Monthly Archives: August 2022
Pessaries are still a taboo topic – but these ancient devices help many women
Pessaries are still a taboo topic – but these ancient devices help many women
Published: August 23, 2022 12.18pm AEST
Authors
- Anna Rosamilia Adjunct associate professor and urogynaecology & pelvic reconstructive surgery, Head Pelvic Floor Unit at Monash Health, Monash University
- Mugdha Kulkarni Consultant Urogynaecologist, Pelvic Floor Unit, Monash Health
Disclosure statement
Anna Rosamilia is Clinical Associate Investigator for studies receiving funding from NHMRC, Past research grants from Boston Scientific, American Medical Systems. Astellas. She has had an expert witness role. None of this funding is related to pessaries. She is affiliated with and member of International Urogynecological Association, Urogynaecological Association of Australia, Continence Foundation of Australia and International Continence Society.
Mugdha Kulkarni is a member of International Urogynecological Association & Urogynaecological Association of Australia.
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A vaginal pessary is a removable device inserted in the vagina to support its walls or uterus (support pessary) or for bladder leakage (continence pessary).
Pessaries have been around for a very long time, the oldest known pessary – as described by the ancient Greek physician Hippocrates – was a pomegranate soaked in vinegar!
Nowadays, pessaries are made from silicone which is non allergenic, long lasting, pliable and can be sterilised. Some are worn continuously for weeks, months or years with appropriate maintenance, while others are inserted as needed.
What they are good for
There are many types of vaginal support pessaries with (mostly) descriptive names: ring, Gellhorn, donut, cube, C-POP and more. At least two models of continence pessaries – branded Contiform and Coo-Wee – are relatively new on the market as well as the continence ring and dish.
Continence pessaries are used for stress urinary incontinence or “light bladder leakage” that occurs with coughing, sneezing or exercise. These act to support the urethra, as can a vaginal tampon, and can prevent leakage in up to 60% of women. They are especially useful if leakage is predictable, such as when a woman goes to the gym or out for a jog.
Vaginal support pessaries can be effective for prolapse (a type of hernia or weakness of the vaginal walls and ligaments that allow the uterus, bladder, or bowel to descend to or beyond the vaginal opening). If successfully fitted, pessaries can help 60% to 70% of women with these problems. There is improvement in the feeling of a vaginal bulge or tissue protrusion, improvement in bladder emptying and bladder leakage and urgency, sexual frequency and satisfaction. About 50% of women who have a vaginal birth will have some prolapse and up to 20% will go on to have surgery during their lifetime.
Pelvic floor muscle training in the early stages can improve symptoms as can vaginal estrogen in women after menopause. A pessary can be an alternative to surgery or used while women are delaying (such as in between pregnancies) or waiting to have surgery.
Read more: Why you shouldn’t make a habit of doing a ‘just in case’ wee — and don’t tell your kids to either
The downside
Pessary use can have a downside too. Side effects may include vaginal discharge or odour or vaginal bleeding. These side effects generally occur after many months or years of continuous use and contribute to discontinuation.
An Australian study reported only 14% women continued long term use of pessaries mainly due to these side effects and the need for long term maintenance.
But a pessary can “buy time”. Theoretically, pessary use can help prevent worsening of prolapse.
A pessary for longer wear is usually fitted in clinic. Generally, all gynaecologists are trained to fit a pessary as are specialised pelvic floor physiotherapists and continence nurse specialists. Women often require a trial of more than one size or type to find the “best fit”. Sometimes a pessary can’t be fitted, is uncomfortable or falls out. This can occur when the vaginal length is short after previous prolapse surgery or hysterectomy, the vagina has a wide opening or the muscles are very weak.
Support pessaries can be self-managed by women who are willing to do this regularly in the same way they might manage a tampon, menstrual cup, or diaphragm contraceptive device. Sexually active women may choose to remove the pessary prior to intercourse; however, this is not essential for all types.
If not self-managed, pessary follow up is needed every six to 12 months, when the device is removed, cleaned, and reinserted or a new one inserted.
There are rare but serious complications like fistula (an opening between vagina and bowel or bladder) and impaction where an anaesthetic or surgery is required to remove the pessary.
Read more: Playing games with your pelvic floor could be a useful exercise for urinary incontinence
Some future models
Recently, there is some research and development occurring in adding personalised or “smart” capabilities to the vaginal support pessary such as electrical stimulation therapy or pressure biofeedback such as already exists for pelvic floor training devices.
Acceptance of pessaries is variable and often related to prior knowledge and appropriate counselling.
There is a lack of knowledge and awareness regarding how common pelvic organ prolapse and urinary incontinence are. We often hear women express embarrassment, shame or fear but many suffer in silence. The main barrier to seeking treatment is the perception that prolapse or incontinence are inevitable parts of childbirth and ageing.
Prolapse and urinary incontinence can have a negative impact on a woman’s physical, emotional and social wellbeing. Women experiencing any pelvic floor dysfunction can speak to their GPs, gynaecologists, or urogynaecologists (gynaecologists specialised in management of prolapse and incontinence).
