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• October 10, 2023
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• 11 minutes Read

‘Hospital at Home’ Could Be the Future of Health Care. Not Everyone Thinks It’s a Good Idea

‘Hospital at Home’ Could Be the Future of Health Care. Not Everyone Thinks It’s a Good Idea

In July 2022, Rudie Watzig collapsed. The diagnosis was as serious as it was unexpected—cirrhosis of the liver—and it landed him in the intensive care unit for what he considered a period of sheer torture. “I hated it. I hated being in the hospital,” says Watzig, 44, of Portland, Oregon. “Not seeing my kids … not having my wife there … not having my nice Purple mattress to sleep on.”

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So imagine his chagrin when he was again rushed to the emergency room a few months later, this time for breathing problems due to fluid buildup around his lungs that needed to be drained with a needle in his back. His heart sank at the thought of another hospitalization stemming from his liver disease—until he was told that once stabilized, he could try something different: hospital at home.

You read that right: inpatient-style care for serious medical issues within the comfort of one’s home. “This isn’t home health light, it is true hospital-level care,” says Colleen Hole, a vice president and chief nurse executive with Atrium Health, a North Carolina-based health system that runs what is thought to be the nation’s largest hospital-at-home program, which Hole oversees. “This model actually delivers care to the patient, like pizza, but way better.”

Hospitals and health systems around the country have been rolling out flavors of “acute hospital care at home” programs as part of a national movement to not only boost the patient experience but to reduce hospital overcrowding and bed shortages, problems that are expected to intensify as more and more baby boomers advance into their senior years. 

Exactly how a program works can vary from hospital to hospital and state to state, based on regulatory issues. But generally, a patient lands in the ER or other inpatient unit and is screened to see if they’d be a good fit. 

If the answer is yes, and the patient is on board, they are “transferred” home, where they’re met by a professional who sets up everything they need to be monitored on their own turf. This may include a 4G-enabled tablet for video visits with a virtual care team accessible 24/7 at the push of a button; a phone that immediately connects to that team; a wearable device that continually tracks their vital signs; a blood pressure cuff; a pulse oximeter; an emergency alert necklace; and so on.

Patients usually get two in-person exams each day from, for example, a nurse or community paramedic, along with daily video or in-person visits with the doctor leading their care. IV medications can often be administered. Basic lab work can be taken and picked up via courier. Electrocardiograms are possible, as are certain imaging tests like ultrasounds. 

“I remember one time, I needed an X-ray of my lungs … so they had this guy—he came over with a frickin’ van, wheeled an X-ray machine into my living room and he put the plate right behind the chair here,” Watzig recalls. “I took an X-ray right where I’m sitting right now … the only thing they couldn’t bring to me was a CT machine.”

At this stage, hospital-at-home programs are being offered to patients who need hospitalization but are stable enough to be cared for safely at home, experts say. Picture everything from heart failure and chronic obstructive pulmonary disease (COPD) to severe skin infections.

Patients must meet certain criteria, which can entail living within 30 minutes of the hospital, in case of emergencies; having running water, heat, AC, and electricity; and often, not living alone, for help with basics like opening the door for care team members or making pharmacy runs. Importantly, hospital-at-home services are voluntary—never required. 

“Patients absolutely love this program,” says Dr. Vivian Reyes, national physician lead for Kaiser Permanente’s Care at Home initiative, available in four states, including Oregon, where Watzig, a Kaiser Permanente member, encountered it.

They can sit in their favorite chair. Sleep in their own bed. Be with beloved pets and family—Watzig gets choked up describing what it meant having his three young sons by his side. They can enjoy their garden between treatments, as one of Reyes’ patients did. Eat home-cooked meals. Watzig’s wife, a trained chef, made him cod with chard after they submitted a shopping list packed with liver-friendly ingredients; a few hours later, groceries arrived at their doorstep, a free perk of  Kaiser Permanente’s program.

Once recovered, patients are typically “discharged,” as with any hospitalization.

Home is where the … hospital is?

The concept isn’t exactly new. It was happening overseas and was pioneered in the U.S. by Dr. Bruce Leff, a geriatrician and researcher at the Johns Hopkins University School of Medicine. Back in the late ’80s, when he was a resident making house calls to elderly adults, he noticed that many of his patients—even those who’d just had heart attacks—were refusing to go to the hospital.

Leff still carries around a slide of one of them, Walter, a retired steelworker who lived with his cat in Baltimore. During a home visit, Leff discovered that Walter had clearly developed pneumonia, on top of his existing heart failure and COPD. “I said, ‘Walter, you need to go to the hospital because you’re really sick.’ And he looked at us and said—and I’ll never forget this—‘I’m so sick and tired of you geniuses from Hopkins. You’re great doctors, but you run a really shitty hotel.’” So Leff and his colleagues brought care to Walter. 

Hospitals can be risky places, particularly for elderly adults, Leff explains. Falls happen more often in unfamiliar quarters. Superbugs break out. Sleep can suffer from constant interruptions and alarm bells. Delirium can set in, raising the risk for long-term cognitive issues, he says. “It’s very common for older adults to decline in their ability to function strictly because of the hospital environment,” Leff says. “That motivated us to think about developing a true hospital-at-home model.”

Leff made it his mission to do just that, piloting the concept in a small group of patients at Hopkins and then expanding it to patients within the Department of Veterans Affairs, among other avenues, as part of a national demonstration study. His research consistently showed positive outcomes, even without the high-tech telemedicine capabilities of today. Patients opted in at high rates. They had fewer complications like delirium, and a better experience compared to traditional inpatient stays. Cost of care was lower.

Leff got to work trying to spread the model nationwide by sharing tools and best practices with other hospitals. “You don’t want to do this with Scotch Tape and Post-it Notes. It really has to be built out” to be done well and safely, he says. New Mexico’s Presbyterian Healthcare Services eventually rolled out an initiative with his help, as did Mount Sinai in New York. The movement was full of potential, and stood to benefit patients well beyond the elderly, he says. 

There was just one big problem: Hospitals had very few ways to get reimbursed for providing hospital-at-home care, since commercial insurers and traditional government payers largely hadn’t stepped up to the plate. “Uptake was very slow,” Leff says. Until “COVID hits, and the world goes nuts.”

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

A home run?

All of a sudden, in March 2020, “hospitals were trying to figure out what are we going to do with all these very sick patients? We don’t have room,” Hole says. Contagion was a grave concern. Field hospitals were being set up in convention centers and on ships. Solutions were urgently needed. 

In response to the pandemic, the Centers for Medicare & Medicaid Services (CMS)—the nation’s largest payer for health care services—provided regulatory flexibility allowing hospitals to offer inpatient-level care outside of the traditional hospital setting, including within people’s homes—and be reimbursed for doing so. The initiative was expanded into the Acute Hospital Care at Home waiver program, to which hospitals must apply,  and that Congress extended through Dec. 31, 2024. 

What happens next is also up to Congress. 

As of late August 2023, CMS had authorized 296 hospitals and 125 health systems in 37 states to offer acute hospital care at home. Although many hospitals haven’t gone beyond the application stage—“it’s a pretty heavy lift to stand up a program,” Hole says, compounded by reluctance tied to the waiver’s uncertain future—interest is proliferating. 

“There’s always going to be reasons you have to go to the hospital, right? We’re not going to mail you an open heart surgery kit,” says Mark Howell, director of policy for the American Hospital Association, which is ultimately advocating for a permanent program regulated by CMS and operated by hospitals. “My biggest fear, though, is that if the waiver is not extended, you lose a lot of momentum,” at a time when “there’s a chance to really change the way we deliver health care in a very innovative way.” 

The vast majority of programs would have to shut down, he says, unless they’re run by payer-providers, like Kaiser Permanente, or have other arrangements. But if the federal government were to give it a seal of permanency, the hope is that more state regulatory authorities and commercial insurers would get on board, Howell says. 

In addition to a growing pile of evidence suggests that hospital at home can produce similar, if not better, outcomes than traditional inpatient hospitalization in many domains, proponents say the model has potential to expand health care access to underserved communities (think: rural America) while addressing some of the social factors that can hinder patients’ well-being. “You get a glimpse into their lives that you can’t possibly get when they’re in a brick-and-mortar hospital,” Reyes says. 

Is there food in the refrigerator or could hunger be an issue? Mold that’s making asthma worse? Is transportation available? “We can identify those barriers and address them,” says Dr. Cheng-Kai Kao, physician leader of the University of Chicago Medicine Hospital at Home program, which recently launched after more than a year of preparation.

A different view

While some experts describe this as the future of health care, others reject that notion. “We are really disturbed by this trend,” says Michelle Mahon, a registered nurse and the assistant director of nursing practice for National Nurses United, the country’s largest union of registered nurses. NNU calls these programs “home all alone” and has published a report condemning the CMS waiver initiative. 

She says the idea that acute care patients—who could experience an urgent decline at any moment—can be cared for at home versus the hospital, where highly trained registered nurses vigilant for subtle signs of trouble are at the bedside 24/7, “is absolutely preposterous, and more importantly, dangerous.” The union views the movement as an effort by the health care industry to maximize profits at the expense of patients, replacing skilled labor with technology, she says.

Susan Reinhard, senior vice president and director of AARP’s Public Policy Institute, has a different concern: the impact on family caregivers. A nurse and “proponent of care at home,” Reinhard’s previous research has shown that family caregivers often feel overwhelmed and unprepared to help loved ones—who’ve chosen to age in place, say, versus move into a nursing home—manage even basic health conditions. 

That’s why AARP helped push through legislation in 45 states requiring hospitals to educate caregivers on the medical tasks they may need to handle once a loved one is discharged from a usual hospital stay, she explains. (Those requirements aren’t yet baked into hospital-at-home programs, she says.)

While advocates say these programs are set up to minimize family involvement, leaving most tasks to the professionals, Reinhard wonders to what degree caregivers are involved in the decision to elect hospital at home when the option is presented to patients. Do they have a say, she asks? Do they know what they’re signing up for? Who’s helping patients get to the bathroom? Bathe? Change the sheets? Do laundry—all of the services hospitals provide, she asks?

Reinhard is currently surveying hospital-at-home caregivers to better understand their views and needs. “This is a changing model of care,” she says. “When you have something new, you have to keep asking questions.”

Now six months out from a liver transplant, Watzig is thriving. He says his health is restored and he’s grateful to be alive. Two month-apart hospital-at-home stints helped him hang on during a dark time, until it became evident that a new organ was the only path forward. A time when he couldn’t tolerate the idea of being traditionally hospitalized. Says Watzig: “I am telling you—and this is not hyperbole—it literally saved my life.” 

Hospital-at-home programs nationwide are delivering inpatient-style care for serious medical issues within the comfort of one’s home. 

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Health – TIME 

Hospital-at-home programs nationwide are delivering inpatient-style care for serious medical issues within the comfort of one’s home.

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• October 10, 2023
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• 5 minutes Read

‘We’re In a New World’: American Teenagers on Mental Health and How to Cope

‘We’re In a New World’: American Teenagers on Mental Health and How to Cope

To be a U.S. teenager in 2023 is both the same as it ever was, and astoundingly different from even a generation ago. Along with all the classic challenges of growing up—grades, parents, first loves—looms a crop of newer ones: TikTok, gun violence, political division, the whipsaw of COVID-19, the not-so-slow creep of climate change.

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“The main domains are the same: school, home, family, and peers,” says Dr. Asha Patton-Smith, a child and adolescent psychiatrist at Kaiser Permanente in Virginia. But the stressors that emerge within those domains have changed tremendously in a world where the internet and real life have largely blurred into one, with everything from school to social interaction now happening at least partially online and a fire hose of bad news always only a swipe away.

This new world has taken a toll on U.S. teenagers, if the staggering data on adolescent mental health are any indication. In 2020, 16% of U.S. kids ages 12 to 17 had anxiety, depression, or both, a roughly 33% increase since 2016, according to an analysis by health-policy research group KFF. The following year, 42% of U.S. high school students said they felt persistently sad or hopeless, 29% reported experiencing poor mental health, 22% had seriously considered suicide, and 10% had attempted suicide, according to the U.S. Centers for Disease Control and Prevention (CDC).

‘In February, I was in front of a Subway … and somebody pointed a gun at me. I’m having dreams—gun-related stuff, like getting shot. I keep getting anxious from time to time. It’s like I’m not able to trust anybody at this point.’

Nolan

These data are sometimes used to argue that kids aren’t as tough as they used to be. But kids see it differently. “Other generations are telling us that we’re a weak generation … and we haven’t lived through this and that,” says 16-year-old Jasmine. “But we’re in a new world experiencing new things … They haven’t experienced half of what we’ve experienced.”

It’s not only big, macro-level societal shifts that are having an effect. CDC data also show that personal traumas like sexual violence, bullying, and social isolation are concerningly common, particularly among teen girls and teens who do not identify as straight—two groups at particularly high risk for poor mental health.

Of course, there’s no single or simple explanation for these trends. “You know, everybody’s different,” says 15-year-old L.B. “It’s not just one issue around the world that can [explain], ‘Oh, this is why this person’s feeling this.’”

Indeed, mental-health issues are as diverse as the young people who experience them. Girls, says 14-year-old Malayah, live with “unhealthy” body and beauty standards, while boys aren’t given as much “space to be sad and be emotional,” says 15-year-old Josiah. Kids who identify as neither boys nor girls may be caught in a “crushing gender binary” that prevents self-expression, says 15-year-old Trey. And kids of color bear the “tremendous weight” of trauma, discrimination, and safety threats, says 17-year-old J.J.

“I hold myself to a high expectation, being the oldest of three brothers. Sometimes it can be really overwhelming. When I don’t succeed in something I’ve been pushing myself very hard to, I tend to be really hard on myself. [But] everybody makes mistakes. There’s always the second time.”

L.B.

With such varied experiences, there is no one-size-fits-all cure. The most important thing adults can do is listen to teenagers, says Dr. Anish Dube, chair of the American Psychiatric Association’s Council on Children, Adolescents, and their Families. “Oftentimes the folks that are missing [from the conversation] are the folks that are most affected,” Dube says. “Young people themselves are going to have the answers more than I as an expert will. It’s about listening to them.”

In an effort to do just that, photojournalist Robin Hammond interviewed dozens of U.S. teenagers from Georgia, Colorado, and the Washington, D.C., area about their mental health, the challenges they’ve faced, and how they cope. From struggles with gender identity and gun violence to bullying and body image, their words offer windows into the messy world of the U.S. teenager.

