Four Thousand Weeks – by Oliver Burkeman
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This is not, strictly speaking, a time management book. It’s more a “contemplating mortality and making things count while still doing the necessaries”.
Burkeman’s premise is that we get around 4,000 weeks of life, on average. If we live to 120, it’s more like 6,200. Unlucky souls may have to do the best they can with 1,000 or so.
The book is thought-provoking; consider:
- how was your last week?
- how will your next week be?
- what if it were your last?
Of course, we cannot necessarily liquidate all our assets and spend next week burning out in style, because then the following week comes. So, what’s the solution?
That’s something Burkeman lays out over the course of the book, with key ideas including passion projects and figuring out what can be safely neglected, but there’s far more there than we could sum up here.
Bottom line: if you ever find yourself struggling to balance what is expected of you with what is of value to you, this book can help you get the most out of your choices.
Click here to check out Four Thousand Weeks, and make yours count!
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Needle Pain Is a Big Problem for Kids. One California Doctor Has a Plan.
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Almost all new parents go through it: the distress of hearing their child scream at the doctor’s office. They endure the emotional torture of having to hold their child down as the clinician sticks them with one vaccine after another.
“The first shots he got, I probably cried more than he did,” said Remy Anthes, who was pushing her 6-month-old son, Dorian, back and forth in his stroller in Oakland, California.
“The look in her eyes, it’s hard to take,” said Jill Lovitt, recalling how her infant daughter Jenna reacted to some recent vaccines. “Like, ‘What are you letting them do to me? Why?’”
Some children remember the needle pain and quickly start to internalize the fear. That’s the fear Julia Cramer witnessed when her 3-year-old daughter, Maya, had to get blood drawn for an allergy test at age 2.
“After that, she had a fear of blue gloves,” Cramer said. “I went to the grocery store and she saw someone wearing blue gloves, stocking the vegetables, and she started freaking out and crying.”
Pain management research suggests that needle pokes may be children’s biggest source of pain in the health care system. The problem isn’t confined to childhood vaccinations either. Studies looking at sources of pediatric pain have included children who are being treated for serious illness, have undergone heart surgeries or bone marrow transplants, or have landed in the emergency room.
“This is so bad that many children and many parents decide not to continue the treatment,” said Stefan Friedrichsdorf, a specialist at the University of California-San Francisco’s Stad Center for Pediatric Pain, speaking at the End Well conference in Los Angeles in November.
The distress of needle pain can follow children as they grow and interfere with important preventive care. It is estimated that a quarter of all adults have a fear of needles that began in childhood. Sixteen percent of adults refuse flu vaccinations because of a fear of needles.
Friedrichsdorf said it doesn’t have to be this bad. “This is not rocket science,” he said.
He outlined simple steps that clinicians and parents can follow:
- Apply an over-the-counter lidocaine, which is a numbing cream, 30 minutes before a shot.
- Breastfeed babies, or give them a pacifier dipped in sugar water, to comfort them while they’re getting a shot.
- Use distractions like teddy bears, pinwheels, or bubbles to divert attention away from the needle.
- Don’t pin kids down on an exam table. Parents should hold children in their laps instead.
At Children’s Minnesota, Friedrichsdorf practiced the “Children’s Comfort Promise.” Now he and other health care providers are rolling out these new protocols for children at UCSF Benioff Children’s Hospitals in San Francisco and Oakland. He’s calling it the “Ouchless Jab Challenge.”
If a child at UCSF needs to get poked for a blood draw, a vaccine, or an IV treatment, Friedrichsdorf promises, the clinicians will do everything possible to follow these pain management steps.
“Every child, every time,” he said.
It seems unlikely that the ouchless effort will make a dent in vaccine hesitancy and refusal driven by the anti-vaccine movement, since the beliefs that drive it are often rooted in conspiracies and deeply held. But that isn’t necessarily Friedrichsdorf’s goal. He hopes that making routine health care less painful can help sway parents who may be hesitant to get their children vaccinated because of how hard it is to see them in pain. In turn, children who grow into adults without a fear of needles might be more likely to get preventive care, including their yearly flu shot.
