Monthly Archives: March 2014
ABC TV’s The Vagina Diaries investigates the worrying trend for increasing numbers of labiaplasty procedures being performed in Australia. Labiaplasty is a surgical procedure to remove or reduce the labia minora, the inner lips of the vagina. Presenter Natalie Harris interviews a number of doctors…
ABC TV’s The Vagina Diaries investigates the worrying trend for increasing numbers of labiaplasty procedures being performed in Australia. Labiaplasty is a surgical procedure to remove or reduce the labia minora, the inner lips of the vagina.
Presenter Natalie Harris interviews a number of doctors, patients, and sex industry professionals in the documentary. She even asks random men on the street about what they think about vaginas and the reasons that women might choose to “go under the knife” to have their labia reduced.
The documentary explores the core issues at the heart of labiaplasty – female self-esteem and confidence. The common thread among the women who have labial reduction surgery is the feeling that they’re abnormal and somehow unattractive to their sexual partner.
Why so worried?
We don’t know why a woman may feel unappealing to her sexual partner. But the reasons for this distress are complex and part of a psychological spectrum of body image disorders.
Women’s distress may be influenced by current grooming trends, especially pubic hair removal, which renders the labia more exposed, and may irritate sensitive skin.
And concerns about labial appearance are unsurprising when one looks at advertising sites for labiaplasty on the internet. Given the intention of these sites is to generate a demand for surgery, they don’t tend to celebrate diversity.
Rather, the image of a smooth exterior with the labia minora tucked inside the labia majora is idealised – and negative comparisons are encouraged.
The fact of the matter is that most women (indeed, most people) haven’t actually seen many vulvas up close, and don’t know about the vast anatomical range of normality.
And, interestingly, Australian censorship laws prohibit the publication of illustrations of the labia minora and the clitoris. So vulvas are invariably made to resemble that of prepubescent girls, with pubic hair removed and a single crease placed between the labia major (external lips of the vagina).
This contributes to the general lack of knowledge and understanding about female genital diversity.
The consequences of this are distorted views of genital normality, leading to insecurities in women whose genitals don’t mirror this idealised image.
Confidence and consequences
In the documentary, a sexual health advocate identified as Danni who has had labiaplasty says that if you ask a surgeon whether an operation should be performed, they’re likely to say yes.
She says although she didn’t regret her operation, in hindsight, she wouldn’t have undergone her labiaplasty procedure and considered it largely unnecessary if she’d been more self assured and mature. And particularly if she’d had the benefit of more information on genital diversity.
But a labiaplasty procedure may precede more then just regret.
Women can experience complications such as bleeding, infection and scarring. And the long-term complications of labial reduction surgery are unknown.
What we do know is that women experience sensation from labia minora that contributes to sexual function. In fact, after the clitoris, the labia minora are regarded the most sensitive part of the female genitalia, helping stimulation and lubrication during sex.
Cutting and burning this delicate tissue causes scar tissue, and interferes with the blood and nerve supply making the labia less sensitive to touch. This may have a negative impact on sexual sensation.
So why would a woman want labiaplasty? Women rate confidence as the big driver for undergoing surgery.
One interviewee, identified as Louise in the documentary, says, despite the pain and illness she suffered as a result of surgery, she felt more confident after her procedure.
But the presenter points out that the surgery seemed to fulfil a space in her mind rather than body; that it seemed to have less of a physical impact than a psychological one.
A much-needed backlash
Medicare’s schedule of pharmaceutical benefits items reports the number of labioplasty procedures has doubled in the last ten years in Australia. And a similar trend is occurring throughout the developed world.
A recently released “ethical opinion paper” by the UK’s Royal College of Obstetricians and Gynaecologists says women should be given accurate information about normal variations in female genitalia. And that those requesting labiaplasty should be offered counselling and psychological treatments for problems such as body image distress.
Knowledge is power, and a recent backlash against genital insecurities has prompted the launch of “labia library” by Women’s Health Victoria. The website contains information, advice and a photo gallery of 20 normal labia.
Sites such as these may help prevent the harm caused by unnecessary, and often expensive, surgery.
Congratulations to the makers of this documentary for what they have achieved in this documentary. This is an important issue that needs attention, you should watch it.
Lifestyle holds key to predicting women’s brain health
18 December 2013
Australian researchers have identified lifestyle factors that impair women’s brain performance as early as age 45.
A joint study from The University of Queensland, the University of New South Wales and Flinders University of South Australia shows certain lifestyle behaviours like smoking, excessive drinking and physical inactivity are linked to negative brain functions in women.
Supported by grants from the National Health and Medical Research Council and the Royal Brisbane and Women’s Hospital Foundation, the eight-year study involved 489 Brisbane middle-aged and older women who were recruited from 2001.
Professors Gerard Byrne from the UQ School of Medicine and Nancy Pachana from the UQ School of Psychology led the study.