“Adults try to make your problems almost disappear. [They say things like,] ‘You’ll get through this. This is a small time in your life. You’ll forget about this in like two years.’ But in that moment, I’m just sitting here thinking that my whole world just caved in on me. They’re not letting me feel how I want to feel.”

jasmine

But their stories also offer hope to other kids growing up in that complex environment. Jack, 15, says he’s learned to overcome his anxiety by focusing on the present, and has found the courage to tell kids who tease him exactly how they make him feel.

“Go have a one-on-one conversation and talk to them,” he says. “It may sound cringe. It may sound like something that you really don’t want to do. But you have to trust me, from one teenager to another. It helps and it will work.”

If you or someone you know is experiencing a mental-health crisis, call or text 988.

This project was produced by Witness Change and Youth Empowerment Group with the support of The Weld Trust.

U.S. teens talk mental health, the stresses of growing up, and how they cope. 

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U.S. teens talk mental health, the stresses of growing up, and how they cope.

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• October 6, 2023
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• 6 minutes Read

The Fight Over AIDS-Relief Program PEPFAR Could Have Far-Reaching Consequences

The Fight Over AIDS-Relief Program PEPFAR Could Have Far-Reaching Consequences

Congress narrowly avoided—at least for now—a federal shutdown thanks to a stopgap funding bill approved on Sept. 30. But throughout the whirlwind of activity on Capitol Hill to keep the government running, the deadline passed to reauthorize a vital global health program that’s been credited over the last two decades with saving more than 25 million lives across some 50 countries.

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The long-term prospects for the President’s Emergency Plan for AIDS Relief (PEPFAR)—launched in 2003 by President George W. Bush and reauthorized with broad bipartisan support in 2008, 2013, and 2018—are now uncertain. Reauthorization has become mired in a political fight over abortion as House Republicans seek to stop PEPFAR funding from going to organizations that offer abortion-related services, something the Democratic majority in the Senate strongly oppose. 

In the meantime, health experts and administration officials warn that non-reauthorization will erode the program’s ability to purchase affordable care and weaken the U.S.’s role as a leader in global health.

A State Department official tells TIME that the non-reauthorization will not “jeopardize PEPFAR’s operations” during fiscal year 2024, which ends on Sept. 30 next year: “PEPFAR has sufficient funding available to cover most PEPFAR-supported operations, pending timely completion of required Congressional notification procedures.”

But the State Department official adds that the non-reauthorization will “limit PEPFAR’s ability to conduct longer-term procurement of critical commodities, reducing our ability to ensure the lowest possible prices and will hinder our ability to support timely scale-up of new product innovations, all of which would risk the lives of the clients that PEPFAR supports.”

Global health practitioners and advocates also worry that even if PEPFAR is eventually reauthorized, the uncertainty created both by Congress missing the deadline and by the fading of bipartisan support for the program could ultimately increase costs and inefficiencies as well as harm the U.S.’s diplomatic interests.

PEPFAR’s ability to plan over a multi-year timeframe is crucial to the program’s ability to provide support to HIV/AIDS patients across the globe, according to Salim Abdool Karim, a leading epidemiologist and H.I.V./AIDS researcher at Columbia University. 

PEPFAR-supported programs have previously been able to buy antiretroviral drugs cheaply because they “procure in long term in large quantities in single quantities.” “Now they’re going to have to procure on an annual basis,” which may ultimately lead to less medical treatment for HIV/AIDS patients, says Abdool Karim.

Most PEPFAR contracts are multi-year, “because that’s the way to get efficient, effective life-saving programming,” says Asia Russell, the executive director of the Health Global Access Project. “With that kind of relationship with a contractor or with an academic institution you actually get durable, smart scale-up and accountability.”

Deborah Birx, who led PEPFAR from 2014-2020, says that the historical bipartisan support for PEPFAR was “absolutely critical” in driving policy reforms to fight the AIDS epidemic. “That kind of hard policy discussions is facilitated by a clarity around the world that this is supported by both Republicans and Democrats. Why is that important? Because they know that within that five year period, more than likely there could be a shift in either the Republicans or Democrats on the Hill or in the White House,” says Birx. Without bipartisan support, Birx says more countries may hope to hold out for a change in government rather than implement changes. Birx adds that she’s now “worried about those big policy engagements that the U.S. is really core in negotiating.”

A spokesperson from the National Security Council also stressed PEPFAR’s importance to U.S. foreign relations, particularly with African nations. “This departure from 20 years of strong support could open the door for Russia and China in the Africa region,” says the official. “We remain confident that the supporters of PEPFAR in both parties will find a path forward to get this critical and lifesaving program reauthorized,” the official says. 

The path forward, however, is anything but clear. Biden Administration officials have been vocal in pushing for a “clean” reauthorization, citing not only PEPFAR’s work on AIDS but also the program’s role in halting other pandemics, such as Ebola and Marburg Virus from growing out of control.

But this year, House Republican PEPFAR skeptics, led by Rep. Chris Smith of New Jersey, chair of the global health subcommittee that controls the program, have been resolute in opposing such a reauthorization. The opponents allege that part of the program’s nearly $7 billion annual budget goes to abortion providers. “PEPFAR has been reimagined—hijacked—by the Biden Administration to empower pro-abortion international non-governmental organizations,” Smith said in a statement on Sept. 28. (Smith did not respond to a request for comment for this story.)

The Biden administration and global health experts have vehemently denied these charges, noting that federal law already does not permit foreign assistance to fund abortion services. Some PEPFAR grantees, however, do provide abortion-related services with funding from other sources.

For now, the GOP-led House has passed a shorter, one-year reauthorization of the program that adds abortion restrictions to any group receiving PEPFAR funding—something critics say could leave certain parts of the world where there is limited healthcare infrastructure with no partner organizations PEPFAR could support—but this has little chance of passing through the Senate. In any case, talk of PEPFAR reauthorization looks likely to stall while the House remains in a state of paralysis following the ousting of former Speaker Kevin McCarthy. 

As the battle lines are currently drawn, it is hard to envision a form of PEPFAR reauthorization that could “get through the House that could also survive the Senate and the White House,” says David P. Fidler, a global health expert at the Council on Foreign Relations. “Anything that might get through the House with a new speaker is not going to get through the Senate. You know, we’re really in uncharted territory here.”

The program has saved over 25 millions lives from AIDS. Now PEPFAR faces an uncertain future in Congress. 

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The program has saved over 25 millions lives from AIDS. Now PEPFAR faces an uncertain future in Congress.

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• October 6, 2023
• 30 views
• 7 minutes Read

How U.S. Hospitals Undercut Public Health

How U.S. Hospitals Undercut Public Health

This article was originally published in Undark Magazine.

Health care in the United States — the largest industry in the world’s largest economy — is notoriously cost inefficient, consuming substantially more money per capita to deliver far inferior outcomes relative to peer nations. What is less widely recognized is that the health care industry is also remarkably energy inefficient. In an era of tightening connections between environmental destruction and disease, this widely neglected reality is a major cause behind many of the sicknesses our hospitals treat and the poor health outcomes they oversee.

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The average energy intensity of U.S. hospitals is more than twice that of European hospitals, with no comparable quality advantage. In recent years, less than 2 percent of hospitals were certified as energy efficient by the U.S. Environmental Protection Agency’s Energy Star program, and only 0.6 percent, or 37 in total, have been certified for 2023. As a result, in 2018, the U.S. health care industry emitted approximately 610 million tons of greenhouse gases, or GHGs — the equivalent of burning 619 billion pounds of coal. This represented 8.5 percent of U.S. GHG emissions that year, and about 25 percent of global health care emissions.

If U.S. health care were its own country, it would rank 11th worldwide in GHG pollution. If every nation produced an equivalent per capita volume of health care emissions, it would immediately consume nearly the entire global carbon budget required to limit global warming to 1.5 degrees Celsius (2.7 degrees Fahrenheit) by 2030. Without even considering their global impact, air pollution from U.S. emissions accounts for an estimated 77,000 excess deaths annually in the U.S. alone. And according to one 2016 study, emissions from the U.S. health care system lead to the loss of more than 400,000 years of healthy life among Americans. This level of harm is commensurate with the tens of thousands of deaths attributable to medical errors each year, around which a massive patient safety movement has been organized in response. But despite these human costs — along with sizable financial costs — there has been no parallel policy movement to address the health care industry’s role in undermining health through its GHG emissions.

Read more: Tackling Climate Change Can Save Hospitals Money

The climate crisis is not just another problem among many. It is instead a meta-problem that layers onto countless other problems, exacerbating their consequences for health. Research suggests that particulate matter resulting from burning fossil fuels can damage every organ in the human body. In light of this, efforts to improve public health, health care quality, and patient safety without confronting the role of emissions are, at best, compromised once one accounts for the health care industry’s substantial contribution to a climate crisis that is driving an ongoing and accelerating sixth mass extinction.

In addition to the general disaster this presents for global public health, it also constitutes a specific problem for U.S. health policy, as the health harms associated with GHG emissions disproportionately harm the populations who constitute Medicare and Medicaid’s roughly 145 million beneficiaries, including the 30 million patients treated at community-based Federally Qualified Health Centers. These care systems are meant to protect poor and vulnerable populations, but the means by which they attempt to do so are causing the very harm they seek to address. Consistent with what Ivan Illich described in his 1975 book “Medical Nemesis: The Expropriation of Health” as cultural iatrogenesis — a phenomenon by which the supposed means of treating disease under capitalist health care regimes becomes not a cure but rather a cause of the debility it claims to alleviate — what we are seeing now is a form of environmental iatrogenesis.

Largely because of fossil fuel combustion, nearly the entire global population now breathes air that exceeds the World Health Organization’s air quality limits, but exposure to unhealthy air and associated health risks are not evenly distributed. In the U.S., Medicare beneficiaries, who are 65 and older and far more likely to suffer chronic lung disease, are particularly threatened by bad air quality. This is inseparable from the fact that fossil fuel-related air pollution, the leading environmental cause of human mortality, accounts for 58 percent of excess annual U.S. deaths, which joins 8.7 million — or one in five, prior to Covid-19 — excess deaths globally, according to a 2021 study.

Beyond breathing polluted air, Medicare seniors, already compromised by higher incidence of comorbidities, are also at greater risk of serious outcomes from climate-related arthropod-borne, food-borne, and water-borne diseases. The climate crisis can exacerbate the spread of over half of known human pathogens. And risk from extreme heat is especially severe: Globally, over the past 20 years, heat-related mortality among seniors has increased by over 50 percent.

Children, 46 percent of whom are Medicaid beneficiaries, are also especially vulnerable. Fine inhalable particles resulting from burning hydrocarbons, called PM 2.5 (particles 2.5 micrometers or less in diameter), are particularly harmful because children breathe more air than adults relative to their body weight, giving these particles more opportunity to diffuse into their bloodstreams and throughout their bodies. Research published last year found that climate-related adverse health effects to fetuses, infants, and children include low birth weight, death, hypertension, kidney and lung disease, immune-system dysregulation, structural and functional changes to the brain, and a constellation of behavioral and mental health diagnoses. Furthermore, evidence published by UNICEF in 2016 indicates that air polluted by fossil fuels contributes to more than half of the 1 million annual pneumonia deaths worldwide among children aged five and younger.

Read more: American Health Care Is Broken. Major Hospitals Need to Be Part of the Solution

With respect to racialized and economically dispossessed groups, a study published in 2021 found that racial and ethnic minorities, regardless of income and geographic location, are disproportionately exposed to higher levels of 11 of 14 sources of particulate air pollution. In a United Nations report titled “Climate change and poverty,” Philip Alston concluded that governments “have failed to seriously address climate change for decades,” and that “climate change threatens to undo the last 50 years of progress in development, global health and poverty reduction.”

The health care industry’s environmental disregard can be explained in part by what three bioethicists recently termed “lifeboat ethics framing.” In their book “Bioethics Reenvisioned: A Path toward Health Justice,” Nancy King, Gail Henderson, and Larry Churchill argue that bioethics has operated in a way such that any problem outside the lifeboat — that is, beyond the hospital bedside — is dismissed as irrelevant.

U.S. health officials have often exhibited the same narrow, clinically focused tunnel vision when it comes to health care emissions and the climate crisis. Public health’s widespread takeover by narrow medical mentalities that sideline root-cause analyses and associated policy action is now one of the most pernicious threats to health.

To add insult to injury, it is in the health care industry’s financial interests to decarbonize. New solar and wind energy are now the most affordable source of generating electricity in 96 percent of the world and cheaper than existing fossil fuels in 60 percent of the world. It is more expensive to continue to operate 99 percent of U.S. coal-fired power plants than to build and operate entirely new solar or wind energy generating stations.

Today, it is cheaper to save the climate than continue to destroy it. But federal policymakers and health care leaders continue to allow the industry to contribute to the climate crisis, which in turn is harming or killing those who are the most vulnerable. And if not stopped, GHG emissions could irreversibly undermine the possibility of health for all. Health care institutions should take a leading role in implementing immediate change to their own energy-use practices. As a core part of their ethical obligation to care, they should also use their enormous lobbying power to demand broader policy action to stop the environmental destruction to which they have been world-leading contributors.

The U.S. health care industry is one of the world’s worst polluters, causing many of the deaths it seeks to prevent. 

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The U.S. health care industry is one of the world’s worst polluters, causing many of the deaths it seeks to prevent.

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• October 6, 2023
• 51 views
• 6 minutes Read

More Americans Are Living to 100. Get Ready for the Super-Aging Era

More Americans Are Living to 100. Get Ready for the Super-Aging Era

It’s a startling projection that conveys an astonishing new American reality: One in every two five-year-olds alive right now will live to 100. That’s according to researchers at Stanford University’s Center on Longevity, who believe a century-long life expectancy will be the norm for all newborns by 2050—less than three decades from now.

Not to mention, more than kindergarteners can anticipate a triple-digit life span. Propelled by aging baby boomers and continued medical advances, the number of centenarians worldwide is expected to increase eightfold. Twenty-five years from now, there will be 3.7 million of us aged 100 or older—roughly equivalent to everyone now living in Connecticut or Los Angeles.

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The United Nations declares this a “longevity revolution,” and it’s going to challenge everything we thought we knew about health care, personal finance, retirement, politics, and more. If we get it right, our 100-year lives will hold the potential for far more brightness than bleakness. Imagine an extra decade or two (or more) to continue creating and contributing—think 101-year-old television producer Norman Lear or 102-year-old fashion icon Iris Apfel—or simply enjoying an extra 20 or 30 vibrant years spent in the company of those we love the most.