In general, the onus will likely be on parents to take a leading role in demanding these measures at medical centers, Friedrichsdorf said, because the tolerance and acceptance of children’s pain is so entrenched among clinicians.
Diane Meier, a palliative care specialist at Mount Sinai, agrees. She said this tolerance is a major problem, stemming from how doctors are usually trained.
“We are taught to see pain as an unfortunate, but inevitable side effect of good treatment,” Meier said. “We learn to repress that feeling of distress at the pain we are causing because otherwise we can’t do our jobs.”
During her medical training, Meier had to hold children down for procedures, which she described as torture for them and for her. It drove her out of pediatrics. She went into geriatrics instead and later helped lead the modern movement to promote palliative care in medicine, which became an accredited specialty in the United States only in 2006.
Meier said she thinks the campaign to reduce needle pain and anxiety should be applied to everyone, not just to children.
“People with dementia have no idea why human beings are approaching them to stick needles in them,” she said. And the experience can be painful and distressing.
Friedrichsdorf’s techniques would likely work with dementia patients, too, she said. Numbing cream, distraction, something sweet in the mouth, and perhaps music from the patient’s youth that they remember and can sing along to.
“It’s worthy of study and it’s worthy of serious attention,” Meier said.
This article is from a partnership that includes KQED, NPR, and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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The S.T.E.P.S. To A Healthier Heart
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Stepping Into Better Heart Health
This is Dr. Jennifer H. Mieres, FACC, FAHA, MASNC. she’s an award-winning (we counted 9 major awards) professor of cardiology, and a leading advocate for women’s heart health. This latter she’s done via >70 scientific publications, >100 research presentations at national and international conferences, 3 books so far, and 4 documentaries, including the Emmy-nominated “A Woman’s Heart”.
What does she want us to know?
A lot of her work is a top-down approach, working to revolutionize the field of cardiology in its application, to result in far fewer deaths annually. Which is fascinating, but unless you’re well-placed in that industry, not something too actionable as an individual (if you are well-placed in that industry, do look her up, of course).
For the rest of us…
Dr. Mieres’ S.T.E.P.S. to good heart health
She wants us to do the following things:
1) Stock your kitchen with heart health in mind
This is tied to the third item in the list of course, but it’s a critical step not to be overlooked. It’s all very well to know “eat more fiber; eat less red meat” and so forth, but if you go to your kitchen and what’s there is not conducive to heart health, you’re just going to do the best with what’s available.
Instead, actually buy foods that are high in fiber, and preferably, foods that you like. Not a fan of beans? Don’t buy them. Love pasta? Go wholegrain. Like leafy greens in principle, but they don’t go with what you cook? Look up some recipes, and then buy them.
Love a beef steak? Well we won’t lie to you, that is not good for your heart, but make it a rare option—so to speak—and enjoy it mindfully (see also: mindful eating) once in a blue moon for a special occasion, rather than “I don’t know what to cook tonight, so sizzle sizzle I guess”.
Meal planning goes a long way for this one! And if meal-planning sounds like an overwhelming project to take on, then consider trying one of the many healthy-eating meal kit services that will deliver ingredients (and their recipes) to your door—opting for a plants-forward plan, and the rest should fall into place.
2) Take control of your activity
Choose to move! Rather than focusing on what you can’t do (let’s say, those 5am runs, or your regularly-scheduled, irregularly attended, gym sessions), focus on what you can do, and do it.
See also: No-Exercise Exercise!
3) Eat for a healthier heart
This means following through on what you did on the first step, and keeping it that way. Buying fresh fruit and veg is great, but you also have to actually eat it. Do not let the perishables perish!
For you too, dear reader, are perishable (and would presumably like to avoid perishing).
This item in the list may seem flippant, but actually this is about habit-forming, and without it, the whole plan will grind to a halt a few days after your first heart-health-focused shopping trip.
See also: Where Nutrition Meets Habits!