Professor Pachana said the effect these lifestyle factors could have on cognitive performance occurred much earlier than expected.
“Although the average person might believe cognitive decline usually occurs later in life, research suggests significant declines in all aspects of cognitive performance may begin as early as age 45 in women,” Professor Pachana said.
“In our study we were able to detect independent and consistent effects across time for smoking, drinking, and physical activity on five measures of cognitive function,” she said.
She said objective thinking and memory tests were administered on three occasions over eight years and each time results showed smoking appeared to have impaired cognitive function.
“Moderate drinking and high physical activity levels offered protective effects over time, compared to not drinking and low levels of physical activity,” Professor Pachana said.
“These effects remained after adjustments were made to take account of the varying ages and levels of education of the women in the study, as well as adjustments for differences in health such as hypertension.
“Effects remained for light to moderate drinkers even after adjusting for physical activity levels.
“Current smokers performed worse than past smokers, who in turn performed worse than those who had never smoked.”
If the women in the study engaged in increasing intensities of physical exercise, rather than just quantity of physical activity, they were less likely to experience declines in thinking.
“Future studies might aim to determine longer-term outcomes across time of cognitive change as influenced by lifestyle behaviours such as exercise,” Professor Pachana said.
If your blood test results suggest you’re low on vitamin D, you’re not alone – nearly one-third of the Australian population isn’t getting enough of the sunshine vitamin. But this doesn’t necessarily mean…
If your blood test results suggest you’re low on vitamin D, you’re not alone – nearly one-third of the Australian population isn’t getting enough of the sunshine vitamin. But this doesn’t necessarily mean you need to take a supplement.
Contrary to some reports, there is no evidence that taking vitamin D supplements reduces your risk of developing diabetes, colon cancer, arthritis or infections, or that supplements help you live longer.
In some cases, taking a supplement merely means you’re wasting your money. But if you’re taking high doses, you may be doing more harm than good.
What is vitamin D?
Vitamin D is a fat soluble vitamin that is not readily available in the diet, apart from in fatty fish, ultraviolet (UV) light-irradiated mushrooms and green leafy vegetables. In fact, an average diet only provides one-sixth of the daily requirement for vitamin D, or about 110 international units (IU).
In many countries, including the United States and Philippines, there is widespread vitamin D fortification of foods, including milk, bread, cereals and orange juice. This does not occur in Australia.
Instead, most circulating vitamin D is generated via the effects of sunlight and UV “B” radiation on a cholesterol precursor in the skin. This then circulates in the blood and is activated in the liver and kidneys to become a hormone.
Anyone with less than 50 nanomoles of vitamin D per litre (nmol/L) at the end of winter or in early spring are categorised as having low levels.
Vitamin D and health
Vitamin D aids the absorption of calcium from the gut and is very important for healthy bones and muscles in both children and adults. Low vitamin D levels cause rickets in children, and soft (osteomalacia) or thin bones (osteoporosis) in adults.
What is less clear is whether low vitamin D levels are associated with other chronic diseases such as bowel cancer, diabetes, heart disease, arthritis, infections and the overall risk of dying. This is because these low vitamin D levels could either be the cause or result of ill health.
A recent study in Lancet Diabetes and Endocrinology shows that earlier findings, derived from studies in which patients with several different chronic diseases had low vitamin D levels, were not reinforced by higher-level evidence resulting from clinical trials using vitamin D supplements.
In these trials, vitamin D supplements were given to correct low levels and to reduce effects of these diseases. The only exception was that vitamin D supplements slightly reduced the risk of dying in the elderly.
This apparent disconnect between the two levels of evidence may mean that low vitamin D levels are a marker of ill health, but not a causative factor for these chronic diseases.
The research solution
Large trials of vitamin D supplements in people with low vitamin D levels are now underway. Our study is based at the Berghofer Queensland Institute of Medical Research and the University of Melbourne, and will track participants over ten years.
We will treat 25,000 people aged from 60 to 79 years with low vitamin D levels to see whether vitamin D supplements will reduce the risk of dying. We will also see whether supplements reduce the risk of developing chronic diseases such as colon cancer, arthritis, infections and diabetes, as well as falls and fractures.
Studies such as ours will also need to look at markers of underlying disease activity.
So while we are waiting for this new evidence, what can you do about your low vitamin D level?
If the level is mildly decreased, rolling up your sleeves and getting outside in the sun more often — say, for about ten minutes at 10am or 2pm in summer, or for about 30 minutes at midday in winter — might help.
At these times, the UV index is likely to be less than three, indicating such limited sun exposure will be relatively safe. You can check how much sun you need on the Healthy Bones Australia website.
Boosting your vitamin D levels, combined with a good dietary calcium intake of at least three serves per day and weight-bearing exercise (which includes brisk walking) for 20 minutes four times a week, will also help ensure your bones remain healthy as you get older.