Revolutions, though, are unpredictable. In our mutiny against mortality, there will be winners and losers, triumph and tragedy—and our action or inaction today will determine the quality of all those bonus tomorrows.

Read More: Believing Myths About Aging Makes Growing Old Worse

First things first: We must do everything in our power to close the unthinkable racial and ethnic gaps in longevity. White Americans live about six years longer than Black Americans, and they account for more than eight in 10 centenarians in this country—a glaring inequity we must address. We can start by lifting communities of color out of poverty, ensuring they have equal access to quality health care, and improving outcomes for Black mothers and infants, who die in childbirth at disproportionately higher rates.

But there’s also another troubling question for anyone contemplating a 100-year life: Where will we find the cash to pay a century’s worth of bills? Too many of us begin preparing for retirement in our 50s when we need to start in our 20s and 30s. That’s especially true in a world now largely devoid of pensions and driven by a growing gig economy. The median amount of money Americans have stashed away for when they stop working is a woefully insufficient $30,000. Already, 40% of those aged 65 and older rely solely on Social Security, which is projected to start running out of money a decade from now if Congress doesn’t act by raising the retirement age, increasing payroll taxes, lowering benefits or doing some combination of those things. Ignoring all this risks ushering in a grim new age of elder poverty on a scale we’ve never seen.

Who’s going to take care of us when we’re 100? Medicare doesn’t pay for long-term care; private care insurance is expensive; and assisted living facilities can run as high as $8,000 a month. On top of that, we face a chronic shortage of caregivers. One solution: sensible immigration reform to bring in skilled newcomers who can help with home health care and understaffed nursing homes, if we can overcome our xenophobia to enact it. In fact, we must, warns Ai-jen Poo, president of the National Domestic Workers Alliance. “There is actually no way to meet the demands of care without a strong immigrant workforce,” she says.

An equally daunting challenge we’ll face at 100: Making sure we don’t wind up all alone. Loneliness theoretically may ease when we eventually hit the stage of our longevity evolution where large numbers of us are reaching 100 together. But we’re not there yet, leaving millions of seniors to languish in solitude. U.S. Surgeon General Vivek Murthy has proclaimed loneliness a public health crisis, and the National Institute on Aging says the health effects of prolonged social isolation are like smoking 15 cigarettes a day. As we hurtle collectively into our super-aging future, we’re going to need to connect with one another—physically, socially, and emotionally—like never before.

And because our youth-obsessed society still values youngsters over elders, we’ll have to contend with rampant and growing ageism. The University of Michigan’s National Poll on Healthy Aging found eight in 10 people 65 and older complain they’ve experienced ageism, something the World Health Organization says is damaging to our health and well-being. Australia offers an elegant solution with its innovative Centenarian Portrait Project: High school artists are paired with 100-year-olds, and they get to appreciate one another as the teens paint or sketch the elders. It’s simple, inspired, and beautiful.

By now, you’re probably wondering whether living to 100 is worth it. If so, take heart: Everything that’s wrong is fixable. And there’s encouraging news on the mental health front even beyond researchers making headway on treatments for Alzheimer’s and other dementia—the scenario we fear the most as we age. A 2021 study by the Amsterdam University Medical Centers of 340 Dutch centenarians living independently found they suffered no serious decline in memory or other brain function and performed at a high level on tests—and some were as old as 108. “Cognitive impairment is not inevitable at extreme ages,” the researchers concluded.

Herlda Senhouse is like that. Adroit and quick-witted at 112, the Massachusetts supercentenarian cracks jokes, discusses politics, dines out with friends, plays the slots at a local casino, and attends church, getting around with a walker she teasingly calls her Cadillac. When I fumbled for my glasses while speaking to her, I suddenly realized she doesn’t wear any herself, and she’s got 40 years on me.

“I’ve had a journey I never thought I’d ever have,” she says.

Will we join her? Our chances have never been better.

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Get ready for the super-aging era, writes William J. Kole. 

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Get ready for the super-aging era, writes William J. Kole.

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Weight-Loss Drugs Come With Serious Side Effects, According to a New Study

Weight-Loss Drugs Come With Serious Side Effects, According to a New Study

There’s been a surge in demand for a class of diabetes drugs that are now popular for their serendipitous byproduct: weight loss.

The drugs belong to a class called GLP-1 agonists and include semaglutide, the main ingredient in Ozempic, Wegovy, and Rybelsus; tirzepatide, which is found in Mounjaro; and liraglutide, used in Victoza and Saxenda. While effective in helping people with diabetes to lose about 15% of their body weight, these drugs are also linked to some risk of gastrointestinal side effects, including inflammation in the pancreas and obstructions of the digestive system.

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But how common are these risks in people who don’t have diabetes, and are increasingly taking the drugs to lose weight? On Sept. 28, the U.S. Food and Drug Administration (FDA) asked manufacturers of the semaglutide drugs to include a warning in the medication label about the possible risk of intestinal blockage, after receiving 8,500 reports of the condition from both diabetic and non-diabetic users.

Now, in a research letter published in JAMA, scientists at the University of British Columbia provide additional data on the magnitude of those risks for people taking them purely for weight loss. They report that among 4,700 people without diabetes taking some form of GLP-1 and 650 people taking an older, different combination of weight loss drugs, those taking GLP-1s had a nine times greater risk of pancreatitis and four times higher risk of both obstructed bowels and gastroparesis, which is a slower emptying of the stomach into the intestines.

“We wanted to examine these risks taking diabetes out of the equation,” says Mohit Sodhi, a fourth year medical student at University of British Columbia and first author of the study, “since so many people are taking these [medications] specifically for weight loss and don’t have diabetes.”

While the researchers only studied semaglutide and liraglutide, they say the adverse effects in the GI system may occur with all drugs in the GLP-1 class, including tirzepatide, which the FDA has approved for treating diabetes but is still reviewing for weight loss.

The absolute risk of these side effects remains small, but given how many people are starting to take the medications not to treat diabetes but purely to lose a few pounds, these side effects could become significant. “Say that a million people are taking GLP-1s,” says Sodhi. “If you look at the incidence of gastroparesis in our study, it was about 1%. If you take 1% of 1 million, that’s 10,000 people who are potentially experiencing that adverse event. Blow that up to millions more patients taking these drugs, and the numbers can get extremely high.”

For people with diabetes, who are more vulnerable to other health complications related to uncontrolled blood sugar, such as circulation issues and kidney and eye abnormalities, the benefits in controlling those conditions may outweigh the gastrointestinal risks. But for those without diabetes, those risks may outweigh the benefits of losing a few pounds. While there are some studies showing other positive health outcomes associated with the weight loss drugs for people without diabetes, including reduction in heart disease risk, more research is needed to confirm those findings.

Additional studies are also needed to better understand why GLP-1 drugs have such adverse effects on the stomach and intestines. Some early work in both people with and without diabetes suggests that the medications slow the normal motion of the stomach and intestines, possibly even stunning the nervous system into inaction.

“We’re hoping that our paper will spur additional research to see if people can replicate our findings and hopefully give people more informed consent when using these medications,” says Sodhi.

Weight-loss drugs like Ozempic and Wegovy come with the risk of serious gastrointestinal issues, including inflammation in the pancreas. 

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Weight-loss drugs like Ozempic and Wegovy come with the risk of serious gastrointestinal issues, including inflammation in the pancreas.

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• October 4, 2023
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What’s At Stake With the Kaiser Permanente Heath Care Strike

What’s At Stake With the Kaiser Permanente Heath Care Strike

More than 75,000 unionized Kaiser Permanente health care workers walked off the job on Oct. 4 in the largest health care industry strike in U.S. history. Picketing began early this morning in Washington, D.C., and Virginia, with employees following suit at Kaiser facilities in Colorado, California, Oregon, and Washington after a fruitless final attempt overnight to settle a contract with chief executives at the non-profit health system. The strike will last a maximum of three days before the coalition will send members back to work amid further negotiation, though D.C. workers are striking for one day only. 

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The eight unions involved in the strike cover 40% of Kaiser Permanente’s workforce, many of whom have expressed concerns with insufficient staffing levels they say have persisted since the pandemic, causing lapses in both patient care and the provision of fair labor practices. Though doctors, some nurses, and other workers not covered by the Coalition of Kaiser Permanente Unions will be working throughout the strike in order to keep hospitals and emergency departments open, the organization has asked for patience from the nearly 13 million Americans it covers, who can expect high wait times and rescheduled non-urgent procedures and appointments.

Read More: American Health Care Faces a Staffing Crisis And It’s Affecting Care

“Kaiser used to hold itself out as the best place to get care and the best place to work, but it is now failing at both. Kaiser can and must do better,” Linda Bridges, president of the OPEIU Local 2 union that represents 8,000 Mid-Atlantic Kaiser workers, said shortly before the workers’ existing contract expired on Sep. 30. 

The resulting strike is the latest to occur as tensions over labor rights ratchet up in numerous U.S. industries. According to the U.S. Bureau of Labor Statistics, 2022 saw a total of 120,600 workers involved in 23 major work stoppages. Along with a United Auto Workers walkout that began in September, the Kaiser strike brings the 2023 total to more than 400,000 with nearly 3 months left in the year. The Kaiser Permanente strike is also a reflection of the widespread problem understaffing has become in the U.S. health care industry. Many of the same concerns were expressed by the 7,000 nurses at two New York City hospitals who protested for three days in January. Because of unions’ commitment to prioritizing patient care, strikes in the health care industry are subject to special requirements that can make them more difficult to execute, including providing organizations with 10 days notice. 

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During COVID, “there was sort of a rupture in the relationship between health care workers and their employers,” says Patricia Pittman, director of the Health Workforce Research Center at George Washington University’s Milken Institute School of Public Health. “There’s a sense among the health care workforce, that, frankly, nobody cared about their safety.”

What’s At Stake

The striking workers make up nearly all elements of patient care at Kaiser clinics, and include emergency department technicians, pharmacists, housekeepers, and hundreds of other positions. “These are the people who you’re going to see from the moment you walk up to the front desk to the nurses [who] are at your bedside,” says Renee Saldana, a spokesperson for California-based SEIU-UHW, the largest of the striking unions. 

In California, where Kaiser is the single largest provider of health care, a May survey of 33,000 workers across health systems conducted by a state health care justice union found that a majority of respondents had witnessed delayed or denied patient care due to staffing shortages. Seventy-four percent specifically cited not having enough time to care for patients properly, while 83% reported understaffing in their departments. 

“Leadership is up against the wall already, because so many people are quitting,” says Pittman. The resulting impacts are present at many non-Kaiser hospitals, she adds: “We see it with the CDC reporting this huge spike in hospital-acquired infections and other patient safety episodes.”

The union coalition cites executives’ unwillingness to invest in staffing as a key cause of these issues. The coalition is demanding not only increased hiring beyond the 10,000 new hire goal for 2023 established earlier this week by Kaiser, but also higher pay and better training, both of which they say could help prevent high turnover in the face of industry-wide burnout and cost-of-living crises in key states where Kaiser operates. The currently proposed 4% maximum annual wage increase in Kaiser’s contracts is insufficient, the coalition says.

Strikers also oppose a proposed change by Kaiser leaders that would make it easier for jobs to be subcontracted and outsourced to independent health care companies, a practice that coalition representatives say prioritizes lower-paid work at the risk of workplace stability.

The strike could also portend similar action in other U.S. health systems, says Pittman, given that Kaiser had for many years been “held up” as a model for labor rights and salary stability in the industry, due in part to forward-looking negotiations in the late ‘90s.

“It’s particularly shocking that this could be happening at Kaiser Permanente,” she says, “and sort of does not bode well for the rest of the healthcare organizations in the country.”

Unions behind the biggest health care strike in U.S. history blame staffing shortages for poor patient care and difficult working conditions. 

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Unions behind the biggest health care strike in U.S. history blame staffing shortages for poor patient care and difficult working conditions.

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Can AI Chatbots Ever Replace Human Therapists?

Can AI Chatbots Ever Replace Human Therapists?

This morning, my wellness coach reminded me to savor each exciting moment in my day, but to always take time to rest and recharge. It’s good advice—good enough that I would believe it came from a human, instead of an artificial intelligence algorithm anthropomorphized as a cartoon panda.

My panda-shaped algorithm lives in the Earkick app. Each day, I can use Earkick to describe my mood through writing, voice note, or video. Roughly 20 seconds later, its algorithm has analyzed my statement for signs of anxiety and spit out a personalized, conversational recommendation for how I can feel my best.

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Earkick is one of a small army of chatbots, Woebot perhaps best-known among them, that promise to use the power of AI to support mental wellness. Describe a problem to one of these chatbots and it can answer with what feels like empathy, offering suggestions or asking follow-up questions just as a human clinician would—and with a pretty good rate of success, according to research on the topic. Early evidence suggests chatbots can deliver elements of cognitive behavioral therapy and other mental-health tools well enough to reduce symptoms of depression and stress at least a little, and Earkick’s data find that people who use the app for about five months report a 34% improvement in mood and 32% reduction in anxiety. In one poll, 80% of people who’d used ChatGPT for mental-health advice found it a good alternative to regular therapy.

But is it really? Therapy, after all, is a practice traditionally built on human interaction, on trust and intimacy and emotional intelligence. Studies repeatedly show that the relationship between therapist and client is one of the best predictors for success in treatment, which means it’s “critical that the patient feels a sense of trust with the therapist, that they experience the therapist as being warm and understanding and empathic, and that they feel the therapist is someone they can talk to,” says David Tolin, an adjunct professor of psychiatry at Yale University School of Medicine and a past president of the Association for Behavioral and Cognitive Therapies.

There is research to suggest that people can develop connections with “conversational agents” like chatbots. And with access to traditional providers hugely inadequate, there are clear potential benefits to relying on them as substitutes. But can AI truly duplicate the experience of talking and growing close to a human therapist—and should it?

“I say this in part as a practicing therapist,” Tolin says. “There is something I would find a little sad if we eventually replaced the human connection with a computer connection.”

To a much greater extent than medical specialties built on biomarkers and test results, mental-health care relies on the subjective: how a patient describes their symptoms, how their clinician perceives them, internal shifts and breakthroughs that can’t be easily measured with numbers. In some ways, this means the field is crying out for AI, with its ability to find patterns and meaning in huge swaths of information that humans can’t easily parse. (Indeed, preliminary research suggests AI could help doctors pick the right antidepressant for a particular patient, or study their speech or writing for signs of mental distress.) But the ineffability of therapy also makes it difficult to duplicate.