Read more: Explainer: what is pelvic organ prolapse?
Mayo Clinic Minute: Benefits of blueberries
Mayo Clinic Minute: Benefits of blueberries
Updated August 13, 2022 | Originally published on Mayo Clinic
Often labeled a superfood, blueberries are bursting with vitamins and minerals ─ many of which are classified as antioxidants. Much of the power of this little berry lies in its color.
Blueberries might be the best example of how good things come in small packages.
“Beyond their tangy sweetness, blueberries offer a wealth of health benefits,” says Anya Miller, a Mayo Clinic dietitian.
She says that includes protection for your heart, thanks to something called an anthocyanin – a compound in these berries that gives them their deep blue hue.
“Blueberries, in particular, have about 25 different anthocyanins, whereas other berries might just have two or three,” says Miller.
Studies have shown eating foods high in these anthocyanins can help lower your risk of developing coronary heart disease.
“And that could be due to the reduction in arterial stiffness and blood pressure,” says Miller. “A half cup is a serving of blueberries. They don’t require any slicing or peeling. You can just pop them in your mouth for the benefits.”
Besides the heart-healthy perk, that serving of blueberries will get you some vitamin C, dietary fiber and natural sweetness. That makes blueberries a boost for physical and mental health.
This article was originally published on Mayo Clinic.
Are we biologically designed to be frugivores?
Personal Health & Wellness > Wellness Matters
Are we biologically designed to be frugivores?
By Sarah Butkovic | Fact-checked by Kristen Fuller, MD
| Updated August 10, 2022
- The frugivore diet mainly consists of fruit, completely omitting animal products and other processed foods.
- This diet, popularized by online vegan influencers, has raised the question of what humans are biologically meant to eat.
- A frugivore diet may be appropriate for some patients, but clinicians should review available evidence and/or consult with a nutritionist before recommending this diet.
The frugivore diet, also known as the fruitarian diet, mainly consists of fruit and raw vegetables, and has been gaining popularity recently. Although eating meat is the norm in almost every culture and region, some people believe humans are biologically designed to be frugivores.
Many vegans strongly claim this belief; there are entire online communities dedicated to the expansion of veganism and promotion of the frugivore lifestyle. However, a 2021 study by Statistica revealed that 86% of the world’s population incorporates meat into their diet.[1]
This poses the question: If nearly 90% of humans consume animal products, how could it be possible that so many of us are ignoring this proposed biological design?
Other animals eat what is advantageous to their genetic makeup, so are we truly meant to be frugivores if our species eats so much meat?
Why we may be frugivores
There are three major different dietary categories: carnivores (who strictly eat meat), herbivores (who strictly eat plants), and omnivores (who eat plants and animals). Frugivores, a subcategory of herbivores, primarily thrive on fruit-like produce like roots, shoots, or nuts.
It is important to note the term “primarily,” as frugivores have a preference for fruit but may also consume seeds, nuts, and leaves. For example, chimpanzees are frugivores, eating about 50% fruit, also known as “flexible omnivores.”[2]
Physiology is key to understanding our needs.
A study published in Human Evolution noted that humans consume meat not because it’s physiologically optimal, but because it’s habitual—something done out of necessity at one point for our ancestors that has remained in our diet for generations.[3] The researchers compared gut measurements from humans and other primates to those of carnivores and found that the human digestive tract is not specialized for meat-eating.
This study posits that our omnivorous behavior may have been caused by a shift in food resources during our evolutionary process; a climate crisis in the late Miocene period likely altered nutrient availability for hominids, early predecessors of neanderthals. Thus, it can be inferred that the interjection of meat into the human diet was not because we were designed to consume it; rather, it happened out of necessity.
But what about our canine teeth? Humans share their sharp incisors with carnivores like lions and wolves. But as the authors of an Insider article wrote, “Contrary to popular belief, human canines are not for tearing and ripping meat. Instead, our ancestors used them to fight male rivals for mating rights.”[4]
Since we no longer fight with our teeth, our canines now serve as an aid to tear through fibrous or hard-to-digest food. However, the misconception regarding their ancestral purpose may be why meat has remained a heavy staple in most of our diets.
Additionally, we have ptyalin in our saliva, which is a type of amylase, an enzyme used to digest starches—but omnivores and carnivores don’t have this in their saliva.[5]
Is being a frugivore healthy?
Even with the physiological similarities, there is conflicting information about the benefits and detriments of adopting a frugivore diet.
This raises questions on what we should be eating, and what nutritionists should recommend to patients.
The health benefits of fruits and vegetables are indisputable. However, it’s easy to underestimate just how crucial they are to our health—especially since the food pyramid also prioritizes grains, dairy, and meat.
According to the American Society for Nutrition, suboptimal fruit consumption caused nearly 1.3 million deaths from stroke and more than 520,000 deaths from coronary heart disease in 2010. Those who eat fruit regularly (and in bulk) are less likely to be obese and have a decreased chance of developing obesity related disorders.