If you are unable to get outdoors, or you cover your skin for cultural reasons, have dark skin, osteoporosis or low bone density (thin bones), you may need to take a supplement. The usual dose is 1,000 or 2,000 international units (IU) per day for most people.
After taking daily vitamin D supplements for three months, your doctor can check if the levels have increased above the recommended level of 50 nanomoles per litre (nmol/L). Such doses are safe, but very large yearly doses are not recommended because they can actually increase the risk of falls and fractures.
I should start by saying that an important part of my job is encouraging hospital staff to clean their hands. The World Health Organisation has a global patient safety campaign reminding us that Clean…
I should start by saying that an important part of my job is encouraging hospital staff to clean their hands. The World Health Organisation has a global patient safety campaign reminding us that Clean Hands SAVE LIVES, and in-hospital hand hygiene is universally recognised as one of the most important ways of reducing healthcare-associated infection.
Most of you don’t live in a hospital, though. So what about at home? Little bottles of hand gel are appearing in more and more places every day. Is this a good idea or just part of a societal “germ panic”?
There are three groups of products to consider: alcohol-based hand sanitisers, antibacterial soaps and other antibacterial products.
These are usually alcohol-based and are highly effective at cleaning hands. They are the preferred method in hospital because they are also fast and convenient – and this increases the likelihood they will be used.
Hand sanitisers kill most bacteria and fungi as well as many viruses (norovirus, a common viral gastroenteritis, is a weakness) and work without water. We have a bottle in our nappy bag for that inconvenient pit stop.
Antibacterial soaps have come in for a bit of a bashing in recent media reports, based on the US Food and Drug Administration releasing a press statement and consumer notice announcing plans to require makers of these products to prove that they work.
All the rest
Are they safe?
By and large at an individual level, yes, they are. Alcohol-based hand rubs are safe to use. They’re obviously not designed to drink and should be kept away from children, but pose no major health risks. Muslim health-care facilities have adopted their use, despite alcohol being haram in Islamic faith.
All hand-hygiene activities take oils from your skin and increase the chance of dry hands or dermatitis, but hand rubs are better from this perspective than soap-and-water hand washing.
Triclosan has received media attention because of concerns about thyroid hormone metabolism in animal models, but has not been shown to cause these effects in humans. There are concerns about its role as an environmental contaminant as it is found in waste water from sewerage, but also as a residue from industrial processes (the manufacture of those antibacterial plastics). Although, again, there is not conclusive proof of harm.
Of concern to people like me, however, is the risk of antimicrobial resistance. If germs in the community are exposed to these products, could we be creating more resistant germs that will cause us problems down the track?
Because hand rubs kill germs by direct action of the alcohol against the germs, there is no risk of resistance. The question is not so clear for the soaps, though.
But hospital-grade triclosan (1%) is a far cry from the concentration in most over-the-counter liquid soaps. A review in 2007 found no additional benefit to these products and identified risks for resistance.
Any microbiologist will tell you that prolonged exposure of bugs to low concentrations of antimicrobials is the textbook way of breeding resistance.
Are they necessary?
So, does the average house and family need to armour up in the war against germs?
I have to say probably not.
Good hygiene is important in preventing disease — and hand washing is part of that (along with cough etiquette, staying home when sick, and so on). But the benefits of these products over soap and water (apart from the portability of gels) have not been shown outside the hospital setting.
Antibacterial chopping boards won’t stop you from getting sick if you don’t practice good food-handling techniques and antibacterial toilet seats do not add to (or replace) washing your hands when you’re done.
And those antibacterial baby toys? Babies put their hand from the toy straight onto the floor, onto the cat or any of a dozen other non-antibacterial surfaces, so any effect is likely to be small (i.e. zero).
We do not – and cannot – live in a germ-free world. Spending money on these products doesn’t guarantee you won’t get sick (of course they can’t) and probably don’t even reduce your risk of getting sick. But they might contribute to bacterial resistance, and they certainly cost more.
Break the marketing cycle of germ panic and reach for the plain old soap
Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: A systematic review.
Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8; Division of Mood and Anxiety Disorders, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, Canada M6J 1H4. Electronic address: firstname.lastname@example.org.
Depressed and anxious patients often combine complementary and alternative medicine (CAM) therapies with conventional pharmacotherapy to self-treat symptoms. The benefits and risks of such combination strategies have not been fully evaluated. This paper evaluates the risk-benefit profile of CAM augmentation to antidepressants in affective conditions.
PubMed was searched for all available clinical reports published in English up to December 2012. Data were evaluated based on graded levels of evidence for efficacy and safety.