Traditional therapy is not perfect by any means, but by some estimates, about three-quarters of people who try it see some improvement. It’s not always clear why it works, though. The “Dodo Bird Verdict,” a long-standing but controversial theory, proposes that different styles of therapy are more or less equal in terms of efficacy, which suggests psychological methods alone aren’t what helps patients. Instead, the benefits of therapy may come, in part, from a difficult-to-quantify mixture of factors including the strength of the therapeutic relationship, the act of consciously carving out time and space for mental well-being, or simply knowing a person is listening to you when you talk, says J.P. Grodniewicz, a philosopher who has researched and written about limitations of AI in therapy.

“Maybe psychotherapy is not really about a particular technique,” he says. “Maybe it’s about co-creating a context in which someone might be growing as a person, exploring themselves, maybe facing existential fears, having someone with whom they can speak about [difficult topics].”

Without being able to clearly define the ingredients in that cocktail and how they come together to improve mental health, it’s difficult—if not impossible—to train an algorithm to duplicate the experience, Grodniewicz says.

Peter Foltz, a machine-learning researcher at the University of Colorado, Boulder, agrees the lack of hard data in mental-health care presents challenges. An algorithm, after all, is only as good as the data it’s trained on.

“What you really want to be able to do is tie the characterizations made by AI to some particular kinds of evidence,” Foltz says. “And in mental health, really what we’re looking at is some kind of neuropsychological change in the brain or the mind…and there needs to be a lot more research to be very clear about what we’re measuring.”

And yet, when looking at things that do lend themselves to measurement—like how people self-report their symptoms—preliminary studies show that chatbots can improve patients’ depression, anxiety, and other issues. Some studies also suggest that processing trauma and emotions through writing is an effective coping strategy, which implies a self-guided mental-health app could be beneficial even if it doesn’t perfectly duplicate the experience of lying on a therapist’s couch.

“The ultimate question is whether a treatment works,” Tolin says. “If it does, then we’re happy.” More research is required to confirm that AI-assisted therapy actually works, Tolin says, and especially to determine whether it can be used on its own or only in conjunction with a traditional provider. But if studies consistently show that it’s effective, it may be more important to know that it works than to know exactly how it works.

In the meantime, however, there’s another big question to answer: “If we did develop a perfect artificial-intelligence therapist,” Tolin says, “would anybody want to see it?”

So far, it seems most people would not. Recent polls have found that only 20% to 25% of U.S. adults are comfortable with the idea of AI-assisted mental health care, and less than 40% think AI will “help more than it hurts” in the medical field.

Tolin isn’t terribly surprised by that resistance. Humans crave connection, and they’re already not getting enough of it. Loneliness is considered an epidemic in the U.S., and less than 40% of U.S. adults say they feel “very connected” to other people, according to Gallup data. It may be possible to develop a connection to an app or chatbot, but Tolin doubts whether it would be a fulfilling alternative.

“If I told you that I was going to replace your best friend with a computer, you probably would be unhappy,” Tolin says. “There would be something deeply unsatisfying about that, because it’s not a person. I think the same principles may apply to a therapist as well.”

That points to a potentially larger hurdle for the field to overcome. An algorithm will never be a human—no matter how convincingly it mimics one.

If you or someone you know may be experiencing a mental-health crisis or contemplating suicide, call or text 988. In emergencies, call 911, or seek care from a local hospital or mental health provider.

And should they? 

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And should they?

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• October 4, 2023
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Who Gets to Sue Hotels Over Disability Access? Supreme Court to Decide

Who Gets to Sue Hotels Over Disability Access? Supreme Court to Decide

WASHINGTON (AP) — A few years back, Joseph Stramondo was a last-minute replacement as a conference speaker in Salt Lake City. He went online and made a reservation for a room accessible for people with disabilities.

“I figured, ‘OK, I should be set,’” Stramondo said.

But when he checked in, the room he was given looked like a standard room, without bars in the bathroom or a door wide enough to accommodate his wheelchair.

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Returning to the front desk, Stramondo learned the room was accessible — for people with hearing loss.

The Supreme Court is taking up a case Wednesday that Stramondo, his wife, Leah Smith, and other people with disabilities worry could make it harder to learn in advance what accommodations are available that meet their needs.

The justices are being asked to limit the ability of so-called testers to file lawsuits against hotels that fail to disclose accessibility information on their websites and through other reservation services.

The information is required by a 2010 Justice Department rule. People who suffer discrimination can sue under the landmark Americans with Disabilities Act, signed into law in 1990.

The issue in the Supreme Court case is whether Deborah Laufer, a woman with disabilities, has the right to sue a hotel in Maine that lacked the accessibility information on its website, despite having no plans to visit it. Laufer, who would not agree to an interview for this story, has filed some 600 similar lawsuits.

A district court dismissed her complaint, but the federal appeals court in Boston revived it. Appeals courts around the country have issued conflicting rulings over whether ADA testers have standing to sue if they don’t intend to go to the hotels.

Acheson Hotels and the business interests supporting it argue that Laufer’s admission that she wasn’t planning to visit the hotel should end the case. Acheson owned the hotel, the Coast Village Inn and Cottages in Wells, Maine, when Laufer filed her lawsuit but has since sold it.

“What we’ve seen for the last 20 years is that people just sit at their house and troll through websites. Small businesses in particular have been targeted,” said Karen Harned, executive director of the Center for Constitutional Responsibility.

On the other side of the case, civil rights groups fear a broad ruling for the hotel could limit the use of testers who have been crucial in identifying racial discrimination in housing and other areas.

Read more: How Donald Trump Inadvertently Sparked a New Disability Rights Movement

It’s possible the Supreme Court could dismiss the case as moot without even reaching the main issue, though the hotel is urging the justices to reach a decision.

In the context of disabilities, testers can’t sue for money, just to get facilities to change their practices. That’s a critical role, Stramondo and Smith said.

Stramondo, a philosophy professor at San Diego State University, and Smith are each under 4 feet, and even a hotel room deemed accessible “doesn’t mean that it’s accessible for us,” Smith said, adding that they often turn over a room’s trashcan to use as a stepstool. Smith is the director of the National Center for Disability Equity and Intersectionality.

There’s no federal agency dedicated to enforcing the ADA. “And so we need to have some kind of enforcement mechanism. And the best one that I’ve seen is testers,” Stramondo said.

The U.S. Supreme Court is taking up a case Oct. 4 that could limit the ability to sue hotels for not accommodating disabled customers. 

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The U.S. Supreme Court is taking up a case Oct. 4 that could limit the ability to sue hotels for not accommodating disabled customers.

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• October 3, 2023
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Self-Silencing Is Making Women Sick

Self-Silencing Is Making Women Sick

“Be more disappointing” is not a piece of advice most people would pay money to hear, but in my therapy office, it’s often the most valuable guidance I can give. My clients are mostly women, and nearly all of them struggle with a fear of disappointing others. Our culture rewards women for being perpetually pleasant, self-sacrificing, and emotionally in control, and it can feel counterintuitive for my clients to say “no”—or firmly assert their wants and needs. But my work is about helping them realize that their health might literally depend on it.

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Today, women account for almost 80% of autoimmune disease cases. They are at a higher risk of suffering from chronic pain, insomnia, fibromyalgia, long COVID, irritable bowel syndrome, and migraines, and are twice as likely as men to die after a heart attack. Women experience depression, anxiety, and PTSD at twice the rate of men, and face a ninefold higher prevalence of anorexia, the deadliest mental health disorder.

Why is it that women are falling ill to these diseases at a rate so much higher than men? Such jarring disparities cannot be accounted for by genetic and hormonal factors alone; psychosocial factors play an important role as well. Specifically, it seems that the very virtues our culture rewards in women—agreeability, extreme selflessness, and suppression of anger—may predispose us to chronic illness and disease.

Read More: The Case for Mediocrity

In the late 1980s, Harvard-trained psychologist Dana Jack identified a recurring theme among female patients suffering from depression: a tendency to self-silence, defined as “the propensity to engage in compulsive caretaking, pleasing the other, and inhibition of self-expression in relationships in an attempt to achieve intimacy and meet relational needs.” Through longitudinal research, Jack found that this learned behavior, strongly rooted in gender norms, was linked to an increased risk of depression.

Since then, considerable evidence has revealed that female self-silencing isn’t just tied to psychological issues like depression and eating disorders, but also to physical illness. For instance, in March of 2022 a team of researchers at the University of Pittsburgh discovered that women of color who strongly agreed with statements like “I rarely express my anger to those close to me,” were 70% more likely to experience increased carotid atherosclerosis, a cardiovascular plaque associated with higher risk of heart attack. Other studies have connected self-silencing to irritable bowel syndrome, HIV, chronic fatigue syndrome, and cancer among women.

Most jarringly, women’s self-silencing has also been linked to higher risk of premature death. In one study, researchers followed nearly 4,000 people in Framingham, Massachusetts over 10 years. They found that women who didn’t express themselves when they had fights with their spouses were four times more likely to die than those who did. This was true even when factors such as age, blood pressure, smoking, and levels of cholesterol were taken into account.

When women push their feelings down and cast their needs aside, their health suffers. But it can be difficult for women to do otherwise in a culture that celebrates these self-silencing practices. While young women are praised for “being chill,” moms are revered for being painstakingly altruistic to the point of self-abnegation. These unspoken standards establish a vicious cycle. For many women, it feels easier—beneficial, even—to silence their needs at the expense of their own health, rather than swim against the prevailing cultural current.

In his best-selling book, The Myth of Normal, physician and author Gabor Mate writes that many of our society’s most “normalized ways of being”—the qualities we regard as “admirable strengths rather than potential liabilities”—are, in fact, incredibly toxic. “That ‘not listening to self’ in order to prioritize others’ needs is a significant source of the health-impairing roles women assume,” Mate explains. “It is among the medically overlooked but pernicious ways in which our society’s ‘normal’ imposes a major health cost on women.”

It seems that the virtues of womanhood are not really virtuous after all; instead, they are wreaking havoc on our bodies and our health. And the way they often do so is through these seemingly “normal,” daily experiences that slowly, over time, chip away at our vitality and erode our well-being. My clients tell me things like, “I don’t deserve to put my needs first. I’m not the breadwinner,” or “I said ‘yes,’ even though I didn’t want to.” In their gradual attempt to be what society considers “good,” they run the risk of compromising their health.

As a psychologist, it can sometimes feel challenging to help my clients take back their emotional and physical health when they are contending against a complex cultural system that is reinforcing them to do the opposite. However, I have found that there are some tangible changes that really do, in practice, make a difference.

It can be paradigm shifting to understand that behind every emotion exists a need. Anger, for example, can signify the desire to change our current circumstances. Rather than women treating our emotions as inconvenient, bodily malfunctions best to be muted and ignored, we can teach ourselves to view them as windows of insight. Instead of casting away our anger, a valuable question we can ask ourselves in moments of frustration is: what am I needing right now?

Another practice, closely related, is boundary setting. For women, who have been unconsciously taught to view our likability as our greatest asset, boundary setting can often feel counterintuitive. Many of us fear that if we honestly communicate our needs and limitations, this will threaten our relationships. But it’s the contrary that’s true: when we set heathy boundaries (rather than toxic ones that can lead to radical individualism) our relationships actually become stronger and healthier. And having healthy relationships is integral to our physical well-being; one meta-analysis showed that people with more supportive social relationships have a 50% lower risk of premature death.

To reshape the virtues of womanhood, a new “normal” needs to emerge—one in which we honor our emotions, prioritize our needs, and actively communicate our boundaries. Such a shift requires change on both the individual and societal level, and will by no means by easy. But it’s certainly worth it—after all, women’s lives depend on it.

For women, being more disappointing could be a lifesaver, writes Maytal Eyal. 

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For women, being more disappointing could be a lifesaver, writes Maytal Eyal.

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• October 2, 2023
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Nobel Prize Awarded to mRNA Pioneers Who Paved the Way for COVID-19 Vaccines

Nobel Prize Awarded to mRNA Pioneers Who Paved the Way for COVID-19 Vaccines

It was an unlikely collaboration, and it began in an unlikely place, but the partnership that Katalin Kariko and Dr. Drew Weissman formed in the 1990s at the University of Pennsylvania has now led to a shared Nobel Prize in Physiology and Medicine.

Kariko and Weissman were awarded the Nobel for their work in tweaking the genetic material mRNA to make it more amenable to working in vaccines. Their discovery led to the first approved mRNA vaccines, targeting the COVID-19 virus, in 2020. And that success is seeding mRNA-based strategies across a number of different conditions, including other infectious diseases as well as cancer.

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Kariko’s husband answered the call from Stockholm early in the morning on Oct. 2 at their home in a Philadelphia suburb. She told nobelprize.org that she initially thought “somebody was just joking.” While she said the conversation involved detailed scientific information that would have been hard to fake, “you never know in these days,” she said.

True to their long-time partnership, Kariko then called Weissman to break the good news. In fact, the early morning call likely reminded him of years of similar emails he and Kariko would exchange at dawn when they were working to crack the problem of turning mRNA into reliable therapies.

That collaboration began at the copy machine between their offices at the University of Pennsylvania. Kariko was obsessed with mRNA, which is the part of DNA that codes for proteins, convinced that it would be the key to developing new treatments for heart disease, stroke and other conditions. Few scientists at the time agreed, since RNA was much less stable than DNA, and despite years of dedicated, unflagging research, Kariko had little to show in the form of results.

Then came the chance meeting with Weissman at the copier in 1997. Weissman is an immunologist and physician and had come to Penn from the National Institutes of Health to continue developing a vaccine against HIV. The more gregarious Kariko tried to sell her colleague on the merits of mRNA, and Weissman listened.

To make mRNA a useful tool for treating people, however, Kariko needed to find a way to suppress its tendency to aggravate the immune system, which ended up creating a dangerous inflammatory reaction and destroying the very mRNA that was supposed to be therapeutic. Their personalities couldn’t be more different—according to Kariko, Weissman said she tended to zig and zag to generate ideas, while he preferred the more straightforward approach. Still, “we worked side by side,” said Weissman. But their research wasn’t popular, either with the leadership at the university, or with the scientific community. “We couldn’t get funding [for our research] we couldn’t get publications [for our work], we couldn’t get people to notice RNA as something interesting,” Weissman said during a press briefing after the Nobel announcement. “RNA had failed in clinical trials, and pretty much everybody had given up on it.”

