told her the same. Soon she started hearing from people in the Montgomery County Democratic Party, which she had joined shortly after returning from New York.

If Montgomery County had been deep red, Phillips might have passed on the idea. But she thought victory was possible. Burkhart had won his seat in 2022 with fewer than 7,000 votes, and no opponent. If she could knock on 15,000 doors, she thought, maybe she could beat him.

It may be an uphill battle. Trump won Montgomery County by double digits in 2020. But abortion bans have reshuffled political dynamics around the country, including in conservative areas. “Her campaign is already off to a strong start because she has such a clear rationale for running,” says Amanda Litman, co-founder of Run for Something, an organization which recruits and trains progressive millennials to run for state and local office. (The group is not yet working with Phillips.) “I think she is the first but not the last of candidates who tried to get abortion care, especially since this is the first cycle where people will have had to newly navigate bans in many states.”

For Phillips, running for office doesn’t ease the pain of losing Miley Rose. But it does give her a sense of purpose. “I’m gonna take my trauma, I’m gonna take the loss of my daughter, and I’m gonna turn it into something good,” she said. “The more I’m able to share my and Miley’s story, the more I’m likely to make positive change.”

After being denied an abortion, Allie Phillips joined a lawsuit challenging her state’s abortion ban—then decided to challenge her state rep

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Health – TIME

After being denied an abortion, Allie Phillips joined a lawsuit challenging her state’s abortion ban—then decided to challenge her state rep

Uncategorized
October 12, 2023
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6 minutes Read

The Story Behind Netflix’s Docuseries Big Vape: The Rise and Fall of Juul

Adaptations in Hollywood are nothing new, but they’ve been at the center of many of this year’s biggest pop-culture conversations. Any intellectual property seems up for reimagining, from books to toys to video games. There are many reasons behind their appeal to studios, among them that they tend to come with built-in audiences—but as I learned firsthand over the past few years, they can also give projects new depth and complexity.

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On Oct. 11, an adaptation of my 2021 book, Big Vape: The Incendiary Rise of Juul, premiered as a Netflix series called Big Vape: The Rise and Fall of Juul. In addition to being interviewed on camera, I served as a consulting producer on the series. My role involved helping translate from page to screen the wild tale of Juul Labs, the vaping company that set out to create an e-cigarette good enough to make cigarettes obsolete—and instead became infamous for hooking countless teenagers on nicotine. Through that process, I watched my reporting take on new life and become enriched by even more perspectives on the complex, controversial story of Juul.

Ahead of the series’ release, I spoke with Big Vape’s director R.J. Cutler, the filmmaker behind documentaries including The September Issue and Billie Eilish: The World’s a Little Blurry, about adapting a work of nonfiction, the differences between documentary filmmaking and journalism, and capturing nuance on screen.

TIME: First of all, what about Juul interested you?

R.J. Cutler: What grabbed me, and to this day has not let go of me, is that this story is a perfect way of exploring the unintended consequences of Big Tech. A couple of design students at Stanford have the bright idea to create an e-cigarette that they believe not only won’t be bad for you, but also will help you quit smoking combustible cigarettes. And what do you know? They ignite the epidemic of teen vaping.

How do you approach adapting nonfiction material? Did it ever feel stifling to base the series on a book instead of starting from scratch?

Quite the opposite. It gave us an incredible foundation for the shape of the narrative and the structure of the narrative, but also highlighted where we would want to add things that weren’t in your book. There was a lot of freedom; this was going to be a cinematic telling of the story as opposed to a prose journalism telling of the story. And what a gift, to have somebody who had already been through the experience, banged your head against the wall, digested it all and suffered through the attendant stomachaches, and came up with a resonant, coherent, dramatic, compelling, character-driven narrative. And guess what? We’re free to use it all!

When we first started working together, though, my book wasn’t finished. Did that scare you? I mean, what if the book turned out terribly?

That didn’t occur to me.

That’s good, because I worried about it a lot!

With a lot of the work I do, you have to have faith that it’s all going to work out. When you get to the other side of the forest, the path to get through seems pretty clear. But we’re always, at the beginning, looking at a forest. If I found that daunting, where would I be? I love to cook, so I often equate the process to making a reduction. You’re reducing, reducing, reducing to get to the essence of the thing.

As you know, my big concern was maintaining the complexity of the story as it transitioned from book to series. It’s easy to see Juul as a villain, and they deserve much of the criticism they get. But, at the same time, Juul has helped some adult smokers. It’s messy.