Generally, the evidence base is significantly larger for depression than for anxiety disorder. In unipolar depression, there is Level 2 evidence for adjunctive sleep deprivation (SD) and Free and Easy Wanderer Plus (FEWP), and Level 3 for exercise, yoga, light therapy (LT), omega-3 fatty acids, S-adenosylmethionine and tryptophan. In bipolar depression, there is Level 1 evidence for adjunctive omega-3s, Level 2 for SD, and Level 3 for LT and FEWP. In anxiety conditions, exercise augmentation has Level 3 support in generalized anxiety disorder and panic disorder. Though mostly well-tolerated, these therapies can only be recommended as third-line interventions due to the quality of available evidence.
Overall, the literature is limited. Studies often had methodological weaknesses, with little information on long-term use and on potential drug-CAM interactions. Many CAM studies were not published in English.
While several CAM therapies show some evidence of benefit as augmentation in depressive disorders, such evidence is largely lacking in anxiety disorders. The general dearth of adequate safety and tolerability data encourages caution in clinical use.
© 2013 Elsevier B.V. All rights reserved.
Anxiety disorders, Augmentation, Combination, Complementary and alternative medicine, Depressive disorders, Systematic review
- [PubMed – in process]
Why a Brisk Walk Is Better
The New York Times, 12/05/2013
Walking, fast or slow, is wonderful exercise. But now a first–of–its–kind study shows that to get the most health benefits from walking, many of us need to pick up the pace. The findings stem from a new analysis of the National Walkers’ Health Study, a large database of information maintained at the Lawrence Berkeley National Laboratory about thousands of middle–age men and women who walk regularly for exercise. Recruited beginning in 1998 at walking events and from lists of subscribers to walking–related publications, these volunteers filled out a lengthy survey about their typical walking distance and pace, as well as their health history and habits. Paul T. Williams, a statistician at Lawrence Berkeley National Laboratory, gathered data about 7,374 male and 31,607 female participants from the walkers’ health study, who represented almost every speed of fitness walker, from sluggish to swift. His findings were published online this month in PLoS One. Unexpectedly, the death rate remained high among the slowest walkers, even if they met or exceeded the standard exercise guidelines and expended as much energy per day as someone walking briskly for 30 minutes. This effect was most pronounced among the slowest of the slow walkers, whose pace was 24 minutes per mile or higher. They were 44 percent more likely to have died than walkers who moved faster, even if they met the exercise guidelines.
Goodnight. Sleep Clean.
By MARIA KONNIKOVAJAN. 11, 2014
SLEEP seems like a perfectly fine waste of time. Why would our bodies evolve to spend close to one-third of our lives completely out of it, when we could instead be doing something useful or exciting? Something that would, as an added bonus, be less likely to get us killed back when we were sleeping on the savanna?
“Sleep is such a dangerous thing to do, when you’re out in the wild,” Maiken Nedergaard, a Danish biologist who has been leading research into sleep function at the University of Rochester’s medical school, told me. “It has to have a basic evolutional function. Otherwise it would have been eliminated.”
We’ve known for some time that sleep is essential for forming and consolidating memories and that it plays a central role in the formation of new neuronal connections and the pruning of old ones. But that hardly seems enough to risk death-by-leopard-in-the-night. “If sleep was just to remember what you did yesterday, that wouldn’t be important enough,” Dr. Nedergaard explains.
In a series of new studies, published this fall in the journal Science, the Nedergaard lab may at last be shedding light on just what it is that would be important enough. Sleep, it turns out, may play a crucial role in our brain’s physiological maintenance. As your body sleeps, your brain is quite actively playing the part of mental janitor: It’s clearing out all of the junk that has accumulated as a result of your daily thinking.
Recall what happens to your body during exercise. You start off full of energy, but soon enough your breathing turns uneven, your muscles tire, and your stamina runs its course. What’s happening internally is that your body isn’t able to deliver oxygen quickly enough to each muscle that needs it and instead creates needed energy anaerobically. And while that process allows you to keep on going, a side effect is the accumulation of toxic byproducts in your muscle cells. Those byproducts are cleared out by the body’s lymphatic system, allowing you to resume normal function without any permanent damage.
The lymphatic system serves as the body’s custodian: Whenever waste is formed, it sweeps it clean. The brain, however, is outside its reach — despite the fact that your brain uses up about 20 percent of your body’s energy. How, then, does its waste — like beta-amyloid, a protein associated with Alzheimer’s disease — get cleared? What happens to all the wrappers and leftovers that litter the room after any mental workout?
“Think about a fish tank,” says Dr. Nedergaard. “If you have a tank and no filter, the fish will eventually die. So, how do the brain cells get rid of their waste? Where is their filter?”