But the over the next decade or so, Kariko and Weissman tenaciously proved the doubters wrong. They eventually figured out that changing one portion of the mRNA code would make it less likely to stimulate the immune system. Not only that, the change also led cells in animals to produce more of the desired protein coded for by the mRNA—exactly what they needed to turn mRNA into a robust vaccine or other treatment.

But even when the scientists published what they thought was their ground-breaking finding in 2005, the scientific community barely noticed. Doubters still prevailed, and Kariko was “kicked out from Penn, and forced to retire,” she said. Eventually, she was hired by BioNTech, a German biotech that shared Kariko’s vision about the promise of mRNA technology. Penn didn’t immediately return an email asking for comment.

That faith was finally borne out when two mRNA-based vaccines, including one made by BioNTech and Pfizer and another by U.S. biotech Moderna, became the first to be authorized and approved to treat SARS-CoV-2, and remain the foundation for the pandemic response. Kariko’s conviction was finally justified—more than two decades later—that mRNA would make an efficient, and potentially more powerful platform for treating disease. Now, researchers are developing mRNA-based vaccines to target other infectious diseases such as mpox and influenza, and the strategy is even showing promise against cancer, as a way to train the immune system to recognize tumors. Because the technology is still so new, scientists are still learning about any side effects of the platform—mRNA vaccines have so far been linked to a slightly higher risk of some heart inflammation, for example—but given that millions of people have received the shots, so far the benefits appear to outweigh the risks.

While it generally takes nearly a decade for the Novel Committee to recognize most physiology and medicine research, the group told Weissman that the committee was eager to be more current in honoring pioneering work. While most of mRNA’s promise remains to be seen, it’s success in controlling a pandemic and changing the way vaccines are made has more than earned it a place, along with its early champions Kariko and Weissman, in medical history.

Katalin Kariko and Drew Weissman discovered a key step toward making mRNA vaccines, leading to the COVID-19 vaccine and the Nobel Prize. 

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Katalin Kariko and Drew Weissman discovered a key step toward making mRNA vaccines, leading to the COVID-19 vaccine and the Nobel Prize.

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• Uncategorized
• October 2, 2023
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• 3 minutes Read

A ‘Widespread’ Bedbug Outbreak Is Taking Over Paris During Fashion Week

A ‘Widespread’ Bedbug Outbreak Is Taking Over Paris During Fashion Week

Away from the glamor of Paris’ ongoing Fashion Week, French officials have warned of a “widespread” outbreak of bedbugs across public spaces in the capital. With tourists expected to flock to the city next year for the 2024 Olympics, concerns about health and safety implications are rising. 

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Transport Minister Clement Beaune has vowed to “reassure and protect” the public by convening a meeting of public transport operators this week to establish countermeasures against the blood-sucking pests which have been spotted in cinemas, at Charles-de-Gaulle Airport, and on public transportation.

Deputy Mayor of Paris Emmanuel Gregoire wrote a letter on behalf of City Hall Thursday, calling on Prime Minister Élisabeth Borne to take action against the “scourge.” 

“The state urgently needs to put an action plan in place against this scourge as France is preparing to welcome the Olympic and Paralympic games in 2024,” Grégoire wrote, according to Reuters.

Despite being firm in his requests, the deputy mayor cautioned against “hysteria,” adding that there is “no threat to the Olympic Games,” and they should all work together to solve the issue. He added: “Bedbugs existed before and they will exist afterward.”

On Friday, Gregoire categorized the rise in bedbugs as “widespread,” telling French TV station LCI that “no one is safe.” He added: “Obviously there are risk factors but in reality, you can catch bed bugs anywhere and bring them home.”

Transport operators, including RATP, the metro operator in Paris, have said they remain “extremely vigilant” but there have been no more recent sightings since a suspected sighting on line 8 of the metro was reported on Wednesday, according to The Local France. RATP told the outlet that “each sighting is taken into account and is subject to a treatment,” adding that “these last few days, there have been no proven cases of bedbugs recorded in our equipment.” 

According to the Center for Disease Control and Prevention, bedbugs are flat, parasitic insects that feed on the blood of humans and animals while they sleep. Infestations occur in all parts of the world, but particularly in areas where people are asleep, such as mattress seams, bed frames, cracks and curves, or behind wallpaper.  

Bedbugs often occur in places where a lot of travel takes place as their bodies allow them to fit into crevices in luggage and clothing. Hygiene is not a determining factor in any case. While the pests are not known for carrying diseases, they can cause skin irritation. Those experiencing symptoms from bedbug bites are advised to wash clothing and fabrics at high temperature and contact pest control services to treat their home. 

France’s problem is far from a new one. Bedbugs were much more common in France before they effectively disappeared in the 1950s. But a rise in global travel accessibility led to a surge in the 1990s. Three years ago, the government launched its anti-bedbug efforts, comprising an informational website and telephone hotline amid surging infestation. By last year, the French government agency ANSES reported that 11% of French households had experienced bedbugs at some point in the years between 2017 and 2022, adding that such occurrences were not linked to wealth.

A surge of bedbugs have been spotted in Paris’ public spaces. But the problem has been years in the making. 

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A surge of bedbugs have been spotted in Paris’ public spaces. But the problem has been years in the making.

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• Uncategorized
• September 29, 2023
• 45 views
• 7 minutes Read

6 Ways to Tap Into Nostalgia—and Why You Should

6 Ways to Tap Into Nostalgia—and Why You Should

When people walk into Keri Piehl’s retro toy store in Albuquerque, N.M., their eyes light up. Wooden spinning tops, Yo-Yos, Trolls, rainbow lava lamps, scratch-and-sniff stickers—it’s like time travel, unlocked.

Some visitors make a beeline for the games and puzzles, eager to relive their glory days. “I sell a ton of jacks to grandparents,” Piehl says. “I always joke that I should have an over-50 league, because every single grandma tells me they were the best at jacks.” Others simply want to settle a score. Grandfathers, in particular, enjoy bringing up old marble-related injustices—like the time so-and-so cheated to win the game. “They’re still salty,” she laughs.

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Indulging in this sort of nostalgia offers a host of wellbeing benefits, experts say. But that hasn’t always been clear. The concept has a complicated past: “Nostalgia” was coined in the 1600s by a Swiss medical student to describe homesickness among soldiers serving in European wars—essentially, the pain of longing to return to one’s native land. (“Nostos” translates to “return,” and “algos” means “pain.”) Because these feelings triggered anxiety and even physical ailments, “it was originally thought of as a brain disease,” says Clay Routledge, a psychologist who’s vice president of research and director of the Human Flourishing Lab at Archbridge Institute, a D.C.-based nonprofit research organization. “There were weird ideas like, maybe it’s demonic forces, or maybe it’s the clanging of cowbells causing damage to their inner ear.”

For centuries, scholars and medical professionals continued to assume nostalgia was detrimental. But that understanding has evolved, and more recent research, including studies led by Routledge, suggests that actually, yearning for the past has an upside: It helps us feel more connected to other people—while lowering prejudice toward “out-groups” (people who are, say, a different ethnicity or age) and increasing our ability to offer emotional support. Nostalgia can also help us find meaning in life, build self-esteem, and allow us to focus more on being true to ourselves, rather than getting caught up in extrinsic standards; plus, it can make us happier. Interestingly, it’s as much about building a better future as it is the past, experts say.

“Originally, I said, ‘OK. The best way to think about nostalgia is it’s this psychological defense mechanism—when life is uncertain and unstable, we look to the certainty and comfort of the past, and that makes us feel better,’” notes Routledge, whose book, Past Forward: How Nostalgia Can Help You Live a More Meaningful Life, will be published in December. “And that’s definitely true.” But he’s also discovered something surprising: When people share nostalgic memories, many are future-oriented. For example, someone might say: “When I was a kid, I spent summers with my grandmother; she’s no longer with us, and that makes me sad. But I cherish that time in my life, and it inspires me to create memories with my own family.” “It’s looking backwards,” Routledge says, “but it’s because you want ideas for how to move forward.”

Here, Routledge and other experts share their favorite ways to tap into nostalgia’s benefits.

1. Watch old movies.

Ask John Medina why he’s interested in nostalgia, and he’ll joke that maybe it’s because he’s 67. After age 30 or so, he says with a laugh, everyone starts looking backwards. More seriously, he’s a developmental molecular biologist who’s long been fascinated by nostalgia—and the ways it can buffer brain health by triggering the release of the feel-good hormone dopamine.

In order to reap nostalgia’s benefits, Medina aims to indulge in it for an hour a day, often watching old Disney movies that he and his mom enjoyed together when he was growing up: Fantasia, Pinocchio, Sleeping Beauty. “That’s my happy place,” he says. Follow Medina’s lead and seek out the movies that remind you of a joyful time in your life. Even better, watch them or discuss them with someone else, he recommends.

2. Dine like you did as a kid.

In need of dinner plans? Load up your plate with a cafeteria-style sloppy joe and some Pop Rocks and Pixy Sticks, and pair it with a nice glass of purple Kool-Aid. If anyone asks, call it the Nostalgia Special. “Indulge in your favorite foods from when you were a kid,” Medina echoes, with a permission-granting aside: “Even if they weren’t all that healthy for you.”

Some research shines light on the idea of food nostalgia: One study, for example, found that people seek out comfort food that reminds them of their past when they experience feelings of isolation. Scents, in particular—maybe a roast dinner, or cookies baking in the oven—can evoke nostalgia, while also increasing self-esteem, optimism, and feelings of meaning in life. So eat up—and if you have trouble recreating old staples, enlist the help of a cookbook like Betty Crocker Lost Recipes: Beloved Vintage Recipes for Today’s Kitchen.

3. Create some playlists.

Research suggests that people prefer music that was popular when they were in their teens and 20s to songs from before or after that time in their lives. Spend part of your day listening to whatever gets you grooving—or better yet, Routledge notes, make a playlist of your favorites. That’s an example of “something that requires a little more active creativity,” he says. “You’re not just listening to nostalgic music—you’re intentionally engaging with it.” 

4. Visit your local library.

When Piehl and her husband started dating, they hit the children’s section at the local library and shared their long-ago favorites with each other. (She favored James Mashall’s books, including the George and Martha series. He preferred books by Chris Van Alsburg, especially The Garden of Abdul Gaz.) “It was a really cool, fun way to learn about the other person,” she recalls. These days, her shop sells an array of nostalgia-inducing titles, including Arnold Lobel’s Days With Frog and Toad, Mad Libs, and Choose Your Own Adventure books. For an efficient shot of nostalgia, follow Piehl’s lead and go back to the picture-book basics.

5. Start a collection.

Medina often advises people to start collecting things—the earlier in life, the better. “That way, when it comes time for you to retire, you’ll have a bunch of objects you can fill a room with, and then just go and sit in as if it were a hot tub,” he says. “A hot tub for the mind.”

Objects can uniquely help conjure the past. Plus, collecting is active and social: You might find yourself combing through antique shops or flea markets, and interacting with those you encounter along the way. Brainstorm what you’re interested in—vintage Coke bottles; antique dishes; Barbies; train sets—and have fun embarking on your scavenger hunt.

6. Write your memories down—and share them with friends.

Researchers have found that when people are asked to write about a sentimental event from their past, they feel loved and supported—which helps protect against loneliness. So grab a journal (or maybe a Lisa Frank notebook for good measure), and make it a point to write regularly.

While journaling can be just for you, there’s value in sharing what you write with others, Routledge notes. “You’re the protagonist because they’re your memories, but the story is about people you care about,” he says. “When we can share them with the people we created them with, it’s a way to keep that bond alive and strengthen it.” Even if that’s not possible, he notes, nostalgia is a form of self-disclosure, so sharing your memories with new friends who didn’t experience them can help build those relationships. In other words? There’s nothing wrong, he says, with passing hours yacking about the good old days.

How to tap into nostalgia to feel more connected to other people, find meaning in life, and build self-esteem. 

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How to tap into nostalgia to feel more connected to other people, find meaning in life, and build self-esteem.

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• September 29, 2023
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• 13 minutes Read

Her Friends Called Her the ‘Vagina Whisperer.’ Now Half a Million Followers Do Too

Her Friends Called Her the ‘Vagina Whisperer.’ Now Half a Million Followers Do Too

The costume that made Sara Reardon famous isn’t all that easy to identify, at least for a child. Her sons guessed that her beloved outfit, in which she films many of her Instagram videos for over half a million followers, was perhaps a sandwich of some sort. “They were like, ‘Mom, why are you in that hot dog costume all the time?’” She had to explain that, in fact, she was dressed as a vulva.

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Acquired for $100 in 2018 to celebrate reaching 10,000 followers on Instagram, the vulva costume has become a signature of Reardon’s Instagram account “The Vagina Whisperer,” and she calls it the “best investment” she’s ever made in her business. Reardon, a physical therapist who specializes in pelvic-floor therapy, started the account in 2017, but her friends had been casually calling her the “vagina whisperer” for years. When they started getting pregnant, giving birth, and encountering common problems like leaking urine, Reardon offered them therapeutic solutions. “Pregnant friends would ask me about perineal massage or what’s the best belly support, and I thought, ‘I’m writing this email over and over again, let me just put it on Instagram,’” she says.

Pelvic-floor therapists focus on the basket of muscles at the base of the pelvis that affects peeing, pooping, menstruation, and sexual health. About one in four American women has a pelvic-floor disorder, according to the National Institutes of Health. Though women can face pelvic-floor issues across their life spans, many patients encounter problems for the first time during pregnancy and after childbirth.

“When you’re pregnant, you sign up for these emails, like, ‘Your baby is as big as a papaya.’ Well, your pelvic floor is basically the hammock stretching to support that papaya as it grows bigger and bigger,” says Reardon, 41. Women can experience complications such as pain during sex, chronic pelvic discomfort, and even pelvic organ prolapse—when a person’s internal organs collapse into her vagina. Those who do seek help often do so when these issues have progressed to an unsustainable level.

“Pregnancy and postpartum is such a huge transformation for our bodies, and we were getting zero education about how to take care of it,” Reardon says. “Every pelvic-floor therapist will tell you, patients come in and ask, ‘Why didn’t anyone tell me this sooner?’” Those conversations require intimacy and trust, something that attracted Reardon to pelvic-floor therapy in the first place.