One of the things I get asked a lot is what surprised me the most about Juul’s story. And to me, the biggest surprise was that the damn thing worked. In spite of all the mistakes the company made and all the things that led to the fall of Juul, they did invent this electronic cigarette that had the potential to do all the things they set out to do.

This was a story that had been told before, but, with the exception of your book, it had often been reduced beyond the complexity of a fine sauce. It was reduced to runny ketchup. I wanted to explore the gray area.

I was similarly surprised by that while writing my book. I had covered vaping for a couple years when I started, but when I fully immersed myself in the story, it became even more complex to me. It was interesting to see my thought process evolve as the book came together.

I like to say films resonate between the things that I witness, the things that I learn, the things that I see being experienced, and the experience I myself have. Even with the same exact footage, I would make a completely different film than another filmmaker. There’s an authorial presence. It’s part of the story that you’re telling.

I agree, though as journalists we’re trained to minimize that authorial presence. How do you see your role as a documentary filmmaker compared to that of a journalist?

Documentary filmmakers are working in cinematic art. And while we are every bit as beholden to the truth as a journalist is, the values of cinematic art are different from the values of objective reportage. They live differently. We’re working with light and color and sound and image and structure. We’re dealing with an art form that is larger than life but resembles life. It deals with human emotion in a way you can experience. You’re on a journey that finds an equilibrium in complexity.

This conversation has been condensed and edited for length and clarity.

Director R.J. Cutler on the process of making a non-fiction book into a documentary.

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Director R.J. Cutler on the process of making a non-fiction book into a documentary.

Uncategorized
October 11, 2023
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Do You Still Have to Isolate If You Catch COVID-19? Here’s What to Know

At this point, life in the U.S. has largely returned to pre-pandemic normal. The COVID-19 public health emergency is over, mask mandates are mostly gone, and offices and schools are open again.

But one hallmark of the pandemic remains in place: The U.S. Centers for Disease Control and Prevention (CDC) still directs anyone who tests positive for COVID-19 to isolate themselves from other people for at least five full days. Once those five days are up, the CDC recommends wearing a high-quality mask, such as an N95 or KN95, around other people when indoors for an additional five days.

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It’s good to be up-to-date on that guidance at a time when many people are testing positive for COVID-19—and when the winter respiratory disease season is just around the corner. Here’s what you need to know about COVID-19 isolation in 2023.

What exactly does it mean to isolate?

Under the CDC’s guidance, anyone with COVID-19 should stay away from other people—including others in their household—for five full days, or longer if they were seriously ill or symptoms haven’t improved after five days. The first day of isolation is defined as either the day after symptoms start, or the day after a positive test result if someone is asymptomatic.

During their five days of isolation, the person who is sick should stay home from school or work and avoid other public places. If they live with others, they should keep away from them as much as possible, including by using a separate bathroom if one is available and not sharing household items such as cups and towels, the CDC says. If total isolation isn’t possible, the CDC recommends that the person with COVID-19 wear a mask whenever they have to be around other people, inside or outside of the home.

Anyone with COVID-19 should also continue masking when around other people indoors for an additional five days after their isolation period ends, as some people remain contagious longer than five days. If someone tests negative on two separate at-home tests taken 48 hours apart, however, the CDC considers them safe to be around other people without a mask, even if it hasn’t been a full 10 days.

How do COVID-19 isolation guidelines compare to those for other diseases?

The CDC’s guidance for people who have the flu—perhaps the closest parallel to its COVID-19 recommendations—is similar but a bit more relaxed. The agency recommends that people with the flu stay home for four to five days, or until their fever has been gone for at least 24 hours.

Does science still support COVID-19 isolation?

“People being aware that they can help stop the spread of infectious disease is still useful and important,” says Alyssa Bilinski, an assistant professor of health policy at the Brown University School of Public Health. Urging people to stay away from others while sick, or to at least wear a mask if they have to be around people, is a good way to do that, she says.

Katelyn Jetelina, an epidemiologist who often interprets COVID-19 research in her newsletter, says that, if anything, five days of isolation isn’t long enough to stop people from spreading the virus. “COVID is not the flu,” she says. “We remain far more contagious for longer with COVID.”

