Children can be more vulnerable in the heat. Here’s how to protect them this summer

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Extreme heat is increasingly common in Australia and around the world and besides making us uncomfortable, it can harm our health. For example, exposure to extreme heat can exacerbate existing medical conditions, or cause problems such as heat stroke.

Due to a combination of physiology and behaviour, children are potentially more vulnerable to severe heat-related illness such as heat stroke or heat exhaustion.

But these are not the only heat-related health issues children might experience on a very hot day. In a new study, we looked at emergency department (ED) visits and unplanned hospital admissions among children in New South Wales on heatwave days.

We found a significant increase in children attending hospital compared to milder days – with a range of health issues.

maxim ibragimov/Shutterstock

Why are children more vulnerable in the heat?

Sweating is the main way we lose heat from our bodies and cool down.

Children have a greater skin surface area to body mass ratio, which can be an advantage for sweating – they can lose more heat through evaporation for a given body mass. But this also means children can lose fluids and electrolytes faster through sweating, theoretically making them more susceptible to dehydration.

Meanwhile, younger children, particularly babies, can’t sweat as much as older children and adults. This means they can’t cool down as effectively.

Children in general also tend to engage in more outdoor physical activity, which might see them more exposed to very hot temperatures.

Further, children may be less in-tune to the signals their body is giving them that they’re overheating, such as excessive sweating or red skin. So they might not stop and cool down when they need to. Young children especially may not recognise the early signs of heat stress or be able to express discomfort.

A boy drinking from a drink bottle, appears hot and bothered.
Children may not easily be able to communicate that they’re hot and bothered. christinarosepix/Shutterstock

Our study

We wanted to examine children’s exposure to extreme heat stress and the associated risks to their health.

We measured extreme heat as “heatwave days”, at least two consecutive days with a daily maximum temperature above the 95th percentile for the relevant area on a universal thermal climate index. This ranged from 27°C to 45°C depending on the area.

We assessed health outcomes by looking at ED visits and unplanned hospital admissions among children aged 0–18 years from NSW between 2000 and 2020. This totalled around 8.2 million ED visits and 1.4 million hospital admissions.

We found hospital admissions for heat-related illness were 104% more likely on heatwave days compared to non-heatwave days, and ED visits were 78% more likely. Heat-related illness includes a spectrum of disorders from minor conditions such as dehydration to life-threatening conditions such as heat stroke.

But heat-related illness wasn’t the only condition that increased on heatwave days. There was also an increase in childhood infections, particularly infectious enteritis possibly related to food poisoning (up 6% for ED visits and 17% for hospital admissions), ear infections (up 30% for ED visits and 3% for hospital admissions), and skin and soft tissue infections (up 6% for ED visits and 4% for hospital admissions).

A boy standing in front of a sprinkler.
Kids can be more vulnerable in the heat because of their behaviour and physiology. K-FK/Shutterstock

We know many infectious diseases are highly seasonal. Some, like the flu, peak in winter. But heat and humidity increase the risk of certain infections caused by bacterial, viral and fungal pathogens.

For example, warmer weather and higher humidity can increase the survival of bacteria, such as Salmonella, on foods, which increases the risk of food poisoning.

Hot weather can also increase the risk of ear infections. Children may be at greater risk during hot weather because they often swim or play at the beach or pool. Water can stay in the ear after swimming and a moist environment in the ear canal can cause growth of pathogens leading to ear infections.

Which children are most vulnerable?

During heatwaves, we found infants aged under one were at increased risk of ED visits and hospital admission for any reason compared to older children. This is not surprising, because babies can’t regulate their body temperature effectively and are reliant on their caregivers to keep them cool.

Our study also found children from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Although we don’t know exactly why, we hypothesised families from poorer areas might have limited access to air-conditioning and could be more likely to live in hotter neighbourhoods.

Keeping kids cool: tips for parents

The highest levels of heat exposure on hot days for young children is usually when they’re taken outside in prams and strollers. To protect their children from direct sunlight, parents often instinctively cover their stroller with a cloth such as a muslin.