Fruit has also been linked to reduced blood pressure and cholesterol levels. Fruits high in antioxidants such as blueberries, blackberries, raspberries, strawberries, and apples may reduce your cancer risk. The fiber in fruit, found mainly in its skin, suppresses your appetite, helping to prevent overeating and weight gain.
A study published in Nutrition Journal found that restricting fruit intake was not beneficial in patients with type 2 diabetes.[6] This was significant, since many people with type 2 diabetes must monitor their sugar intake to keep their insulin balanced. This mainly has to do with the metabolism of natural vs refined sugar.
But can we still get all the nutrients we need from strictly eating fruit? A 2021 study published in Current Developments in Nutrition found that humans may actually benefit from a meat-heavy diet.[7]
Scientists tracked the health of 2,029 people (all ranging in age) on a carnivorous diet.
“Adults consuming a carnivore diet experienced few adverse effects, and instead reported health benefits and high satisfaction.”
— Lennerz, et al.
However, cardiovascular disease risk factors were variably affected, including an increase in lipids and LDL cholesterol levels.
Most study participants reported improvements in their chronic medical conditions as well as their general health; energy, strength, sleep, memory, focus, and mental clarity all improved on a meat-based diet. This flies in the face of research suggesting enhancements in all of these categories on a diet that’s heavy in fruit.
It’s important to note that vitamin B12 is almost exclusively found in animal products such as fish, meat, dairy, and eggs and is an essential nutrient. It’s therefore recommended that vegans—including frugivores—supplement their diets with a B12 vitamin supplement.
Individual preference
The information from these conflicting studies obscures the physiological evidence that suggests we’re not solely meat eaters. Even so, the health benefits of fruit are undeniable, and should not be restricted when prompting or following a well-balanced diet program.
Since there is no universally accepted nutrition regimen, nutritionists should try to adapt their practice to the health needs of individual patients.
Those with underlying health issues or dietary restrictions like allergies, irritable bowel syndrome (IBS), or certain nutrient deficiencies may require larger or smaller amounts of fruit, meat, or other staples from the food pyramid in their diet.
For example, patients with digestive tract issues or IBS may want to avoid red meat and consume easy-to-digest proteins like chicken, turkey, and fish and eat fruit sparingly. Other undesirable medical symptoms and disorders may be alleviated by different amounts and types of these foods.[8]
The benefits of both fruit and meat show that there’s no correct way of eating; a carnivorous or frugivore diet may align with an individual’s preferences and lifestyle. Physicians should take this into account when making diet recommendations to patients. It’s best to make such recommendations on a case-by-case basis as nutritionists would, taking into account the patient’s unique health situation, lifestyle preferences, and dietary needs.
Don’t blame women for low libido. Sexual sparks fly when partners do their share of chores – including calling the plumber
Don’t blame women for low libido. Sexual sparks fly when partners do their share of chores – including calling the plumber
Published: August 19, 2022 6.05am AEST
Authors
- Simone Buzwell Senior Lecturer in Psychology, Swinburne University of Technology
- Eva johansen PhD candidate, Swinburne University of Technology
Disclosure statement
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
Swinburne University of Technology provides funding as a member of The Conversation AU.
View current jobs from Swinburne University of Technology
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When a comic about “mental load” went viral in 2017, it sparked conversations about the invisible workload women carry. Even when women are in paid employment, they remember their mother-in-law’s birthday, know what’s in the pantry and organise the plumber. This mental load often goes unnoticed.
Women also continue to do more housework and childcare than their male partners.
This burden has been exacerbated over the recent pandemic (homeschooling anyone?), leaving women feeling exhausted, anxious and resentful.
As sexuality researchers, we wondered, with all this extra work, do women have any energy left for sex?
We decided to explore how mental load affects intimate relationships. We focused on female sexual desire, as “low desire” affects more than 50% of women and is difficult to treat.
Our study, published in the Journal of Sex Research, shows women in equal relationships (in terms of housework and the mental load) are more satisfied with their relationships and, in turn, feel more sexual desire than those in unequal relationships.
How do we define low desire?
Low desire is tricky to explore. More than simply the motivation to have sex, women describe sexual desire as a state-of-being and a need for closeness.
Adding to this complexity is the fluctuating nature of female desire that changes in response to life experiences and the quality of relationships.
Relationships are especially important to female desire: relationship dissatisfaction is a top risk factor for low desire in women, even more than the physiological impacts of age and menopause. Clearly, relationship factors are critical to understanding female sexual desire.
As a way of addressing the complexity of female desire, a recent theory proposed two different types of desire: dyadic desire is the sexual desire one feels for another, whereas solo desire is about individual feelings.
Not surprisingly, dyadic desire is intertwined with the dynamics of the relationship, while solo desire is more amorphous and involves feeling good about yourself as a sexual being (feeling sexy), without needing validation from another.
Assessing the link
Our research acknowledged the nuances of women’s desire and its strong connection to relationship quality by exploring how fairness in relationships might affect desire.
The research involved asking 299 Australian women aged 18 to 39 questions about desire and relationships.