4) Partner with your doctor, family, and friends
Good relationships, both professional and personal, count for a lot. Draw up a plan with your doctor; don’t just guess at when to get this or that checked—or what to do about it if the numbers aren’t to your liking.
Partnership with your doctor goes both ways, incidentally. Read up, have opinions, discuss them! Doing so will ultimately result in better care than just going in blind and coming out with a recommendation you don’t understand and just trust (but soon forget, because you didn’t understand).
And as for family and friends, this is partly about social factors—we tend to influence, and be influenced by, those around us. It can be tricky to be on a health kick if your partner wants take-out every night, so some manner of getting everyone on the same page is important, be it by compromise or, in an ideal world, gradually trending towards better health. But any such changes must come from a place of genuine understanding and volition, otherwise at best they won’t stick, and at worst they’ll actively create a pushback.
Same goes for exercise as for diet—exercising together is a good way to boost commitment, especially if it’s something fun (dance classes are a fine example that many couples enjoy, for example).
5) Sleep more, stress less, savor life
These things matter a lot! Many people focus on cutting down salt or saturated fat, and that can be good if otherwise consumed to excess, but for most people they’re not the most decisive factors:
Hypertension: Factors Far More Relevant Than Salt ← sleep features here!
Stress is also a huge one, and let’s put it this way: people more often have heart attacks during a moment of excessive emotional stress—not during a moment when they had a bit too much butter on their toast.
It’s not even just that acute stress is the trigger, it’s that chronic stress is a contributory factor that erodes the body’s ability to handle the acute stress.
Changing this may seem “easier said than done” because often the stressors are external (e.g. work pressure, financial worries, caring for a sick relative, relationship troubles, major life change, etc), but it is possible to find peace even in the chaos of life:
Want to know more from Dr. Mieres?
You might like this book of hers, which goes into each of the above items in much more depth than we have room to here:
Heart Smarter for Women: Six Weeks to a Healthier Heart – by Dr. Jennifer Mieres
Enjoy!
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Health Hacks from 20 Doctors
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Doctor Mike’s Approach
You may be used to Tuesday’s expert insights column, where we break down the work or research of a medical expert. Doctor Mike, the creator of the video below, has put us to shame, interviewing 20 experts and condensing it into one, sub 12-minute video.
In short, Doctor Mike has interviewed medical professionals and asked them to share a unique piece of advice, specific to their field, that’s easy to incorporate into your daily routine. He calls them Health Hacks (hey, that sounds similar to our Life Hacks section).
We aren’t going to list out all 20—you’ll have to watch the video for that—but here are a few of our favourites
Toenail Fungus Treatment
Dr. Dana Brems, a podiatrist, reveals that Vicks VapoRub has antifungal properties, and thus can be used on toenails affected by fungus.
Water Intake Myth
Dr. Rena Malik, a urologist, debunks the myth that everyone needs to drink eight glasses of water daily, advising people to drink when thirsty and monitor urine color for hydration.
(You can see what we’ve written on this subject here, as well as here).
Natural Lip Plumper
Dr. Anthony Youn, a plastic surgeon, offers a simple recipe for plumping lips—add a drop or two of food-grade peppermint oil to your lip gloss.
Toothbrushing Technique:
Dr. Winters, an orthodontist, explains that brushing teeth at a 45-degree angle towards the gums is more effective than the common side-to-side method. See our thoughts on this here and here.
Want more tips? Watch them all in the video below:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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From immunotherapy to mRNA vaccines – the latest science on melanoma treatment explained
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More than 16,000 Australians will be diagnosed with melanoma each year. Most of these will be caught early, and can be cured by surgery.
However, for patients with advanced or metastatic melanoma, which has spread from the skin to other organs, the outlook was bleak until the advent of targeted therapies (that attack specific cancer traits) and immune therapies (that leverage the immune system). Over the past decade, these treatments have seen a significant climb in the number of advanced melanoma patients surviving for at least five years after diagnosis, from less than 10% in 2011 to around 50% in 2021.