Read More: Exhaustion, Incontinence and the Messy Reality of Returning to Work After a Baby

Instagram was the most expedient way to reach women before they encountered problems. “I was seeing a lot of women in my clinic who had these mesh surgeries for prolapse and their lives and vaginas were completely destroyed because this mesh situation went totally wrong,” Reardon says. “And I was like, ‘I don’t really want to spend my career doing damage control for people.’ There’s so much we can do to prevent this.” (In 2019, the FDA halted the sale of surgical mesh devices used in transvaginal surgeries to treat pelvic organ prolapse; mesh is still used in abdominal surgeries to treat the condition.)

Reardon has made it her mission to alert women to proactive solutions that they can start implementing even during pregnancy. She rarely uses obscure medical terminology and tries to infuse humor into her posts, whether they involve her squatting over a toilet making exaggeratedly strained faces to demonstrate what not to do or showing off kitschy knitted vulvas she ordered online. She shimmies to the latest viral pop song while explaining how to properly wash a vulva (with just water!). Her Instagram page contains a lot of basic information that can be revelatory: Busy women, she says, often rush and push to pee, unwittingly damaging their pelvic floor.

Most women assume pain and incontinence to be a natural consequence of childbirth, just one of many sacrifices mothers make when they become parents. Others are simply too embarrassed to ask for help. Women’s health is understudied and under-discussed in general, but that’s particularly true when it comes to the most intimate parts of the body.

Dr. Karen Tang, a gynecologist and gynecological surgeon, has built a large Instagram following herself talking about, among other things, chronic pelvic pain. “I actually went through an entire ob-gyn residency and didn’t learn about pelvic-floor physical therapy,” she says. “It’s kind of ridiculous.” Only once, when she was in her fellowship, did a doctor point out to her that pelvic-floor therapy could be a great, noninvasive option for many patients before turning to medication or surgery. Tang, 44, thinks things have changed a lot since she was in medical school, though she still would like to see more awareness. She now does a pelvic-floor check on anyone who comes to her complaining of chronic pain, sexual issues, or incontinence, and refers almost every patient with these concerns to pelvic-floor physical therapy.

Read More: Why There’s So Much Pregnancy Trauma on TV Right Now

The feeling that information is hidden and that patients are on their own to seek it out is widely shared by Reardon’s followers. “Wish this was discussed prior to birth!! I thought something was seriously wrong with me,” one person commented on one of Reardon’s post about peeing after childbirth. On a post about diastasis recti, when the ab muscles separate during pregnancy, a mother who gave birth three times wrote that she had this condition and “found out by coming across your page. I never knew and my doctors never looked for that after I had children.”

Sara Nicolas, a 44-year-old in Tigard, Ore., was only vaguely aware of the concept of her pelvic floor when she discovered “The Vagina Whisperer.” “When I was in my 20s, it was all the rage to just do a ton of kegels to ‘have better sex,’ and it was really eye-opening for me to look at her account and realize pelvic-floor therapists exist and physical therapy is a lot more nuanced than just kegels.” Nicolas does not have children but discovered through Reardon’s content that women who have never given birth can struggle with pelvic-floor problems too. “She is sitting there on a toilet, and it could be a situation where you can’t believe she’s putting this on the Internet, but the visual helps,” she says. “I’m a lot more comfortable talking to my gynecologist about any issues I have now.” Nicolas says her mother, who emigrated from Mexico, did not speak openly about these problems. “She grew up very poor and moved to the States, and in her generation, you just didn’t talk about these issues,” she says.

Reardon believes more women are now pushing back against this societal silence about female pain. “I think my generation of women were brought up with, ‘Here’s a book and a box of tampons. Figure it out,’” she says. “I think a younger generation of women is like, ‘F-ck this. I don’t want to end up in diapers. Help me out here.’”

Interest in exercising the pelvic floor has soared in recent years. Google Trends shows that searches for “pelvic floor therapy” have increased 244% since 2018. Celebrities like Ilana Glazer, Lena Dunham, and Meghan Trainor have brought attention to pelvic health in interviews about their own experiences with the health care system. Emily Oster, the author of hit pregnancy and parenting books like Expecting Better and Cribsheet, has boosted Reardon’s profile by citing her in her newsletter and including her in a conversation with comedian Amy Schumer.

Read More: Emily Oster Still Thinks Data Can Help Ease (Some) Parental Anxiety

Reardon attributes the rise in conversation about the pelvic floor—and the boost in her followers—in part to the pandemic. Clinics shut down. Everything went digital. TikTok blew up in the United States. Pelvic-floor therapists proliferated on the platform: Pelvic-floor therapist Alicia Jeffrey-Thomas has attracted 1 million TikTok followers with the account ThePelvicDanceFloor. U.K.-based physiotherapist Suzanne Vernazza went viral for her “squeeze along” videos, which encouraged her followers to practice kegels to trendy TikTok songs.

“Birth was a scary thing during that time,” says Reardon. “Raising babies in isolation is a hard thing. So I think people really went to Instagram for connection and information and education.” In March 2020, Reardon had 100,000 followers. Today, she has 550,000.

Tang points out that increasingly people are turning to social media to find information about their health that they’re not getting in doctors’ offices or sex-ed classes, a reflection of larger structural problems in the American health care system. She is publishing a book next year called It’s Not Hysteria about the things women are never told about their gynecological health. “You feel uncomfortable talking with friends or family or even a doctor, but you find a funny video and it seems accessible,” she says of Reardon’s content. “If you can do it in a way that is nonjudgmental and entertaining but also so honest, I think that’s what the Vagina Whisperer does so well.”

Investors, seeing the skyrocketing demand, have begun to fund femtech companies, like Bloom and Pelvic Gym, focused on pelvic-floor therapy. The Academy of Pelvic Health Physical Therapy, a nonprofit professional association with 4,032 members, says it’s seen a 21% increase in membership since 2018. Three years ago, a company called Origin launched in-person and online pelvic-floor-therapy. A representative says Origin has since treated more than 30,000 patients in all 50 states through their 20 in-person clinics as well as virtual instruction. (Glazer joined the company as an adviser last year.)

Online therapy has its drawbacks. As with all medical topics, misinformation on pelvic health proliferates on the Internet; as one pelvic-floor therapist posted earlier this year, it helps to look for accounts created by licensed pelvic-floor therapists with degrees in physical therapy rather than those who portray themselves as “trainers” or “coaches.” Tang also argues that physical examinations are needed, at least initially, to make sure patients are exercising their internal muscles correctly—though she believes virtual therapy is better than no therapy at all. These companies say they are attempting to fill a gap in our health care system. Some 40% of U.S. women who give birth do not even attend a postpartum visit with their ob-gyn, according to the American College of Obstetricians and Gynecologists.

“Health care literacy is a huge part of this,” Reardon says. “You don’t even know what you need, and then you don’t know how to get it once you need it.” Congress introduced a bipartisan bill, the Optimizing Postpartum Outcomes Act, last year that could help more women get access to pelvic-floor care after birth through Medicaid. It was revised and reintroduced in April.

In France, by contrast, postnatal pelvic-floor therapy is covered for every new mother. “I question the priorities in America. Our medical system is really based on efficiency,” she says. Doctors focus on making sure mother and baby survive birth, and that the baby is healthy, she says, but there is far less focus on the mother’s well-being once the baby is out. “How can mom be healthy? Some hospitals bring in lactation consultants to help with breastfeeding for the baby. Why not pelvic-floor therapists to help with recovery for mom?”

Read More: The Goddess Myth: Why So Many New Mothers Feel Guilt

These days Reardon spends about 30% of her time in her clinic in New Orleans and the rest making reels for social media and videos for her subscription-based platform, the V-Hive, which includes pre-recorded video courses, virtual consults, and a newsletter and has become three times as lucrative as her physical-therapy practice. For a monthly fee, you can watch Reardon demonstrate exercises and, for her pregnancy series, how to push correctly, minimize tearing, and prevent common problems like diastasis recti. She also partners with companies like Frida Mom promoting their postpartum recovery products on Instagram.

In September, Reardon announced that she is writing a book titled Floored, described on Publishers Marketplace as a “rallying cry for women’s health and a complete guide to pelvic floor care at every age and stage.” She is working on partnering with hospital systems or insurance companies to get her workout videos for pregnancy and postpartum into the hands of women who are expecting or have given birth. And someday she hopes to turn the V-Hive platform into an app with pelvic-floor-therapy information and workouts that proves as popular as—but more useful than—the ones that compare your baby to a fruit.

Reardon has found that while she tries to focus on health and biology, some view the fact that she is talking about women’s body parts as inherently political. While she posted frequently on the importance of bodily autonomy in the lead-up to the Supreme Court overturning Roe v. Wade, she’s done less of that recently. “I do find myself pulling back from commenting on reproductive rights just because people are a—holes,” she says. When online publications write about Reardon or people on social media post pictures of her in her costume, she says the comments can turn “sexist, raunchy, and trollish.” One that’s stuck with her: “The problem isn’t vaginas, it’s what they’re attached to.” “My Instagram followers who chose to follow me are so supportive, but then when I venture outside that platform, I realize sometimes that there’s still this stigma,” she says. She’s begun turning down media opportunities where an interviewer won’t allow her to say “vagina” on air.

But among her devotees, Reardon’s directness is her very appeal. Reardon says it’s critical that we use correct anatomical vocabulary and applies this rule to her own home as well. She tells her 6- and 8-year-old sons, for instance, to use terms like “testicles” instead of “balls.” They know she helps patients with their pelvic floors. They’re permitted to play with the models of the female reproductive system sitting on desks and coffee tables all over her house. Just one thing is off limits: they are not allowed to touch the vulva costume with which their mom built her brand. The company that made it shut down so she’s unable to buy a backup. “It’s very precious,” says Reardon.

Her friends called her that name. Now half a million Instagram followers do too. 

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Her friends called her that name. Now half a million Instagram followers do too.

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• Uncategorized
• September 26, 2023
• 31 views
• 5 minutes Read

Tuberculosis Could Be the Next Global Health Crisis. Is the World Ready?

Tuberculosis Could Be the Next Global Health Crisis. Is the World Ready?

For those living in affluent countries, it’s easy to forget about tuberculosis, which seems like a disease of the Victorian era. In the U.S., thanks to investments in public health and TB surveillance infrastructure, less than 600 people died from the disease in 2020. Compared to COVID-19, which caused 350,000 deaths that same year, it’s understandable why it’s not at the top of the U.S. public health agenda.

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But if you zoom out and look at global public health, TB gets much more scary. It is the world’s most deadly infectious disease, killing approximately 1.5 million people per year, reclaiming the top spot from COVID-19 in October 2022. Experts warn that while the spread of TB might seem confined to developing countries right now, its unchecked spread could lead to mutations which result in more drug resistant versions of the disease. That’s something that could be highly disruptive to rich countries, too. 

As a result, the world health community is mobilizing, and last week concluded the second-ever United Nations high-level meeting focused on taming the disease. In a major breakthrough, a manufacturer of testing equipment agreed to lower the price of its devices, expanding testing to millions more.

A highly contagious disease

TB is caused when the tuberculosis bacteria spreads in the lungs. Anyone can get the disease, including healthy people, but those who are malnourished, living in crowded living conditions, or are immunocompromised are most susceptible. If untreated, a person with TB will spread the disease to an average of 15 people per year. Most often, patients will first notice that they are sick when they begin experiencing a persistent cough that lasts weeks, sudden weight loss, or a high fever. Without treatment, approximately half of those with TB disease would die within five years.

“TB knows no borders,” says Dr. Lucica Ditiu, Executive Director of Stop TB Partnership, a U.N. hosted organization that aligns global funding agencies, NGOs, and civil society groups working on ending TB. “I keep telling everyone, you can eat healthy, you can be vegan or vegetarian. You can run, you can use a condom, and you can sleep under a bed net. But so long as you breathe, you can still catch TB.”

In the 20th century, multiple new antibiotics were created to cure TB disease but with each case of TB, the bacteria has the chance to continue multiplying in the body of its human host. Sometimes, during the reproduction process, some strains of the bacteria will develop traits that make it resistant to antibiotics. The most recent data suggests that 3.6% of all new tuberculosis cases today are resistant to multiple TB drugs.

Read More: How an Innovative Deal Will Give Millions Access to Cheaper Tuberculosis Drugs

Multidrug-resistant TB has a higher mortality rate, and doctors are often forced to resort to using more toxic drugs with severe side effects to treat the disease. Some have been known to cause total deafness in patients.

Two years ago, a groundbreaking study found that TB, once thought to be spread by coughing, spreads primarily through breathing. Every time an infected person exhales, they propel aerosols containing the bacteria into the air. Crowded indoor spaces, like prisons, are especially fertile breeding grounds for TB, just like COVID. TB is much less contagious than COVID, but the more it mutates, the more chances it has to acquire mutations that make it more contagious.

“There’s no biological reason that multi-drug-resistant TB can’t acquire what it takes to transmit easily,” says David Bishai, the director of the school of public health at the University of Hong Kong. “We know that ancestral TB was extremely contagious through airborne methods. And so this does represent a pandemic threat.”

On Sept. 22, the United Nations held a high-level meeting on TB, where countries reported on the progress achieved so far and revealed their plans for tackling the disease over the next five years. Currently, the international community has set a target for reducing global TB cases by 80% by the year 2030. Prominent TB activists attended the meeting as well, including writer and YouTuber John Green.

Social media pressure

Green, author of The Fault in Our Stars, has launched multiple social media campaigns aimed at getting major companies to reduce their pricing of TB tests and drugs in lower and middle income countries.

“In the 21st century, you can’t say that tuberculosis deaths are even caused by the bacteria Mycobacterium tuberculosis because we know how to kill that bacteria,” said Green. “Death from tuberculosis is caused by human choice. It’s caused by human built systems…It means we’re not doing a good job of assigning equal value to every human life. But it’s also hopeful in the sense that if we are the cause of tuberculosis, we may also be the cure.”

Last week, activists scored a major win when Danaher, a U.S. company which manufactures test cartridges that make TB testing more affordable and accurate, announced it would reduce the price of each cartridge from $9.98 to $7.97. Ditiu of the Stop TB Partnership says that this means that countries around the world will be able to provide an additional 5 million tests. Approximately one in every 13 TB tests administered comes back positive, according to Ditiu.

“Every person can infect up to 15 others per year,” says Ditiu. “If we can find people with TB as early as possible and diagnose them, we can put them on treatment and stop this chain of transmission.”