Indeed, one study from 2022 found that, in a small group of people who caught COVID-19 in either 2020 or 2021 and were tested multiple times during their illnesses, two-thirds were still infectious five days after symptoms began. Meanwhile, a 2023 modeling study estimated that each 100 people who isolate for five days and then return to normal life cause 23 secondary infections—a number that the authors estimated would go down to only three if people self-tested after six days, leaving isolation if they tested negative or continuing to stay home if they tested positive.

If stopping infections were the only consideration, Jetelina says she’d recommend people isolate themselves for 10 days. The challenge, she says, is that public-health policies have to take into consideration what’s realistic and manageable for the general population—and with limitations around sick leave and affordable child care, many people can’t afford to pause their lives for 10 days.

As Bilinski sees it, anyone with access to at-home tests should put more stock in their test results than in the number of days they’ve stayed home. Studies suggest that antigen test results are a good indicator of contagiousness, with a positive test meaning someone could still transmit the virus and a negative test meaning they likely won’t.

Just be sure to take more than one test if you can, Jetelina says. Most manufacturers recommend taking a second test one to two days after a negative result to confirm it’s not a fluke that could put others at risk.

How long will COVID-19 isolation policies last?

A CDC representative declined to comment on the agency’s plans for keeping COVID-19 isolation guidelines in place. But Jetelina predicts they aren’t going anywhere, at least for the upcoming illness season. “How [respiratory-disease season] unfolds this winter,” she says, “will have implications on how we start managing this disease, if any differently.”

What to know about the CDC’s isolation guidance in 2023.

Uncategorized, COVID-19, healthscienceclimate

Health – TIME

What to know about the CDC’s isolation guidance in 2023.

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October 11, 2023
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13 minutes Read

Bed Bugs Aren’t Just a Problem In Paris. Here’s Why

The news reports are alarming to say the least. Paris, the city known for its style, cuisine, and amour, has a bed bug problem. Video of the insects crawling over Metro seats, in hotels, and swarming buses and movie theaters swept the internet, and bed bug anxiety reached a new high.

But what’s behind the Parisian invasion? How did bed bugs launch such a widespread infestation of the city? With Paris hosting the first Olympics in the post-COVID-19 era next summer, those questions aren’t just matters for idle conversation.

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The reality is that the infestation didn’t happen overnight. It’s likely that Paris, as well as other cities and even less-densely populated areas around the world, harbor a consistent, and persistent bed bug problem. And with the boom in travel since the pandemic, people in Paris are noticing them.

A number of factors keep bed bugs surviving and thriving, say entomologists, many of which are directly related to human behavior. Part of the problem may be the way we manage the pests. Unlike mosquitos and ticks, which government groups address with wide-scale, community-wide spraying and eradication efforts, bed bugs are seen more as an individual, rather than a societal, problem. And not everyone has the time or money to take the proper steps to get rid of them, so the insects continue feeding, breeding, and spreading to find new hosts.

Contrary to anecdotal reports, bed bugs aren’t the result of poor hygiene and aren’t limited to lower income communities. It’s just that less advantaged people don’t have the resources to eradicate them. “I’ve dealt with reports from five star hotels, first class airline seats, and high end apartments,” says Zachary DeVries, assistant professor of entomology at the University of Kentucky. “Anybody can get bed bugs, but only those with resources can get rid of them.”

That’s why, particularly in densely populated cities like Paris, there may be reservoirs of bed bug populations in more disadvantaged communities, which then spread as the insects hitch rides on public transportation, into restaurants, movie theaters, retail stores—essentially anywhere people go.

But there are other reasons why the bugs are so difficult to eradicate.

Humans and bed bugs—a long, and close, history

Bed bugs are unique in that they depend almost exclusively on humans to survive. They only need blood—while they feed on livestock and chicken blood they preferentially suck on people—to keep them going. If they have a human host, they don’t even need water. And they established this parasitic relationship centuries ago. Cave drawings depict bed bugs, while wood prints captured their flat, tiny bodies and when cameras were developed, the first pictures of them emerged in the 1800s.

Culturally, bed bugs have also shaped human history. Some historians suggest that the annual practice of spring cleaning may have begun as an attempt to flush out bed bugs, which tend to be less active during the colder winter months, before they were reinvigorated in the spring and summer.

“They are reclusive and extremely shy,” says Gail Ridge, an associate scientist at The Connecticut Agricultural Experiment Station, a state and federally funded research facility. “They are dependent on human beings to live, so they live a conflicted life of terror, since we are the prime predator on the planet. So they can only survive by having a series of mechanisms to elude our efforts to kill them.”