While this is great news, there are still many melanoma patients who cannot be treated effectively with current therapies. Researchers have developed two exciting new therapies that are being evaluated in clinical trials for advanced melanoma patients. Both involve the use of immunotherapy at different times and in different ways.
The first results from these trials are now being shared publicly, offering insight into the future of melanoma treatment.
Svitlana Hulko/Shutterstock Immunotherapy before surgery
Immunotherapy works by boosting the power of a patient’s immune system to help kill cancer cells. One type of immunotherapy uses something called “immune checkpoint inhibitors”.
Immune cells carry “immune checkpoint” proteins, which control their activity. Cancer cells can interact with these checkpoints to turn off immune cells and hide from the immune system. Immune checkpoint inhibitors block this interaction and help keep the immune system activated to fight the cancer.
Results from an ongoing phase 3 trial using immune checkpoint inhibitors were recently published in the New England Journal of Medicine.
This trial used two types of immune checkpoint inhibitors: nivolumab, which blocks an immune checkpoint called PD-1, and ipilimumab, which blocks CTLA-4.
More than 16,000 Australians are diagnosed with melanoma each year. Delovely Pics/Shutterstock Some 423 patients (including many from Australia) were enrolled in the trial, and participants were randomly assigned to one of two groups.
The first group had surgery to remove their melanoma, and were then given immunotherapy (nivolumab) to help kill any remaining cancer cells. Giving a systemic (whole body) therapy such as immunotherapy after surgery is a standard way of treating melanoma. The second group received immunotherapy first (nivolumab plus ipilimumab) and then underwent surgery. This is a new approach to treating these cancers.
Based on previous observations, the researchers had predicted that giving patients immunotherapy while the whole tumour was still present would activate the tumour-fighting abilities of the patient’s immune system much better than giving it once the tumour had been removed.
Sure enough, 12 months after starting therapy, 83.7% of patients who received immunotherapy before surgery remained cancer-free, compared to 57.2% in the control group who received immunotherapy after surgery.
Based on these results, Australian of the year Georgina Long – who co-led the trial with Christian Blank from The Netherlands Cancer Institute – has suggested this method of immunotherapy before surgery should be considered a new standard of treatment for higher risk stage 3 melanoma. She also said a similar strategy should be evaluated for other cancers.
The promising results of this phase 3 trial suggest we might see this combination treatment being used in Australian hospitals within the next few years.
mRNA vaccines
Another emerging form of melanoma therapy is the post-surgery combination of a different checkpoint inhibitor (pembrolizumab, which blocks PD-1), with a messenger RNA vaccine (mRNA-4157).
While checkpoint inhibitors like pembrolizumab have been around for more than a decade, mRNA vaccines like mRNA-4157 are a newer phenomenon. You might be familiar with mRNA vaccines though, as the biotechnology companies Pfizer-BioNTech and Moderna released COVID vaccines based on mRNA technology.
mRNA-4157 works basically the same way – the mRNA is injected into the patient and produces antigens, which are small proteins that train the body’s immune system to attack a disease (in this case, cancer, and for COVID, the virus).
However, mRNA-4157 is unique – literally. It’s a type of personalised medicine, where the mRNA is created specifically to match a patient’s cancer. First, the patient’s tumour is genetically sequenced to figure out what antigens will best help the immune system to recognise their cancer. Then a patient-specific version of mRNA-4157 is created that produces those antigens.
The latest results of a three-year, phase 2 clinical trial which combined pembrolizumab and mRNA-4157 were announced this past week. Overall, 2.5 years after starting the trial, 74.8% of patients treated with immunotherapy combined with mRNA-4157 post-surgery remained cancer-free, compared to 55.6% of those treated with immunotherapy alone. These were patients who were suffering from high-risk, late-stage forms of melanoma, who generally have poor outcomes.
It’s worth noting these results have not yet been published in peer-reviewed journals. They’re available as company announcements, and were also presented at some cancer conferences in the United States.