Ditiu estimates that approximately 300,000 people will be diagnosed earlier thanks to the reduced price of Danaher’s test cartridges. 

The world is mobilizing to prevent the spread of tuberculosis, which kills 1.5 million people a year. 

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The world is mobilizing to prevent the spread of tuberculosis, which kills 1.5 million people a year.

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• September 26, 2023
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• 6 minutes Read

Does It Matter Which COVID-19 Booster Shot You Get?

Does It Matter Which COVID-19 Booster Shot You Get?

Now that it’s fall, it’s time to get updated on your COVID-19 vaccines if you want to stay protected throughout the winter, when infectious diseases flourish. But does it matter which shot you get?

For now, there are only two options—both mRNA-based vaccines, made by Moderna and Pfizer-BioNTech. The U.S. Food and Drug Administration (FDA) is still reviewing data from Novavax, which makes a different type of vaccine based on recombinant viral proteins. Both Moderna’s and Pfizer-BioNTech’s vaccines are approved for people 12 years and older, and have an emergency use authorization for children under 12.

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Practically speaking, if you’re eager to get your shot soon, you’ll get an mRNA vaccine, since these are the only ones approved so far. And the sooner you get boosted, the sooner you’ll be protected against getting infected and also from getting really sick, so most health officials will probably advise you not to wait for Novavax’s shot, if and when it is authorized. While the updated mRNA shots target XBB.1.5, a different virus variant than the ones that are circulating now, studies that the manufacturers presented to health officials show that the shots still produce a strong antibody response against the newer variants like EG.5 and BA.2.86.

But if and when Novavax’s vaccine becomes available, does it make sense to switch if you’ve received mostly mRNA shots so far? Does the type of vaccine matter when it comes to how well you’ll be protected, both against infection and against serious disease?

Dr. Kirsten Lyke, professor of medicine at the University of Maryland School of Medicine, who conducted some of the earlier mix-and-match studies on previous combinations of vaccines, says she didn’t see much difference when people who were vaccinated with earlier mRNA vaccines received boosters of earlier Novavax shots. “It doesn’t look like Novavax following mRNA is any better than mRNA-mRNA,” she says. Those data, however, were based on studies that only looked at antibody levels people generated up to six months after a booster shot.

Looking more specifically at how the mRNA and recombinant protein vaccines work, Dr. Otto Yang, professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, says there may be a difference between the two technologies in how the immune system sees SARS-CoV-2. Vaccines using the mRNA technology contain the genetic code for the virus’ spike protein, and this code instructs certain cells in the human body to make this viral protein and then present it to the immune system. Recombinant protein vaccines, like Novavax’s, skip that step and directly provide the viral protein. In theory, Yang says, that would mean that the levels of viral protein that the immune system initially sees might be higher with Novavax than with mRNA vaccines, since the amount produced by the mRNA vaccines depends on how many immune cells get the code and start producing the protein. But it’s not clear whether those potentially higher levels of protein translate into stronger immune responses in the form of antibodies.

The genetic approach of the mRNA vaccines, however, also has an advantage because it may produce a more robust T cell response. T cells and antibodies make up two of the major parts of an immune response; antibodies are the front-line defenses designed to prevent viruses from infecting cells in the first place, and T cells are then recruited to recognize and destroy infected cells, and provide protection against serious disease. But in order for the body to generate killer T cells, viral proteins need to make their way into a specific part of the immune cell, and mRNA vaccines ensure that happens. “[Viral] proteins have to be in that area of the cell to generate the killer T cell response, which has evolved to deal with problems like infected cells by killing the cells,” says Yang. “Recombinant protein vaccines are not going to access this part of the cell.”

Studies have shown that it’s likely the T cell response, which could be slightly more durable than the antibody response, that may be largely responsible for protecting vaccinated people from severe disease, since antibodies produced by any vaccine tend to wane after a few months. “Antibodies seem to be the upfront gatekeepers, and T cells seem to be the palace guard that clears out invaders once they get in,” says Yang. That may explain why, as new variants emerge, some people who are vaccinated still get infected, but they don’t end up in the hospital or die from their infections as many people did in the early days of the pandemic before vaccines were available.

Another advantage of a stronger T cell response is that T cells can also target parts of the virus that are less exposed to immune system attacks, and therefore, less prone to mutating. Experts believe T cells  may be recognizing the virus’ nucleocapsid protein, which forms the core structure of the virus, and which remains relatively similar among the various variants that have appeared so far.

Novavax says that its original vaccine also produces a good T cell response, because the vaccine is fortified with an adjuvant, or additive, that is designed to rev up the immune response and amplify it. “That adjuvant can induce the types of T cell responses that we think are more important in fighting viruses,” says Bob Walker, chief medical officer for Novavax. He says the company is currently testing its updated vaccine in people to get more specific data on the antibody and T cell responses the shot can produce.

“Personally, I think there is probably not a lot of difference between the [two types of vaccines,” says Lyke. “You get good responses with all of them. That’s why anyone who is vaccinated probably has good protection even this far out from getting severe disease.” Which means that it’s not that important which vaccine you get—but that you get one of the updated shots.

With a new booster available, it’s time to look at whether switching up your shots makes a difference in your immunity 

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With a new booster available, it’s time to look at whether switching up your shots makes a difference in your immunity

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• Uncategorized
• September 25, 2023
• 29 views
• 5 minutes Read

What a Doctor Is Seeing In COVID-19 Today

What a Doctor Is Seeing In COVID-19 Today

Hospitalizations for COVID-19 have been on the rise since the beginning of July. Then came the identification of the heavily mutated and possibly highly-transmissible BA.2.86 variant by the global surveillance network. Such a variant has the potential to evade our vaccine- and infection-induced antibodies and cause a surge of seasonal hospitalizations. The recommendation by the FDA’s VRBPAC in June that the Fall updated vaccine be composed of an XBB-lineage of the Omicron variant appeared to be at risk. There was mounting concern we be faced with a similar situation from last year where the virus had already mutated well beyond the BA.4/5-bivalent vaccines by the time they were rolled out.

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But the landscape of the pandemic—especially the clinical disease caused by SARS-CoV-2—has significantly changed. On the front lines of the emergency department (ED), we are seeing a different virus. This is likely a combination of both high levels of population hybrid immunity and evolution of the virus itself to favor infection of the upper airway and cause less severe disease.

The CDC’s recent decision to universally recommend vaccines for everyone, while falling short of a much-needed targeted recommendation for high-risk groups, paves the way for equity of access and insurance coverage for Americans needing to top up their protection against infection. And recent preliminary studies from multiple labs on BA.2.86 has actually been reassuring.

Read More: Pandemics Don’t End. They Echo.

New hospital admissions had increased nationally by 9% in the first week of September and have been on an upward trajectory since the beginning of July driven by EG.5, FL.1.5.1, and the XBB subvariants. At 16,000 current hospitalizations, this is still far below the Omicron peak of 145,000 hospitalizations that overwhelmed our health care system in January 2022.

Hospitalizations are highest in those patients 70 and older. Compared to earlier in the pandemic when our ED and hospitals were overrun with patients suffering from hypoxia and viral pneumonia requiring various oxygen modalities, proning techniques, and ventilators—elderly patients are lately presenting to my ED with weakness, fatigue, dehydration, and electrolyte abnormalities. Even though these symptoms are caused by covid infection, they are less staff- and resource-intensive compared to years past. Management of such illness is less challenging, and patients are discharged home after a few days.

Immunologically, this is not surprising that older Americans are becoming sick with COVID as head into the fall. It’s been a year or more since many of them last had a COVID-19 infection or a vaccine dose. In fact, only 46.5% of those 75 and older ever received the most recent bivalent booster.

Even though protection against severe disease remains robust, protection against any infection has most certainly waned. For healthy individuals under 65 years, current variants are expressing a predilection for the upper respiratory tract and follow a particular pattern. Symptoms typically start with a sore throat, and progress to headache, rhinorrhea, and nasal congestion.

This tracks with what we observed from Omicron in multiple lab studies since early 2022. Omicron family variants are approximately 10-times less efficient than the Delta variants at replicating in lung tissue and mutations favor preference for upper airway tissue.

A UNIVERSAL RECOMMENDATION

Recently the CDC’s Advisory Committee on Immunizations Practice (ACIP) voted to approve the updated XBB.1.5 monovalent vaccine for everyone 6 months and older. ACIP members were likely convinced mostly by data that a universal recommendation will prevent 400,000 hospitalizations and 40,000 deaths due to COVID-19 infection.

Read More: These Are the Vaccines You Should Get

As this is the first vaccine rollout since the end of the pandemic emergency that is not financed by the federal government, a universal recommendation also paves the way for insurance coverage. For those without insurance, the CDC announced its Bridge Access Program for the 25-30 million Americans without insurance.

Some ACIP members and other front-line physicians like myself would still like to see the CDC more strongly advocate for vaccination in high-risk groups who stand to benefit the most from updated protection. The Joint Committee on Vaccination and Immunisation—the United Kingdom’s version of our ACIP—outlined such a targeted, evidence-based strategy focused on adults 65 and older and those in care homes, frontline health care staff, and those 6 months–64 years with underlying medical problems, such as chronic kidney and lung disease, and those who are immune-compromised, from chemotherapy treatment, for example. The Infectious Diseases Society of America echoed this support for a targeted strategy in its own response to the CDC decision—that certain high-risk groups are at increased risk of severe disease and should be prioritized for vaccination this fall.

Even for healthy individuals under 65, the XBB.1.5 monovalent updated vaccine is a good match for currently circulating variants and enables a top up of protection against any infection. While on the decline, the XBB family subvariants still comprises a large percentage of new infections. In addition, the widespread EG.5 variant is different from XBB.1.5 by just two new mutations, at F456L and Q52H; suggesting the updated vaccine will work well against it. And a switch back to a monovalent formulation ensures that those vaccinated receive a full undiluted dose against the most prevalent variants.

ACIP members were also likely reassured by recent preliminary pseudovirus and sera neutralization studies from four laboratories—two in the U.S. and in Sweden and China—demonstrating that BA.2.86 is likely 1) not more immune evasive than previous variants and 2) not very efficient at infecting our cells.

Most importantly, the sera of those previously infected with XBB was able to generate a significant response against BA.2.86 portending that the updated XBB-targeted vaccine will maintain its protection if BA.2.86 takes hold as the fall and winter unfolds. In the only human clinical trials to date, Moderna announced its XBB.1.5 vaccine generated an 8.7-11-fold increase in neutralizing antibodies against BA.2.86, EG.5 and FL.1.5.1 variants.

COVID-19 and how the body responds to it is changing thanks to vaccines and building immunity. 

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COVID-19 and how the body responds to it is changing thanks to vaccines and building immunity.

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• September 25, 2023
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• 9 minutes Read

Is It Flu, COVID-19, or RSV? How to Navigate the New World of At-Home Testing

Is It Flu, COVID-19, or RSV? How to Navigate the New World of At-Home Testing

Before COVID-19, figuring out whether a sore throat, fever, and runny nose were caused by a cold, flu, or strep wasn’t a top priority. You either powered through, knowing you’d be miserable for a few days but would probably feel better soon or you visited the doctor’s office, urgent care, or emergency room where you might get a test to figure out which virus or bacteria was behind your misery, and maybe a prescription to treat it. But even doctors often don’t order tests, preferring instead to make diagnoses based on symptoms.

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During the pandemic, however, it became more critical to know who was infected with SARS-CoV-2 so those people could isolate and not spread the virus. At-home test kits became household products, and most people are by now adept at squeezing out a few drops of solution onto a card, sticking a swab up their nose, swirling the swab in the testing liquid, and waiting for a result.

Tests for COVID-19

A number of companies, offer at-home test kits for COVID-19 that people can buy without a prescription. Most of these are rapid antigen tests, which pick up antigens, or substances that the SARS-CoV-2 virus makes. While they are relatively accurate, because it takes some time for levels of these antigens to build up after an infection, these tests are less reliable in the day or so immediately after exposure to the virus. That’s why doctors recommend repeating the test a couple of days apart.

Then there are PCR, or molecular, tests, that are closer to the gold standard used in laboratories, and rely on finding the smallest genetic signatures of the virus and amplifying them. Cue Health sells a palm-sized COVID-19 PCR device that people can purchase for $300 that allows for 10 at-home tests and doesn’t require a prescription. The device reads a saliva sample and provides results to a smartphone app in 20 minutes.

Other testing companies, such as Labcorp and Everlywell, also sell PCR-based tests for COVID-19, but they are technically collection kits, which means that you have to send a saliva sample into a lab to get results, which can mean critical days will pass before you get results.

Tests for seasonal flu

There is only one at-home test authorized by the FDA for influenza: Lucira, now owned by Pfizer, makes a combined flu and COVID-19 molecular test. The kit uses a PCR-related method of amplifying and reading any viral genes in a sample, providing a result in about 30 minutes. In coming months, eMed, a digital health company that sells test kits and telehealth services, plans to offer that kit, as well another that is currently being reviewed by the U.S. Food and Drug Administration. (The combined kit currently available on eMed’s website only tests for COVID-19 and provides a survey to help telemedicine professionals determine if a user likely has the flu.)

Tests for RSV

There currently aren’t at-home tests for RSV, because typically only infants and the elderly are at risk for severe illness. Doctors’ offices, hospitals, and urgent care centers can perform RSV tests that provide results in about 30 minutes.

The advantages of at-home testing

The currently cumbersome journey from symptoms to treatment rests on people making appointments with their doctors or at an urgent care center and could be contributing to the spread of viruses. Self-testing could reduce some of that risk since people are most infectious while they are waiting to get tested and receive treatment. Ideally, if someone tests themselves at home and finds they are positive for influenza or COVID-19, for example, they don’t necessarily have to physically visit their doctor or go into an urgent care or emergency room, where they could spread the virus to others. Instead, they could video conference with a doctor who could assess their symptoms and at-home test results, then write a prescription for, say, oseltamivir if it’s the flu, or Paxlovid if it’s COVID-19. “If you’re trying to minimize morbidity and mortality, and cut down on transmission, then [at-home] testing is an incredible tool to have,” says Thomas Denny, chief operating officer of the Duke University Human Vaccine Institute.