These questions included assessments of housework, mental load – such as who organised social activities and made financial arrangements – and who had more leisure time.
We compared three groups:
- relationships where women perceived the work as equally shared equal (the “equal work” group)
- when the woman felt she did more work (the “women’s work” group)
- when women thought that their partner contributed more (the “partner’s work” group).
We then explored how these differences in relationship equity impacted female sexual desire.
What we found
The findings were stark. Women who rated their relationships as equal also reported greater relationship satisfaction and higher dyadic desire (intertwined with the dynamics of the relationship) than other women in the study.
Unfortunately (and perhaps, tellingly), the partner’s work group was too small to draw any substantial conclusions.
However, for the women’s work group it was clear their dyadic desire was diminished. This group was also less satisfied in their relationships overall.
We found something interesting when turning our attention to women’s solo desire. While it seems logical that relationship inequities might affect all aspects of women’s sexuality, our results showed that fairness did not significantly impact solo desire.
This suggests women’s low desire isn’t an internal sexual problem to be treated with mindfulness apps and jade eggs, but rather one that needs effort from both partners.
Other relationship factors are involved. We found children increased the workload for women, leading to lower relationship equity and consequently, lower sexual desire.
Read more: Women aren’t better multitaskers than men – they’re just doing more work
Relationship length also played a role. Research shows long-term relationships are associated with decreasing desire for women, and this is often attributed to the tedium of over-familiarity (think of the bored, sexless wives in 90s sitcoms).
However our research indicates relationship boredom is not the reason, with the increasing inequity over the course of a relationship often the cause of women’s disinterest in sex.
The longer some relationships continue, the more unfair they become, lowering women’s desire. This may be because women take on managing their partner’s relationships, as well as their own (“It’s time we had your best friend over for dinner”).
And while domestic housework may start as equally shared, over time, women tend to do more household tasks.
What about same-sex couples?
Same-sex couples have more equitable relationships.
However, we found the same link between equity and desire for women in same-sex relationships, although it was much stronger for heteronormative couples.
A sense of fairness within a relationship is fundamental to all women’s satisfaction and sexual desire.
What happens next?
Our findings suggest one response to low desire in women could be to address the amount of work women have to take on in relationships.
The link between relationship satisfaction and female sexual desire has been firmly established in previous research but our findings explain how this dynamic works: women’s sense of fairness within a relationship forecasts their contentment, which has repercussions on their desire for their partner.
To translate our results into clinical practice, we could run trials to confirm if lowering women’s mental load results in greater sexual desire.
We could have a “housework and mental load ban” for a sample of women reporting low sexual desire and record if there are changes in their reported levels of desire.
Or perhaps women’s sexual partners could do the dishes tonight and see what happens.
Will One Moldy Berry Ruin the Rest?
Will One Moldy Berry Ruin the Rest?
Here’s what the experts say.
Credit…Aileen Son for The New York Times
By Alice Callahan
- March 7, 2022
Q: If I open a box of berries and one berry is moldy, do I need to throw out the whole box?
Fresh strawberries, blueberries and blackberries are among America’s favorite fruits, but their goodness can be fleeting. Within a few days of bringing them home from the farmer’s market or grocery store, it’s common to find that some gray or white fuzz has staked a claim to a berry or two, prompting many to wonder: Are the rest safe to eat?
Food safety experts say that while you shouldn’t eat berries that are obviously moldy, those without visible signs of the spores are fine to eat. And luckily, unlike other food safety concerns that may be invisible to the naked eye, berries with mold growth are easy to spot, said Benjamin Chapman, a professor and food safety specialist at North Carolina State University. (Botanically minded readers may note that many fruits commonly known as berries, including strawberries, raspberries and blackberries, aren’t true berries, but we will describe them as such for the sake of simplicity.)
If his basket or clamshell is tainted by one or two moldy berries, “I don’t throw out the whole thing,” Dr. Chapman said. Instead, he tosses the moldy ones and carefully inspects adjoining berries for fuzz, which often appears around a bruise or the site of stem attachment. With the rest, he tries to eat them soon, because lingering mold spores may spread and develop more fuzz in a day or two.
Molds are a type of fungi that, when viewed under a microscope, often “look like skinny mushrooms,” according to the U.S. Department of Agriculture. They grow threadlike roots that invade the interior of the food, and tiny stalks topped with spores on the surface. Certain types of molds produce toxins that can be harmful if eaten, and in some people, molds can trigger allergic reactions, Dr. Chapman said.
The good news for berry eaters is that the molds commonly found on them “are actually not known to produce toxins, like some fungi do, and so there’s less risk,” said Elizabeth Mitcham, a professor and director of the Postharvest Technology Center at the University of California, Davis. Foods that have been found to grow these more dangerous molds include nuts, grains and apples, she said.
Because molds on berries are usually innocuous, even accidentally eating a moldy berry — though not recommended — would be unlikely to make you sick, Dr. Mitcham said. Also, “you would probably spit it out before you managed to swallow it,” because moldy berries “have a very off, very bad flavor,” she added.