UNTIL a few years ago, the prevailing model was based on recycling: The brain got rid of its own waste, not only beta-amyloid but other metabolites, by breaking it down and recycling it at an individual cell level. When that process eventually failed, the buildup would result in age-related cognitive decline and diseases like Alzheimer’s. That “didn’t make sense” to Dr. Nedergaard, who says that “the brain is too busy to recycle” all of its energy. Instead, she proposed a brain equivalent of the lymphatic system, a network of channels that cleared out toxins with watery cerebrospinal fluid. She called it the glymphatic system, a nod to its dependence on glial cells (the supportive cells in the brain that work largely to maintain homeostasis and protect neurons) and its function as a sort of parallel lymphatic system.
She was hardly the first to think in those terms. “It had been proposed about one hundred years ago, but they didn’t have the tools to study it properly,” she says. Now, however, with advanced microscopes and dyeing techniques, her team discovered that the brain’s interstitial space — the fluid-filled area between tissue cells that takes up about 20 percent of the brain’s total volume — was mainly dedicated to physically removing the cells’ daily waste.
When members of Dr. Nedergaard’s team injected small fluorescent tracers into the cerebrospinal fluid of anesthetized mice, they found that the tracers quickly entered the brain — and, eventually, exited it — via specific, predictable routes.
The next step was to see how and when, exactly, the glymphatic system did its work. “We thought this cleaning process would require tremendous energy,” Dr. Nedergaard says. “And so we asked, maybe this is something we do when we’re sleeping, when the brain is really not processing information.”
In a series of new studies on mice, her team discovered exactly that: When the mouse brain is sleeping or under anesthesia, it’s busy cleaning out the waste that accumulated while it was awake.
In a mouse brain, the interstitial space takes up less room than it does in ours, approximately 14 percent of the total volume. Dr. Nedergaard found that when the mice slept, it swelled to over 20 percent. As a result, the cerebrospinal fluid could not only flow more freely but it could also reach further into the brain. In an awake brain, it would flow only along the brain’s surface. Indeed, the awake flow was a mere 5 percent of the sleep flow. In a sleeping brain, waste was being cleared two times faster. “We saw almost no inflow of cerebrospinal fluid into the brain when the mice were awake, but then when we anesthetized them, it started flowing. It’s such a big difference I kept being afraid something was wrong,” says Dr. Nedergaard.
Similar work in humans is still in the future. Dr. Nedergaard is currently awaiting board approval to begin the equivalent study in adult brains in collaboration with the anesthesiologist Helene Benveniste at Stony Brook University.
So far the glymphatic system has been identified as the neural housekeeper in baboons, dogs and goats. “If anything,” Dr. Nedergaard says, “it’s more needed in a bigger brain.”
MODERN society is increasingly ill equipped to provide our brains with the requisite cleaning time. The figures are stark. Some 80 percent of working adults suffer to some extent from sleep deprivation. According to the National Sleep Foundation, adults should sleep seven to nine hours. On average, we’re getting one to two hours less sleep a night than we did 50 to 100 years ago and 38 minutes less on weeknights than we did as little as 10 years ago. Between 50 and 70 million people in the United States suffer from some form of chronic sleep disorder. When our sleep is disturbed, whatever the cause, our cleaning system breaks down. At the University of Pennsylvania’s Center for Sleep and Circadian Neurobiology, Sigrid Veasey has been focusing on precisely how restless nights disturb the brain’s normal metabolism. What happens to our cognitive function when the trash piles up?
At the extreme end, the result could be the acceleration of neurodegenerative diseases like Alzheimer’s and Parkinson’s. While we don’t know whether sleep loss causes the disease, or the disease itself leads to sleep loss — what Dr. Veasey calls a “classic chicken-and-egg” problem — we do know that the two are closely connected. Along with the sleep disturbances that characterize neurodegenerative diseases, there is a buildup of the types of proteins that the glymphatic system normally clears out during regular sleep, like beta-amyloids and tau, both associated with Alzheimer’s and other types of dementia.
“To me,” says Dr. Veasey, “that’s the most compelling part of the Nedergaard research. That the clearance for these is dramatically reduced from prolonged wakefulness.” If we don’t sleep well, we may be allowing the very things that cause neural degeneration to pile up unchecked.
Even at the relatively more benign end — the all-nighter or the extra-stressful week when you caught only a few hours a night — sleep deprivation, as everyone who has experienced it knows, impedes our ability to concentrate, to pay attention to our environment and to analyze information creatively. “When we’re sleep-deprived, we can’t integrate or put together facts,” as Dr. Veasey puts it.
But there is a difference between the kind of fleeting sleep loss we sometimes experience and the chronic deprivation that comes from shift work, insomnia and the like. In one set of studies, soon to be published in The Journal of Neuroscience, the Veasey lab found that while our brains can recover quite readily from short-term sleep loss, chronic prolonged wakefulness and sleep disruption stresses the brain’s metabolism. The result is the degeneration of key neurons involved in alertness and proper cortical function and a buildup of proteins associated with aging and neural degeneration.