Read more: What It Will Take to Avoid a Tripledemic This Winter

In addition to the altruistic public health reasons to test yourself, there are more selfish ones. Knowing what infection you have means you can get the right treatment, and hopefully avoid prolonged and serious illness. And for the first time, there are effective ways to manage all three major respiratory illnesses that dominate the winter: flu, COVID-19, and respiratory syncytial virus (RSV). Self-testing kits are especially useful for influenza and COVID-19, since antiviral treatments for both are most effective when people taken them within the first few days after their symptoms appear. (And while there aren’t treatments for RSV, new vaccines and antibody treatments can help to prevent infections and potentially serious complications in the most vulnerable.) Waiting to make an appointment to get tested at a health facility means many people could miss this small treatment window. “A lot of people are happy with the status quo, and don’t see a need for self-testing,” says Dr. Michael Mina, chief science officer at eMed.

And the availability of COVID-19 kits has set new expectations for at-home testing, leading both the public and health professionals to ask why more people can’t test for other illnesses themselves. In many cases, “we don’t need people to come into doctors’ offices,” says Dr. Howard Heller, an infectious disease specialist at Massachusetts General Hospital and Harvard Medical School. “The home testing space is evolving and snowballing.”

During the pandemic, the Biden Administration launched the Test to Treat program, which streamlined the process of getting a prescription from a doctor by making it possible for people to test themselves and then go to their local pharmacy where the pharmacist could write a prescription for COVID-19 antiviral medications if they were positive The availability of more self-tests means moving that entire process into the home, which would make testing and treating respiratory diseases more convenient and streamlined, which in turn could reduce their spread.

eMed is working with the National Institutes of Health to study what impact having more at-home tests will have in controlling spread of disease. The team is tracking the average time it takes for people who test positive using eMed’s at-home kits—combined with a telehealth visit on eMed’s platform—to get treatments compared to people who make appointments with their doctor or visit a pharmacy. NIH is funding the test kits and telehealth visits for 80,000 to 100,000 people who enroll in the study through June 2024.

Mina argues that wider testing, driven by at-home kits and telehealth, could lead more people to reach out to their health care professionals for the proper treatment, which in turn could keep spread of infectious diseases down, and lower hospital costs for those who develop complications. “A $25 home testing kit and telemedicine visit could avoid what could turn into an $8,000 hospital visit,” says Mina.

The negatives of at-home testing

There is a downside to more DIY testing, however. The results are essentially invisible to public health authorities, so they don’t have a clear picture of how many people are getting sick, and where. If at-home testing, especially for infectious diseases, continues to grow, then public health officials will have to look beyond lab-based results for alternative ways to track the ebb and flow of cases, such as relying on anonymous sampling of wastewater from communities.

The future of at-home testing

Researchers are continuing to work on improving the accuracy, convenience, and price of at-home tools to test for infections. They are developing cheaper versions of rapid antigen tests that utilize paper strips (similar those used for urinary tract infection tests) that could bring the price of these tests down from over $20 to a few dollars. These, and other rapid antigen tests, will continue to be useful for people who don’t have symptoms but want quick answers to whether they can safely visit loved ones in the hospital without putting them at risk—or, if they have symptoms, whether they should go to work or school if they aren’t feeling well. “If your kids are sick and you want to test them before sending them to school and causing a flu outbreak, you don’t need perfect tests when you’re trying to be a good citizen,” says Mina. “Rapid antigen tests that are 80% or more sensitive are amazingly important for public health.”

Read more: What to Know About the New COVID-19 Vaccine Booster

PCR-quality tests are also becoming cheaper and more effective. The FDA recently issued an emergency use authorization for a test made by Aptitude, called Metrix, that mimics PCR by relying on electrochemical signals from saliva or nasal swab samples that can pick up viral genes in about 30 minutes. The reader device, which can be reused, costs $75 and a single-use saliva test kit for COVID-19 is $48. Researchers are working on cheaper versions of these molecular tests, and some may eventually be read through devices that attach to smartphones.

“The biggest challenge continues to be price,” says Dr. Carlos del Rio, president of the board of directors of the Infectious Diseases Society of America and professor of medicine at Emory University. “We need to hopefully see the price come down like they have for some cell phones and computers.” Even the lowest-priced option, the rapid antigen tests, are currently in the range of $25 per test—which can add up, especially when families need to buy several kits to test everyone multiple times in a household.

Eventually, even PCR-based devices may become small, convenient, and cheap enough for people to have at home. Such diagnostic testing may follow the example of pregnancy testing, which for decades could only be done at a doctor’s office with blood and urine samples and can now be done at home with an inexpensive urine stick. “I truly believe that within five years we will have little molecular devices in our homes that can test for a panel of five things,” says Dr. Luis Ostrosky, chief of infectious diseases at UTHealth Houston and Memorial Hermann. “We’re living in a revolution in diagnostics.”

At-home testing is becoming a thing not just for COVID-19, but for seasonal flu and other infections. Here’s what you need to know. 

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At-home testing is becoming a thing not just for COVID-19, but for seasonal flu and other infections. Here’s what you need to know.

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• September 22, 2023
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• 6 minutes Read

What It Will Take to Avoid a Tripledemic This Winter

What It Will Take to Avoid a Tripledemic This Winter

Over the coming months, more than 100,000 Americans will likely die, mostly unnecessarily, from respiratory infections. Yes, that is the reality we are now facing this fall and winter—and likely every fall and winter for the foreseeable future. Unless we act. Between flu, COVID-19, and RSV, we are likely looking at a very large number of Americans getting sick, ending up in the hospital, and dying. Most of these Americans will be our most vulnerable: older Americans, the youngest children, and those with chronic diseases. And that number of 100,000 may be an underestimate, given that many of these infections go undetected and can substantially increase the risk of heart attacks or strokes weeks later.

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It doesn’t have to be this way. We can prevent another “tripledemic” and more—we can stop respiratory infections from harming and killing so many people.

For the first time, this fall and winter, we have highly effective, safe vaccines available to protect Americans against all three major causes of serious respiratory infections. In addition to flu shots, which should work well this year (their efficacy can vary from year to year), we now have effective RSV vaccines for people 60 years of age or older. Substantial data now show that the updated COVID-19 vaccine is effective against the latest variants.

But as the pandemic has shown many times, having tools—like vaccines and treatments—to save lives is just the beginning. We now need to provide broad and easy access to these shots for every American. Along the way, we need to rebuild trust in vaccines.

The work starts with acknowledging that for many Americans, vaccines are not a top priority amidst other pressing economic, health and safety challenges right now. To reach them in the coming weeks, we need to continue the progress we made during the pandemic in meeting people where they already are, be that at the barber shop, the fall festival or the community kitchen.   

We also need to counter the mis- and disinformation that has permeated the information landscape, bad information that discourages Americans from protecting themselves and their families through vaccinations. Around the nation, many public health communicators are trying new approaches to do just that. We know that billions of people around the world and in our country got safely vaccinated against COVID-19, and that helped end the emergency phase of the pandemic. These vaccines are safe. And they work.

Read More: Pandemics Don’t End. They Echo.

Finally, we need to help people navigate when is a good time to get the vaccine, based on their risk profile. That’s because the vaccine guidance is different for people at lower risk—younger people who are not immunocompromised without other severe medical conditions—than for those at higher risk.

People under the age of 60 who do not have an immunocompromising or other severe medical condition are, relatively speaking, at lower risk of complications from respiratory illness. They should get their annual flu and COVID shots because they will have milder infections if they are vaccinated and they are less likely to spread it to others if they get infected. They can get the shots as soon as it is convenient to do so. Getting these vaccines early in the season should provide a good degree of protection throughout the fall and winter.

For more vulnerable Americans—and there are around 100 million adults in the U.S. who are considered at higher risk—the situation is a bit different. Our strategies to protect older Americans, those with substantial chronic illnesses, and the very youngest children, need to consider three sets of factors: When do flu, COVID and RSV infections rise? When does protection from vaccines begin to wane? And when will vaccines be widely available to the people who need them the most? For high-risk Americans, timing may matter.

Over the last three winters, we have seen COVID peak in late December to mid-January. Flu generally peaks later. And RSV can be quite variable but is often earlier. For older and other vulnerable Americans, the protection from vaccines against infection and even serious illness can begin to wane within months of vaccination. This is largely due to an immune response to the vaccine that is less robust than it is for younger people.

High-risk Americans who get vaccinated in September, when flu shots are first made available, may experience some waning immunity by the time flu peaks, which typically happens between late January and early March. Given that there is no recommendation for a 2nd flu shot late in the season, it may make sense to wait on taking the flu shot until a little later. One could make the same case for COVID shots.

Given that RSV can come early, it may be reasonable to get RSV vaccines now and flu and COVID shots later in October. But getting all three shots together sometime during October, not later than Halloween, is also a reasonable option. And to be sure: the administration of multiple vaccines at one time has been extensively studied and the evidence shows that it is both safe and as effective as getting shots spaced out over time.

Around the nation, pharmacies, workplaces, and community clinics have started fall flu and COVID vaccinations. People can get both in one visit. Pharmacies, state and local health departments and the agencies and institutions that care for older Americans should work with community partners on intensive outreach in the upcoming weeks, standing up accessible clinics with convenient hours that offer all three vaccinations. Family caregivers should mark their calendars and schedule appointments.

For years, we tolerated tens of thousands of our vulnerable citizens dying each year from the flu and RSV. With the arrival of COVID, the number of Americans dying of respiratory infections has increased substantially. We can save many of these lives. All Americans are better off getting both the flu and COVID vaccines. But all of us also have an obligation to ensure that the nearly 1 in 3 Americans who are most vulnerable get these life-saving vaccines. If we do, we can break the deadly cycle of respiratory viruses and save lives, particularly those of the oldest and youngest among us.

RSV, the flu, and COVID-19 are racing towards us this winter, but we have the tools to fight back and focus on te most vulnerable. 

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Health – TIME 

RSV, the flu, and COVID-19 are racing towards us this winter, but we have the tools to fight back and focus on te most vulnerable.

• 
• Uncategorized
• September 21, 2023
• 39 views
• 5 minutes Read

How Wastewater Testing Can Help Tackle America’s Opioid Crisis

How Wastewater Testing Can Help Tackle America’s Opioid Crisis

Among the many lasting legacies of COVID-19 may be a newfound appreciation for the value of what we flush down the toilet and wash down the drain.

Wastewater can be a rich source of information about infectious diseases, like COVID-19, as well as flu, respiratory syncytial virus (RSV), mpox and polio, since pathogens like viruses are shed in feces, urine and saliva, all of which is drained into sewage treatment plants. Sampling that water is a good way to screen for certain viruses, and, as more people bypass the medical system and labs in favor of testing themselves at home for things like COVID-19, health agencies like the U.S. Centers for Disease Control and Prevention (CDC) have less data from which they can monitor the ebb and flow of infections. Wastewater, however, could change that and is quickly becoming the most reliable way to track such diseases.

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Now that same system will not only screen for infectious disease agents but for opioids as well. Biobot, the first company to offer commercial wastewater surveillance, is launching a program in collaboration with the National Institutes of Health’s National Institute on Drug Abuse (NIDA) to track trends in opioid use in wastewater. In 2018, Biobot, based in Cambridge, Mass., began tracking opioids such as morphine, hydrocodone, oxycodone, codeine, heroin and fentanyl in a pilot program with several dozen cities including Cary, N.C. By highlighting areas where use of these drugs was higher, the city directed more resources to educating people about the dangers of overdose, as well as intervene with naloxone to reverse overdoses, which helped to reduce overdoses by 40% within a year.

Tracking opioids nationwide

The new NIDA-supported program, which is the first of its kind to regularly monitor opioid use in municipalities, will include 70 locations around the country, focusing on regions with high opioid overdoses. The scientists will screen for five substances, including cocaine, fentanyl, methamphetamine, and xylazine, as well as the overdose treatment naloxone.

“The idea is that these data will be shared not just to federal agencies but to local health departments to help them develop their own programming to address over doses,” says Mariana Matus, co-founder of Biobot. Having that information in as close to real-time as possible is important for making sure adequate resources such as treatment programs are in place, says Matus. “When we first founded the company in 2017, this type of information was very delayed,” she says. “We measured the consumption of prescription and street substances through wastewater, and that real-time information can be useful to public health officials to reduce overdoses.” Communities that see increasing trends in the presence of opioids in their wastewater, for example, can launch more harm reduction efforts such as education, treatment and intervention programs.

Read More: These Scientists are Sewer Diving to Detect Silent COVID-19 Outbreaks

Matt Meyer, county executive for New Castle, Del., hopes that’s the case for his county. In addition to opioids, Biobot will be screening for, among other things, tobacco to better direct smoking cessation and tobacco-free kids education efforts to parts of the county where use might be higher. Otherwise, he says, “my instinct would be to distribute resources equally to all schools for tobacco prevention to try to get kids not to smoke and vape. But if the sewer data is telling us where there is higher prevalence of tobacco, that would probably encourage us to spend more in certain school neighborhoods than in others. The same is true of cocaine and methamphetamine since sewage gives us unbiased data.” New Castle, for example, has a police behavioral unit that addresses substance-use complaints, and information about where use might be higher could redirect these teams to those regions.

Screening for pathogens and drugs

Everything starts with collecting the sample at the sewage treatment plant, with a kit Biobot provides. Once the sample arrives at the company’s labs, the process of scanning for opioids differs slightly from that behind screening for infectious disease agents. For viruses, the team uses gene-based detection methods to find and then amplify genetic signals of pathogens like SARS-CoV-2, influenza or mpox. In the case of opioids, which are chemical substances, they rely on mass spectroscopy, which breaks down compounds by their main ingredients and produces unique chemical fingerprints of things like fentanyl.

In the first phase of the program, the data will be fed back to local public health officials to better allocate resources for fighting the opioid epidemic—specifically addressing overdoses. Ultimately, however, Matus says wastewater surveillance for opioids could be used to detect changes in the substances and alert authorities if more dangerous and potentially deadly versions are beginning to make the rounds.

Public health officials are just beginning to tap into the power of wastewater surveillance, says Matus. During its partnership with the CDC on COVID-19 tracking, Biobot provided about 30% of the national data on COVID-19 cases from wastewater, and the information was useful enough for the agency to renew its wastewater surveillance efforts. The CDC has asked for submissions for a commercial partner and Matus hopes Biobot will be able to renew its collaboration with the CDC, and continue to provide data to the agency.

“Wastewater surveillance is becoming more mature and more mainstream month over month, year over year,” she says.

A wastewater surveillance company is expanding its program to track opioids in sewage. 

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Health – TIME 

A wastewater surveillance company is expanding its program to track opioids in sewage.