Mold is a common enemy of berry growers and sellers, so it’s not surprising to find it in your berry basket, Dr. Mitcham said. Mold spores are ubiquitous in the environment; they can be carried by air or water and live in the soil of farm fields. The spores typically infect a berry plant’s flowers or fruit and then lie dormant until the fruit fully ripens. Given enough time, those spores will eventually germinate and can spread to adjoining fruits, especially in warmer temperatures, Dr. Mitcham said.
Because mold spores are so pervasive, they’re probably present in small amounts on most fresh produce you eat. “I’m likely consuming mold spores all the time, and those mold spores are not making me sick,” Dr. Chapman said.
Molds become more dangerous when they grow and invade deeper into the food product, where some types produce toxins. While this isn’t usually a problem with berries because of their shape, small size and the types of molds that grow on them, it is a greater concern with larger foods that are moist or have a soft or porous texture, like leftover meats or casseroles, jams and jellies, soft cheeses and breads. If there is mold on the surface of these foods, you should assume they are contaminated within and throw them away, according to the U.S.D.A.
Before buying berries, inspect them carefully and avoid purchasing any with even slight signs of mold, Dr. Chapman said. At home, do another quick check and remove any fruit that is visibly moldy; then refrigerate the rest as soon as possible, Dr. Mitcham said. Don’t wash berries until just before you plan to eat them or cook with them, because moisture encourages mold growth, she added.
Mold spores can settle and survive on surfaces, so it’s a good idea to clean your fridge regularly “to break the mold spore cycle,” Dr. Chapman said. The U.S.D.A. recommends cleaning the inside of your fridge with a tablespoon of baking soda dissolved in a quart of water every few months. And if you discover food that’s “egregiously moldy” in your fridge, you might decide that “Yep, today’s the day that I’m going to clean it out,” to prevent too many spores from making themselves at home and spreading to other foods, he added.
Alice Callahan is a health and science journalist.
What allegations of Alzheimer’s research fraud mean for patients
Research fraud is a major problem for the public. We trust Pharmaceutical companies to be ethical, and act in the public good. Too often it appears that they are only interested in their profits, and will stoop to cheating to achieve this. The British Medical Journal produced evidence that the trials done for the mRNA vaccines had some dubious practices. It is a serious state of affairs if we cannot trust Big Pharma to do the right thing. The billions of people who have had the Covid vaccines would be concerned to know that the trials for the vaccines had questionable practices. Here is the link for those who are interested in this issue (That is all of us).
What allegations of Alzheimer’s research fraud mean for patients
Published: August 2, 2022 6.05am AEST
Author
- John Mamo John Curtin Distinguished Professor of Health Sciences, Director, Curtin Health Innovation Research Institute, Curtin University
Disclosure statement
John Mamo receives funding from the Australian National Health and Medical Research Council; the Medical Research Future Fund; the Australian Research Council and Multiple Sclerosis Western Australia.
Curtin University provides funding as a member of The Conversation AU.
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Alzheimer’s disease is the most prevalent form of dementia and, with a rapidly ageing global population, it is fuelling unprecedented demand for costly patient care. There have been an estimated 400 clinical studies since the first Alzheimer’s drug trial in 1987.
The demand for treatment solutions however, is not without significant risk. There have been recent allegations that research underpinning widely held understandings of what causes Alzheimer’s may be fraudulent. The impact of this on clinical trials is a potentially huge blow for people living with Alzheimer’s and their carers.
In this case, it might be a stretch to say all Alzheimer’s research is now compromised. But the allegations can prompt us to interrogate whether the governing bodies of research and drug approvals are truly effective.
A potentially flawed hypothesis
The concerns of possible Alzheimer’s research fraud follow findings by neurologist and physician Matthew Schrag, detailed in the journal Science.
Schrag wrote that an ongoing Alzheimer’s trial investigating the experimental drug simufilam was based on manipulated images published by scientists years earlier. If true, then volunteer patients to drug trials, including the simufilam studies, may be facing unnecessary health risks associated with experimental treatment – likely with no hope of clinical benefit.
Moreover, years of drug development costing tens of millions of dollars might have been wasted. The fundamental premise of what causes brain cell death in Alzheimer’s and by extension, what type of drugs are needed to be developed for treatment, may now need reconsideration.
Some contemporary Alzheimer’s clinical trials are based on a now potentially flawed hypothesis: that brain cell death is triggered by the early formation in the fluid that bathes the brain, of small clumps of protein called amyloid-oligomers.
One highly influential and highly cited study is at the centre of the current controversy. The authors claimed mouse models of Alzheimer’s showed memory impairment was associated with the accumulation of amyloid-oligomers. Schrag found compelling evidence the image presented in the 2006 paper may have been modified.
Read more: What causes Alzheimer’s disease? What we know, don’t know and suspect
What about peer review though?
The internationally adopted peer review system, where discipline experts anonymously review scientific data put forward for publication, usually ensures robust outcomes. This should reassure the public about a study’s scientific claims. However, as the saying goes, science doesn’t lie, but people may.