It’s like the difference between a snowstorm’s disrupting a single day of trash pickup and a prolonged strike. No longer quite as easy to fix, and even when the strike is over, there’s likely to be some stray debris floating around for quite some time yet. “Recovery from sleep loss is slower than we’d thought,” Dr. Veasey notes. “We used to think that after a bit of recovery sleep, you should be fine. But this work shows you’re not.”
If you put her own research together with the findings from the Nedergaard lab, Dr. Veasey says, it “very clearly shows that there’s impaired clearance in the awake brain. We’re really starting to realize that when we skip sleep, we may be doing irreparable damage to the brain, prematurely aging it or setting it up for heightened vulnerability to other insults.”
In a society that is not only chronically sleep-deprived but also rapidly aging, that’s bad news. “It’s unlikely that poor sleep as a child would actually cause Alzheimer’s or Parkinson’s,” says Dr. Veasey, “but it’s more likely that you may shift one of those diseases by a decade or so. That has profound health and economic implications.”
It’s a pernicious cycle. We work longer hours, become more stressed, sleep less, impair our brain’s ability to clean up after all that hard work, and become even less able to sleep soundly. And if we reach for a sleeping pill to help us along? While work on the effects of sleeping aids on the glymphatic system remains to be done, the sleep researchers I spoke with agree that there’s no evidence that aided sleep is as effective as natural sleep.
There is, however, reason to hope. If the main function of sleep is to take out our neural trash, that insight could eventually enable a new understanding of both neurodegenerative diseases and regular, age-related cognitive decline. By developing a diagnostic test to measure how well the glymphatic system functions, we could move one step closer to predicting someone’s risk of developing conditions like Alzheimer’s or other forms of dementia: The faster the fluids clear the decks, the more effectively the brain’s metabolism is functioning.
“Such a test could also be used in the emergency room after traumatic brain injury,” Dr. Nedergaard says, “to see who is at risk of developing decline in cognitive function.”
We can also focus on developing earlier, more effective interventions to prevent cognitive decline. One approach would be to enable individuals who suffer from sleep loss to sleep more soundly — but how? Dr. Nedergaard’s mice were able to clear their brain’s waste almost as effectively under anesthesia as under normal sleeping conditions. “That’s really fascinating,” says Dr. Veasey. Though current sleeping aids may not quite do the trick, and anesthetics are too dangerous for daily use, the results suggest that there may be better ways of improving sleep pharmacologically.
Now that we have a better understanding of why sleep is so important, a new generation of drug makers can work to create the best possible environment for the trash pickup to occur in the first place — to make certain that our brain’s sleeping metabolism is as efficient as it can possibly be.
A second approach would take the opposite tack, by seeking to mimic the cleanup-promoting actions of sleep in the awake brain, which could make a full night of sound sleep less necessary. To date, the brain’s metabolic process hasn’t been targeted as such by the pharmaceutical industry. There simply wasn’t enough evidence of its importance. In response to the evolving data, however, future drug interventions could focus directly on the glymphatic system, to promote the enhanced cleaning power of the sleeping brain in a brain that is fully awake. One day, scientists might be able to successfully mimic the expansion of the interstitial space that does the mental janitorial work so that we can achieve maximally efficient round-the-clock brain trash pickup.
If that day comes, they would be on their way to discovering that all-time miracle drug: one that, in Dr. Veasey’s joking words, “could mean we never have to sleep at all.”
Maria Konnikova is the author of “Mastermind: How to Think Like Sherlock Holmes.”
What does compassion sound like?
“Good to see you. I’m sorry. It sounds like you’ve had a tough, tough, week.” Spoken by a doctor to a cancer patient, that statement is an example of compassionate behavior observed by a University of Rochester Medical Center team in a new study published by the journal Health Expectations.
Rochester researchers believe they are the first to systematically pinpoint and catalogue compassionate words and actions in doctor-patient conversations. By breaking down the dialogue and studying the context, scientists hope to create a behavioral taxonomy that will guide medical training and education.
“In health care, we believe in being compassionate but the reality is that many of us have a preference for technical and biomedical issues over establishing emotional ties,” said senior investigator Ronald Epstein, M.D., professor of Family Medicine, Psychiatry, Oncology, and Nursing and director of the UR Center for Communication and Disparities Research. Epstein is a national and international keynote speaker and investigator on mindfulness and communication in medical education.
His team recruited 23 oncologists from a variety of private and hospital-based oncology clinics in the Rochester, N.Y., area. The doctors and their stage III or stage IV cancer patients volunteered to be recorded during routine visits. Researchers then analyzed the 49 audio-recorded encounters that took place between November 2011 and June 2012, and looked for key observable markers of compassion.
In contrast to empathy – another quality that Epstein and his colleagues have studied in the medical community — compassion involves a deeper and more active imagination of the patient’s condition. An important part of this study, therefore, was to identify examples of the three main elements of compassion: recognition of suffering, emotional resonance, and movement towards addressing suffering.