One of them may be a remarkable ability to inbreed. For most living things, finding new, and distantly related, mates is key to passing on genes and keeping their kind going. Inbreeding is normally a species-killer, since mating with genetically related members can introduce dangerous, and potentially lethal, mutations. But bed bugs aren’t saddled with such limitations; in fact, a single female carrying eggs can seed a new colony of bugs in a location as the future generations breed among themselves. “We have seen brother-sister matings for 20 to 30 generations and nothing happens,” says DeVries. “The later generations are just as happy and healthy as the first.”

How pesticides solved the bed bug problem—before making it worse

The most aggressive human efforts to eradicate the bugs involve pesticides such as DDT and organophosphates. They were so effective that from the 1950s to the 2000s, these chemicals largely eliminated bed bugs from the developed world. But bans on them after their toxic effects on human health were discovered gave the bugs a break, along with broader international trade rules that opened the exchange of goods across the world. “Bed bugs became a problem after we went through the ban on organophosphates indoors,” says Jody Gangloff-Kaufmann, an entomologist at the New York State Integrated Pest Management program at Cornell University. The bugs came back in the early 2000s, spread primarily along trade routes from developing nations to industrialized countries, and flourished in a new world with less aggressive chemical attacks. In 2010, cities like New York experienced massive bed bug infestations, with alarming sightings closing retail stores in Soho and South Street Seaport. Even workplaces weren’t immune, as the insects infiltrated Time Warner’s headquarters near Central Park as well.

Worse, the new generations of bugs were highly resistant to any chemicals used to treat them. “The bugs we have today are not the same as their grandparents,” says Dini Miller, professor of entomology and urban pest management specialist at Virginia Tech University. “We have thick-skinned, hard-drinking, mutant bed bugs.”

Exposure to the pesticides has pushed the bugs to develop harder exoskeletons, which prevents the chemicals from penetrating into their bodies for two reasons. One,, “bed bugs walk on hooked claws and lift their bodies off the ground,” says Nina Jenkins, an affiliate professor of entomology at Penn State University. “So the amount of bed bug that contacts a surface when they are walking is a very small proportion of their body—so if they walk over a toxin-treated surface, they don’t absorb enough to kill them.”

And even if the bugs do absorb some of the chemicals, they have developed enzymes that can break apart toxins and neutralize them. “We may knock them down and they look dead, but four hours later, they get up and shake it off because the enzymes in their bodies are breaking down the insecticide and they can recover,” says Miller. “We have basically killed off all the bugs that are susceptible to insecticides, and selected for the resistant ones. We’ve done it to ourselves.”

Not only have people introduced pesticides that have generated new super breeds of resistant bugs, but humans have also removed one of the bed bug’s primary predators: cockroaches. “Cockroaches, like bed bugs, can get into cracks and crevices and they hunt bed bug eggs,” says Ridge. “But now that cockroaches are being knocked out in many cities, bed bugs have no predator.”

They never went away

These resistant bugs are getting hardier and hardier. Cross breeding with different populations makes them even more fertile, says Ridge. She has crossed two different lab populations of bed bugs and found that the fecundity of the females doubled. “I can only assume that’s happening in the wild as well,” she says, especially since bugs from different parts of the world are likely mixing and matching thanks to widespread human travel.

And thanks to the fact that simply spraying with a can of insecticide doesn’t get rid of them, these bugs are finding hospitable habitats in certain populations. “One of the things I’m seeing is a huge increase in the demographic of elderly disabled living with thousands upon thousands [of bed bugs] in their home,” says Miller. “These are individuals with 17 other problems, including physical, mental ,and financial [problems], and bed bugs are just one of them. Those are the sources that we are now seeing.”

Because the bugs aren’t being eliminated from these populations, they may continue to hitch rides to other locations where they find new hosts. “Bed bugs settle in with people who can’t deal with them effectively,” she says. So despite media reports about infestations in hotels, they are rarely the source of widespread problems, since hotels can afford effective, and often expensive, pest control measures. Individual home owners, and owners of apartment buildings, halfway houses, and nursing homes, however, often cannot.