In this instance, Schrag reviewed scores of images in scientific papers authored by neuroscientist Sylvain Lesné and suggested significant image tampering had consistently occurred. Leading independent image analysts and internationally recognised Alzheimer’s researchers backed Schrag’s claims.
Neuroscientists can rightfully be exceedingly disappointed publications that changed what we know about Alzheimer’s or other diseases now appear based on manipulated data. It potentially brings neuroscientists into disrepute and undermines public confidence.
The allegations have brought trials for two drugs with simfilam under serious scrutiny.
It’s important to stress simufilam has not been approved by any regulatory agency. But a recent United States Food and Drug Administration (FDA) approval of the drug aducanumab – against expert advice which warned there wasn’t enough evidence to show it worked – has made physicians treating people living with Alzheimer’s extra sensitive.
Other avenues of research
So does news of this potential fraud mean the field of Alzheimer’s research is corrupted? Can we be confident that what is prescribed to patients is safe and works?
We should keep in mind the broader context that publishing incorrect data is rare and research misconduct is even rarer. If incorrect data is identified, restorative practices are usually swift and comprehensive, including publishing “errata” corrections, or possibly, a retraction of findings by scientific journals. Significant penalties are also imposed for deliberate research misconduct.
Also, there are multiple clinical trials considering multiple aspects of the complex Alzheimer’s cascade from what causes the disease to how it affects memory and thinking. These are based on credible scientific findings.
Amyloid-oligomer clearance, which is now being questioned, is only one avenue that scientists have pursued.
The overwhelming majority of scientists are doing the right thing all of the time and if regulatory approval authorities such as our Therapeutic Goods Administration and the FDA continue to sensibly and thoroughly examine the evidence provided for approval, then we can hope for a better future for people living with Alzheimer’s.
Physician heal thyself? After 4 years of treatment for stage 4 cancer I just wanted some encouraging words from my oncologist
Physician heal thyself? After 4 years of treatment for stage 4 cancer I just wanted some encouraging words from my oncologist
Published: August 4, 2022 6.05am AEST
Author
- Tim Baker PhD Candidate, School of Philosophy/author and journalist, Griffith University
Disclosure statement
Tim Baker receives funding from Griffith University under a creative writing PhD scholarship
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My oncologist has one of those little motivational prints hanging on his waiting room wall, with the simple statement, “Trust Your Instincts”. One day, bored with the long purgatory of the waiting room, I tweet this news to the world with the observation: “If I trusted my instincts, I’d run screaming from this place and never come back.”
I’m only half-joking. I don’t wish to appear ungrateful for the miracles of modern medicine, without which I very probably would not be alive. Yet the routine of the oncologist’s visit feels deeply dispiriting.
I sit and wait for anywhere up to an hour or more, in an atmosphere thick with dread and stress and anxiety, whiling away the time on my phone or with a trashy magazine, until my name is called. My oncologist takes a cursory glance at my latest blood test results, usually tells me to continue the medication I’m on, writes me a script for another blood test and tells me to come back in four to six weeks.
The final straw comes about four years after my diagnosis of stage four metastatic prostate cancer, as I stand up to leave another perfunctory ten-minute consultation after an hour’s wait.
Something just doesn’t sit right about all this. It’s my life hanging in the balance. I have been through radiation therapy (reasonably tolerable), chemotherapy (seriously debilitating), hormone therapy (made me almost suicidally depressed) and surgery (harrowing but quickly over with).
The lack of opportunity for a more wide-ranging conversation about treatment options, how I’m holding up emotionally and strategies to mitigate the life-sapping side effects of treatment just feels wrong.
I walk towards the door, pause, turn and announce, “Oh, one more thing”.
My oncologist does not appear pleased by this development. He has a waiting room full of patients and is already running an hour behind schedule.
“It’s been four years now. I work really hard at this,” I begin tentatively. We’re entering uncharted territory. I’m talking about my feelings and expecting him to respond, a betrayal of our unspoken doctor–patient contract up to this point. I press on regardless.
“I follow a strict diet, exercise and meditate daily, do everything I can to support my health. How do you think I’m going?”
I pose, opening the way for him to offer some soothing words of encouragement. He briefly ponders this unscripted moment, as if I’ve just told a joke he doesn’t quite get.
“About average,” he eventually declares, coolly. “Some of my patients are doing better than you, some worse. You’re about average.”
His response seems designed to ensure I never again have the impertinence to ask such a question, or to attribute any therapeutic powers to my own lifestyle interventions. Even if this was his sincerely held professional view, would it have killed him to say something vaguely positive like, “It’s great that you are being so proactive about supporting your health”? Or a kind-hearted white lie, even if he didn’t actually believe it: “You’re doing great. Keep it up.”
Read more: How kindness can make a difference in cancer care
Emotional distance
I have no reason to doubt my oncologist’s professional expertise and deep knowledge of his chosen field. But I’ve become frustrated by his uninterest in anything I might be doing to support my own health, or any research or suggestions I’ve come across for credible supportive or adjuvant treatments, all of which are swiftly dismissed.