Emotional resonance, or a sense of sharing and connection, was illustrated by this dialogue: Patient: “I should just get a room here.” Oncologist: “Oh, I hope you don’t really feel like you’re spending that much time here.”
Another conversation included this response from a physician to a patient, who complained about a drug patch for pain: “Who wants a patch that makes you drowsy, constipated and fuzzy? I’ll pass, thank you very much.”
Some doctors provided good examples of how they use humor to raise a patient’s spirits without deviating from the seriousness of the situation. In one case, for example, a patient was concerned that he would not be able to drink two liters of barium sulfite in preparation for a CT scan.
Doctor: “If you just get down one little cup it will tell us what’s going on in the stomach. What I tell people when we’re not being recorded is to take a cup and then poor the rest down the toilet and tell them you drank it all (laughter)… Just a creative interpretation of what you are supposed to take.”
Patient: “I love it, I love it. Well, I thank you for that. I’m prepared to do what I’ve got to do to get this right.” Researchers evaluated tone of voice, animation that conveyed tenderness and understanding, and other ways in which doctors gave reassurances or psychology comfort.
Here’s an instance in which an oncologist encouraged a reluctant patient to follow through with a planned trip to Arizona: “You know, if you decide to do it, break down and allow somebody to meet you at the gates and use a cart or wheelchair to get you to your next gate and things like that. And having just sent my father-in-law off to Hawaii and told him he had to do that, he said no, no, I can get there.
Just, it’s okay. Nobody is gonna look at you and say, ‘What’s an able-bodied man doing in a cart?’ Just, it’s okay. It’s part of setting limits.”
Researchers also observed non-verbal communication, such as pauses or sighs at appropriate times, as well as speech features and voice quality (tone, pitch, loudness) and other metaphorical language that conveyed certain attitudes and meaning.
Compassion unfolds over time, researchers concluded. During the process, physicians must challenge themselves to stay with a difficult discussion, which opens the door for the patient to admit uncertainty and grieve the loss of normalcy in life.
“It became apparent that compassion is not a quality of a single utterance but rather is made up of presence and engagement that suffuses and entire conversation,” the study said. First author, Rachel Cameron, B.A., is a student at the University of Rochester School of Medicine and Dentistry; the audio-recordings were reviewed by a diverse group of medical professionals with backgrounds in literature and linguistics, as well as palliative care specialists.
The National Cancer Institute funded the study.
Herbal preparations for the menopause: Beyond isoflavones and black cohosh.
- Menopause Clinic, Department of Obstetrics and Gynecology, University Hospital of Ghent, De Pintelaan, 185, 9000 Gent, Belgium. Electronic address: email@example.com.
Complementary and alternative medicines (CAM) such as isoflavones and black cohosh are commonly used to deal with menopausal symptoms, but benefit a limited proportion of women. The aim of this minireview is to summarize the evidence of the efficacy and safety of other herbal preparations. Randomized controlled trials (RCTs) find that the extracts of Mediterranean pine bark (Pycnogenol®), linseed, and Lepididium meyenii (Maca) reduce vasomotor symptoms. The results of RCTs of the hop flavonoid 8-prenylnaringenin are conflicting. Animal and human studies suggest that Dioscorea villosa (Wild yam),and Broccoli may protect against osteoporosis and breast and gynecological cancers but further evidence is required. Linseed may protect against breast cancer but the results are conflicting.
Copyright © 2013. Published by Elsevier Ireland Ltd.
Growing up unvaccinated
- Date January 8, 2014
I am the ’70s child of a health nut. I wasn’t vaccinated. I was brought up on an incredibly healthy diet: no sugar till I was 1, breastfed for over a year, organic homegrown vegetables, raw milk, no MSG, no additives, no aspartame. My mother used homeopathy, aromatherapy, osteopathy; we took daily supplements of vitamin C, echinacea, cod liver oil.
I had an outdoor lifestyle; I grew up next to a farm, walked everywhere, did sports and danced twice a week, drank plenty of water. I wasn’t even allowed fizzy drink; even my fresh juice was watered down to protect my teeth, and I would’ve killed for white, shop-bought bread in my lunchbox once in a while and biscuits instead of fruit, like all the other kids.
We ate (organic and local) meat maybe once or twice a week, and my mother and father cooked everything from scratch. Oven chips were reserved for those nights when Mum and Dad had friends over and we got a “treat.”
As healthy as my lifestyle seemed, I contracted measles, mumps, rubella, a type of viral meningitis, scarlet fever, whooping cough, yearly tonsillitis and chickenpox. In my 20s I got precancerous HPV and spent six months of my life wondering how I was going to tell my two children under the age of seven that Mummy might have cancer before it was safely removed.