The best ways to get rid of bed bugs

There is no single approach that effectively controls bed bugs. It takes a series of painstaking steps, performed correctly—usually with professional training—to truly get an infestation under control. “There is very little the homeowner can do to get rid of the problem,” says DeVries. Sprays that claim to eliminate bed bugs won’t truly get the job done since the bugs are resistant to most of them, and, if they are effective, they only push the bugs from one place to another. And online advice about using heat or steam by directing hair dryers or steam irons at mattresses is wrong—doing so also just drives the bugs from one place to another. Even some professional pest control services that perform heat or steam methods aren’t all effective, since they may not achieve high enough temperatures—bed bugs only die at around 125°F—or may not run the devices long enough. “I’ve heard of multi-family apartment complexes where they start at the top and work their way down, and by the time they get to the first floor, there are already reports of problems back on the top floor,” says DeVries.

As contrary as it seems, one of the most effective strategies is to not disturb the bugs as much as possible. Bed bugs don’t like to stray far from their blood meal, which means they remain in areas where people sleep and sit—hidden in cracks and crevices in mattresses and sofas. “They won’t be in the bathroom where they have to walk half a mile to feed,” says DeVries. “If you don’t disturb them, you can keep the problem concentrated to a sofa, chair or bed.” After determining where the bed bugs are, vacuuming them is the first step. Miller recommends attaching a long stocking to the outside of the vacuum hose to ensure no bugs can escape, and once the vacuuming is done, tying off the stocking and either soaking it in water to drown the bugs or disposing of them in a sealed container.

If bed bugs are crawling on clothing, putting the clothes in a hot dryer will desiccate them. Sealing the clothes once they come out of the dryer in a tight plastic bag and leaving them undisturbed for a few weeks ensures that no eggs and new generations of bugs remain.

Read more: Bed Bugs Are Most Drawn to This Color

There are also newer insecticides that don’t rely on the harmful chemicals of the past. One increasingly popular one that Miller and her team are testing is Aprehend, a fungus-based treatment that can only be applied by licensed pest control specialists. The treatment is a spore in a liquid form that is sprayed on affected areas; the contact with the fungus gives the bugs a dermal infection that kills them. The reason it’s so effective, says Jenkins, who co-developed the product at Penn State and founded a company to commercialize it, is that it’s designed to remain active for up to three months. Millions of fungal spores are spread in a thin band around the areas where bed bugs travel, and just a few steps on the treated area will bind those spores to their claws. They then bring those spores back to their nests, which may be in hidden areas no human treatment could ever reach, and spread them to other bugs, and ultimately any exposed bug dies of the fungal infection. “To be completely honest, it shocked us how successful this product has been,” says Jenkins.

Sealing infested articles or clothing can also dry them out, but bed bugs can live for months without feeding, so starving them out could take a while and it’s not always practical—nor is it guaranteed to work. Gangloff-Kaufmann had a colleague who put some bugs in a freezer for five years and once thawed, one survived.

Dust-based treatments such as silica dust can also be effective in killing bugs by suffocating them, but requires precise application since breathing in the dust can also be harmful to people, leading to cancer and lung disease.

“No one strategy is going to be effective but if you start stacking them up you could eventually catch everything,” says DeVries. “Vacuuming doesn’t get everything, but steaming could get the bugs that vacuuming misses. And if steaming doesn’t get them, then insecticides like Aprehend could. Then, setting up physical barriers could help too. We don’t know if one is working better than the other, but we know that if you incorporate them all, it could be an effective management plan.”

Even more important, entomologists agree, is recognizing that bed bugs aren’t just an individual’s problem. They should be treated as a societal problem with a societal solution. But that’s been challenging, since bed bugs don’t transmit diseases like mosquitos and ticks do. While they feed on human blood, they don’t pass on whatever they pick up, since they have a unique ability to fracture the DNA of pathogens they ingest so they are no longer capable of causing disease. “If you imagine the DNA of a virus like polio or HIV or influenza as a glass vase, once it is ingested by a bed bug, it shatters,” says Ridge. That makes controlling bed bugs a hard sell for government intervention, since they don’t technically cause public harm other than a general sense of anxiety and discomfort. Yet, says Gangloff-Kaufmann, “I like to call bed bugs a communicable insect.” DeVries agrees, noting that “everybody uses public transportation, everybody uses airlines, and everybody goes to the movies. Everybody ventures into society, and the bugs have constant opportunity to reinfest and reinvade everywhere. We let them persist. Ultimately unless they are dealt with on a broader, community-wide scale, the problem will not go away.”

Bed bugs have an intimate relationship with humankind, and our behaviors have as much to do with infestations as anything.

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Health – TIME

Bed bugs have an intimate relationship with humankind, and our behaviors have as much to do with infestations as anything.

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