Based on the results of this trial, the combination of pembrolizumab and the vaccine progressed to a phase 3 trial in 2023, with the first patients being enrolled in Australia. But the final results of this trial are not expected until 2029.
It is hoped this mRNA-based anti-cancer vaccine will blaze a trail for vaccines targeting other types of cancer, not just melanoma, particularly in combination with checkpoint inhibitors to help stimulate the immune system.
Despite these ongoing advances in melanoma treatment, the best way to fight cancer is still prevention which, in the case of melanoma, means protecting yourself from UV exposure wherever possible.
Sarah Diepstraten, Senior Research Officer, Blood Cells and Blood Cancer Division, WEHI (Walter and Eliza Hall Institute of Medical Research) and John (Eddie) La Marca, Senior Research Officer, Blood Cells and Blood Cancer, WEHI (Walter and Eliza Hall Institute of Medical Research)
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Pomegranate vs Figs – Which is Healthier?
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Our Verdict
When comparing pomegranate to figs, we picked the pomegranate.
Why?
In terms of macros, pomegranate has a lot more protein* and fiber, while the fig has more carbs. Thus, a win for pomegranate.
*Why such protein in a fruit? In both cases, it’s mostly from the seeds, which in both cases, we’re eating. However, pomegranates have a much greater seed-to-mass ratio than figs, and thus, a correspondingly higher amount of protein. Also some fats from the seeds, again more than figs, but the margin of difference is smaller, and not really enough to be of relevance.
In the category of vitamins, pomegranates lead with more of vitamins B1, B5, B9, C, E, K, and choline, while figs have more of vitamins A, B3, and B6. The largest margins of difference are in vitamins B9, E, and K, so all in pomegranate’s favor.
The minerals scene is closer to even; pomegranate has more copper, phosphorus, potassium, selenium, and zinc, while figs have more calcium, iron, magnesium, and manganese. Thus, a 5:4 lead for pomegranate, and the larger margins of difference are again for pomegranate.
In short, enjoy both, but pomegranates are the more nutritionally dense. Also, don’t throw away the peel! Dry it, and turn it into a powdered supplement—see our linked article below, for why:
Want to learn more?
You might like to read:
Pomegranate’s Health Gifts Are Mostly In Its Peel
Take care!
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The Calorie Myth – by Jonathan Bailor
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First we’ll mention: the author is not a doctor, but the book is endorsed by assorted well-known doctors in the field, and the science described is consistent with current scientific consensus (and, for that matter, consistent with what we wrote in our mythbusting feature: Are You A Calorie-Burning Machine?).
It’s often (correctly) said that “not all calories are created equal”, but how should we quantify them? He proposes his “SANE solution”, which is based around the ideas of:
- Satiety: how quickly calories fill us up
- Aggression: how likely calories are to be stored as fat
- Nutrition: how many micronutrients calories bring with them, and how much
- Efficiency: how easily calories are converted
To this end, he recommends a diet high in foods that score well on his “SANE” factors, and provides such things as recipes, meal plans etc to help, as well principles for exercising more usefully in the context of metabolic base rate, and moving (rather than fighting) one’s “set point”, which is usually associated with one’s weight but it really has more to do with metabolic base rate. In fact, Bailor recommends throwing out the bathroom scale and focusing on pursuing good health itself, rather than obsessing over changing one’s relationship with the Earth’s gravitational field.
Yes, it says “lose weight” in the subtitle, but the idea is that this will be a by-product rather than the thing actively pursued. After all, we can control our actions, so that input variable is where we should put our focus, not the output variable of the numbers on the scale which can often be misleading (muscle weighing more than fat, tendency to water weight fluctuations, etc).
The style is a little flashy and salesy for this reviewer’s personal taste (a lot of references to his own businesses and neologisms associated with such), but it doesn’t take away from the quality of the content, and in terms of science, study references come at a rate of about one per page on average.
Bottom line: if you’d like to rethink your relationship with calories, then this book can help give you a much more practical angle.
Click here to check out The Calorie Myth, and take control of your metabolic base rate!
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