More than anything, I’d like a bit more evidence that he cares, which must be hard to deliver when he’s seeing dozens of patients every day at roughly ten-minute intervals, many with conditions far more dire than mine, most of whom he won’t be able to cure.
Scottt Morrison reportedly spent almost $200,000 on an empathy consultant for his government, but politicians are not the only ones who need a bit of guidance on reading emotional cues. A 2011 US randomised clinical trial offered oncologists a lecture on good patient communication. Half the group were also offered a tailored CD-ROM presentation to improve their communication styles, recording and critiquing their patient interactions.
The researchers noted the distress and mental health challenges of many cancer patients, observing:
Oncologists frequently miss opportunities to respond to patient emotion and may instead exhibit behaviours that block feelings and create emotional distance.
Report author Dr James A. Tulsky observed:
So often patients aren’t satisfied with the communication they have with their doctor, yet I know physicians care so much about their patients and really want to express that. Physicians may wish to communicate what they are feeling but may not always use the proper words.
The problem here appears to be twofold. Oncologists generally fit a particular psychological profile – disciplined high achievers, able to process and retain vast amounts of highly specialised and technical information and make cool-headed decisions in what are often the most trying circumstances.
People with the skill set to perform these demanding functions might not be naturally inclined towards obvious displays of emotion and empathy. And even if they were, it would be almost impossible to be deeply emotionally invested in every patient. Compassion fatigue is real.
But oncologists also suffer from a terrible physical and mental health profile. Numerous studies have shown they have higher incidence of anxiety, depression and suicide than the general population, and are worse at seeking assistance. It’s difficult to offer emotional support when you’re experiencing psychological distress yourself. According to one US study at the Mayo Clinic up to 35% of oncologists suffer burnout.
Oncologists are faced with life and death decisions on a daily basis, administer incredibly toxic therapies with narrow therapeutic windows, must keep up with the rapid pace of scientific and treatment advances, and continually walk a fine line between providing palliation and administering treatments that lead to excess toxicity. Personal distress precipitated by such work-related stress may manifest in a variety of ways including depression, anxiety, fatigue, and low mental quality of life.
A 2019 study found that over 300 physicians die of suicide in the US every year.
The stigma of depression runs deep in the helping professions and in medicine in particular. Although burnout in oncology is acknowledged, the other stigmatised mental health aspects of medical practice — depression and suicide — are rarely recorded or talked about.“
To compound the problem, oncologists are often reluctant to report mental health issues, considering it a potential blot on their career record. “Physicians have been trained to be perfectionists. They’ve been trained not to ever show any weakness, and they think of mental health issues as weakness,” Anthony L. Back, MD, professor of medical oncology at University of Washington Medical Center, told HemOnc Today, an online journal of oncology and hematology.
Another US study found 30% of oncologists “drink alcohol in a problematic way”, and up to 20% of junior oncologists use hypnotic drugs or sleeping pills.
A 2016 Australian qualitative study on workforce sustainability in oncology paints a similar picture.
Researchers conducted in-depth interviews with 22 medical oncologists at various stages of their careers and concluded:
There is considerable concern here that increased patient volume and intensification – also shown in other studies – will lead to poorer outcomes for both themselves (e.g. burnout), and their patients in terms of the quality of care and support they expect from their medical oncologists.
As one early-career cancer specialist put it:
I think you need to be able to commit that time [to patients] in order to be doing an effective job and if [treatment] becomes a box-ticking exercise … it dehumanises the relationship, which I find a struggle … When there isn’t time to see everyone and you have to rush them out, I think that really wears down that important part of the patient-doctor dynamic.
Read more: You should care about your doctor’s health, because it matters to yours
Ironies
In my own case, I eventually took the advice of that wall mounted print in my oncologist’s office and trusted my instincts.
I sacked my oncologist and found a new one more open to discussing my own lifestyle strategies, showing empathy and concern for my mental struggles and quality of life along with my cancer.
Does it strike anyone else as sadly ironic that one of the most dire health issues of our times is presided over by a profoundly unhealthy physician population? The current model of cancer care serves no one’s best interests, leaving complex patient needs unmet and exacting a cruel toll on clinicians. We are all – patients and doctors alike – casualties in the war on cancer.
This is an edited extract from Patting The Shark by Tim Baker, published by Penguin Random House Australia, RRP $34.99.
Sun key to vitamin D as pills prove worthless
I have been explaining to my patients for many years now, that there is nothing as good as the sun for Vitamin D. Forget the tablets, as the sun is much better. I am pleased to see this confirmed by this article in the Australian.
Sun key to vitamin D as pills prove worthless
- Natasha RobinsonHEALTH EDITOR@NC_Robinson
- 7:19AM August 3, 2022
- 52 Comments
The biggest study in the world into vitamin D supplements has found the pills do not prevent bone fractures and are unlikely to provide the same benefits as obtaining the vitamin from the sun.
About one-third of Australians are vitamin D-deficient, and many have been advised by their doctor to supplement with vitamin D pills, the biggest-selling supplement in the country.