So the anti-vaccine advocates’ fears of having the “natural immunity sterilised out of us” just doesn’t cut it for me. How could I, with my idyllic childhood and my amazing health food, get so ill all the time?
My mother would have put most of my current “crunchy” friends to shame. She didn’t drink, she didn’t smoke, she didn’t do drugs, and we certainly weren’t allowed to watch whatever we wanted on telly or wear plastic shoes or any of that stuff. She lived alternative health. And you know what? I’m glad she gave us such a great diet. I’m glad that she cared about us in that way.
But it just didn’t stop me getting childhood illnesses.
My two vaccinated children, on the other hand, have rarely been ill, have had antibiotics maybe twice in their lives, if that. Not like their mum. I got many illnesses requiring treatment with antibiotics. I developed penicillin-resistant quinsy at age 21 – you know, that old-fashioned disease that supposedly killed Queen Elizabeth I and that was almost wiped out through use of antibiotics.
My kids have had no childhood illnesses other than chickenpox, which they both contracted while still breastfeeding. They, too, grew up on a healthy diet, homegrown organics, etc. I was not quite as strict as my mother, but they are both healthier than I have ever been.
I find myself wondering about the claim that complications from childhood illnesses are extremely rare but that “vaccine injuries” are rampant. If this is the case, I struggle to understand why I know far more people who have experienced complications from preventable childhood illnesses than I have ever met with complications from vaccines. I have friends who became deaf from measles. I have a partially sighted friend who contracted rubella in the womb. My ex got pneumonia from chickenpox. A friend’s brother died from meningitis.
Anecdotal evidence is nothing to base decisions on. But when facts and evidence-based science aren’t good enough to sway someone’s opinion about vaccinations, then this is where I come from. After all, anecdotes are the anti-vaccine supporters’ way: “This is my personal experience.” Well, my personal experience prompts me to vaccinate my children and myself. I got the flu vaccine recently, and I got the whooping cough booster to protect my son in the womb. My natural immunity – from having whooping cough at age five – would not have protected him once he was born.
I understand, to a point, where the anti-vaccine parents are coming from. Back in the ’90s, when I was a concerned, 19-year-old mother, frightened by the world I was bringing my child into, I was studying homeopathy, herbalism and aromatherapy; I believed in angels, witchcraft, clairvoyants, crop circles, aliens at Nazca, giant ginger mariners spreading their knowledge to the Aztecs, the Incas and the Egyptians, and that I was somehow personally blessed by the Holy Spirit with healing abilities. I was having my aura read at a hefty price and filtering the fluoride out of my water. I was choosing to have past life regressions instead of taking antidepressants. I was taking my daily advice from tarot cards. I grew all my own veg and made my own herbal remedies.
I was so freaking crunchy that I literally crumbled. It was only when I took control of those paranoid thoughts and fears about the world around me and became an objective critical thinker that I got well. It was when I stopped taking sugar pills for everything and started seeing medical professionals that I began to thrive physically and mentally.
If you think your child’s immune system is strong enough to fight off vaccine-preventable diseases, then it’s strong enough to fight off the tiny amounts of dead or weakened pathogens present in any of the vaccines.
But not everyone around you is that strong, not everyone has a choice, not everyone can fight those illnesses, and not everyone can be vaccinated. If you have a healthy child, then your healthy child can cope with vaccines and can care about those unhealthy children who can’t.
I would ask the anti-vaxxers to treat their children with compassion and a sense of responsibility for those around them. I would ask them not to teach their children to be self-serving and scared of the world in which they live and the people around them. (And teach them to love people with autism spectrum disorder or any other disability supposedly associated with vaccines – not to label them as damaged.)
Most importantly, I want the anti-vaxxers to see that knowingly exposing your child to illness is cruel. Even without complications, these diseases aren’t exactly pleasant. I don’t know about you, but I don’t enjoy watching children suffer even with a cold or a hurt knee. If you’ve never had these illnesses, you don’t know how awful they are. I do. Pain, discomfort, the inability to breathe or to eat or to swallow, fever and nightmares, itching all over your body so much that you can’t stand lying on bedsheets, losing so much weight you can’t walk properly, diarrhea that leaves you lying prostrate on the bathroom floor, the unpaid time off work for parents, the quarantine, missing school, missing parties, the worry, the sleepless nights, the sweat, the tears, the blood, the midnight visits to the emergency room, the time sitting in a doctor’s waiting room on your own because no one will sit near you because they’re rightfully scared of those spots all over your face.
Those of you who have avoided childhood illnesses without vaccines are lucky. You couldn’t do it without us pro-vaxxers. Once the vaccination rates begin dropping, the drop in herd immunity will leave your children unprotected. The more people you convert to your anti-vax stance, the quicker that luck will run out.
Amy Parker is the mother of two teenagers and a new baby. She teaches music and the arts on the Fylde coast of England. This piece originally appeared on Voices for Vaccines.