A US study published in the New England Journal of Medicine suggests it would be far better to expose the skin to some sunlight every day instead.
The large study known as Vital, which involved 26,000 mid-life men and women, found vitamin D pills provide little benefit to most people. The headline finding was that vitamin D supplements do not prevent osteoporosis and were found not to prevent bone fractures even in people who already had bone thinning.
Vitamin D in the body plays a role in helping the gut absorb calcium, which strengthens bones.
Researchers on the study also found that vitamin D supplements did not provide the benefits of vitamin D obtained from sunlight, which include the prevention of cancer, prevention of heart disease, improvements in brain function and protection of the joints and eyes.
The NEJM published an editorial along with the study findings recommending people stop taking vitamin D supplements.
The author of the editorial was Steven Cummings, who is a research scientist at the California Pacific Medical Centre Research Institute.
“Providers should stop screening for 25-hydroxyvitamin D levels or recommending vitamin D supplements and people should stop taking vitamin D supplements in order to prevent major diseases or extend life,” Dr Cummings said.
“The trials show they have no benefit, even in people with vitamin D deficiency.
“With very few exceptions, such as those in nursing homes deprived from sun and ordinary diets, everyone gets enough vitamin D to maintain the functions and balance they need.”
You can also obtain vitamin D from foods including oily fish, eggs and red meat.
University of South Australia professor Elina Hypponen, who has extensively studied Vitamin D, said the US study did not include people who were truly vitamin D-deficient, and that such people would be likely still to obtain benefit from taking the supplements.
“If you can get vitamin D naturally and safely from the sun without risk of sunburn, then you don’t need to think about supplements,” Professor Hypponen said.
“But in situations where people are seriously vitamin D-deficient, then vitamin D supplements are sometimes necessary.”
The Vital study was funded by the US National Institutes of Health and began after an expert group examined the health effects of vitamin D supplements and found little evidence.
The Vital study reinforces a series of other research projects that have cast doubt on the efficacy of vitamin D supplements.
Natasha Robinson
Health Editor
Natasha Robinson began her career at The Australian in 2004. A Walkley awards finalist and a Kennedy Awards winner, she was appointed Health Editor in 2019, and has covered rounds including national affairs.
LDN and CFS/Long Covid/ME
The Courier Mail had an article about the use of Naltrexone (LDN) in the treatment of CFS. They claim this as a breakthrough by Qld researchers. I have been using this successfully for many years, with good results. This is the link to the article : https://www.couriermail.com.au/news/national/gamechanging-new-test-and-treatment-for-long-covid/news-story/c0e9894c5731cbac66104542237ea704
I am really pleased that LDN is at long last being recognised as an effective treatment for a whole range of diseases.
Menopause and frailty
Later menopause onset linked to lower risk of frailty: review
Maintenance of oestrogen may be a key factor, researchers say, but evidence in the literature is limited
Later age at menopause is associated with a reduced risk of prevalent frailty, with the delay in hormonal changes thought to play a pivotal protective role, a new analysis shows.
Results from the first systematic review and meta-analysis of its kind suggest that for each one-year increase in age of menopause onset, there is a 2% lower risk of prevalent frailty.
“These findings enhance our understanding of pathophysiology of frailty development and, possibly, sex disparity of frailty,” the Japanese-led researchers say.
Writing in Maturitas, the investigators reported results from their meta-analysis of four studies — from the UK, US, Canada and South Korea — that involved a total of nearly 26,000 women (mean age range 48-50).
The follow-up period for the two longitudinal studies examining incident frailty was four and 18 years, respectively, while the other two included studies looked at cross-sectional associations between
Two studies showed frailty prevalence of 11.6% and 11.2%, respectively.
In addition to the main finding linking later onset of menopause to lower likelihood of frailty, the researchers found that surgical menopause did not predict frailty risk.
However, they said this “counterintuitive” finding could be the result of the limited number of studies, as well as the potential initiation of menopausal hormone therapy (MHT) after surgery.
The single study providing data on use of MHT showed that frail women were significantly less likely to use the medication than non-frail women (7% vs 19%).
“Further studies with appropriate adjustments for important related factors, such as [MHT] or reasons for surgery, [are] warranted,” wrote the authors, led by Professor Tomohiko Urano at the International University of Health and Welfare in Chiba.
Although the specific underlying mechanisms linking menopause and frailty were yet to be established, Professor Urano and colleagues suggested that oestrogen deficiency postmenopause was the likely culprit.
“One possible explanation for the association … is loss of oestrogen’s protective effects on muscles,” they wrote.
“Oestrogen receptors are found in the nuclei of human [muscle] fibres and capillaries, and some evidence suggested that oestrogen preserves muscle mass, strength and functions.”
In addition, oestrogen had a role in immune and inflammatory processes.
“Emerging evidence showed that a decline in oestrogen is closely associated with systemic chronic inflammation and increased risks of cancer, cardiovascular disease, neurodegeneration and stroke.”
The review was limited by the small number of papers suitable for inclusion, only one of which was a prospective study
Dr Colin Holloway 