However, a recent study from our group showed this actually increases temperatures inside a stroller to as much as 3–4˚C higher than outside.

But if the cloth is wet with water, and a small fan is used to circulate the air close to the child, stroller temperatures can be 4–5˚C lower than outside. Wetting the cloth every 15–20 minutes (for example, with a spray bottle) maintains the cooling effect.

When young children are not in a stroller, and for older children, there are a few things to consider to keep them cool and safe.

Remember temperatures reported on weather forecasts are measured in the shade, and temperatures in the sun can be up to 15˚C higher. So sticking to the shade as much as possible is important.

Exercise generates heat inside the body, so activities should be shortened, or rescheduled to cooler times of the day.

Sunscreen and hats are important when outdoors, but neither are especially effective for keeping cool. Spraying water on the child’s skin – not just the face but arms, legs and even the torso if possible – can help. Wetting their hats is another idea.

Proper hydration on hot days is also essential. Regular water breaks, including offering water before, during and after activity, is important. Offering foods with high water content such as watermelon and orange can help with hydration too.

Wen-Qiang He, Research Fellow in Biostatistics and Epidemiology, Faculty of Medicine and Health, University of Sydney; James Smallcombe, Post-doctoral Research Associate, Faculty of Medicine and Health, University of Sydney; Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney, and Ollie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response

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    BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.

    Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.

    Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”

    As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.

    Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.

    The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.

    Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.

    But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.

    Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.

    Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.

    “If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”

    From Pioneer to Lagger

    California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.

    The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.

    Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.

    In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.

    When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.

    Fall From Grace

    Morrow’s troubles started long after the original California program had been shut down.

    The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.

    But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.

    The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.

    Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”

    By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”

    Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.

    “I didn’t have to feel naked and judged,” she said.

    Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.

    Physician Privacy vs. Patient Protection

    The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.

    Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.

    Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.

    Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.

    “To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.

    Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.

    The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.

    People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.

    “The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.

    The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.

    Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.

    “I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    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.

    Subscribe to KFF Health News’ free Morning Briefing.

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  • How to Eat (And Still Lose Weight) – by Dr. Andrew Jenkinson

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    You may be wondering: what diet is he recommending?

    The answer is: some guiding principles aside…. He’s not recommending a diet, per se.

    What this book does instead is outline why we eat too muchlink is to where we previously had this author as a spotlight featured expert on this topic! Check it out!

    He goes into a lot more detail than we ever could have in our little article, though, and this book is one of those where the reader may feel as though we have had a few classes at medical school. The style, however, is very comprehensible and accessible; there’s no obfuscating jargon here.

    Once we understand the signalling that goes on in terms of hunger/satiety, and the signalling that goes on in terms of fat storage/metabolism, we can simply choose to not give our bodies the wrong signals. Yes, it’s really that simple. It feels quite like a cheat code!

    Bottom line: if you’d like a better understanding of what regulates our body’s “set point” in weight/adiposity, and what can change it (for better or for worse), then this is the book for you.

    Click here to check out How To Eat (And Still Lose Weight), and enjoy eating (while still losing weight)!

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  • Should Men Over 50 Get PSA?

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    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Loved the information on prostate cancer. Do recommend your readers get a PSA or equivalent test annually for over 50 yr old men.❞

    (This is about: Prostate Health: What You Should Know)

    Yep, or best yet, the much more accurate PSE test! But if PSA test is what’s available, it’s a lot better than nothing. And, much as it’s rarely the highlight of anyone’s day, a prostate exam by a suitably qualified professional is also a good idea.

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  • The Paleo Diet

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    What’s The Real Deal With The Paleo Diet?

    The Paleo diet is popular, and has some compelling arguments for it.

    Detractors, meanwhile, have derided Paleo’s inclusion of modern innovations, and have also claimed it’s bad for the heart.

    But where does the science stand?

    First: what is it?

    The Paleo diet looks to recreate the diet of the Paleolithic era—in terms of nutrients, anyway. So for example, you’re perfectly welcome to use modern cooking techniques and enjoy foods that aren’t from your immediate locale. Just, not foods that weren’t a thing yet. To give a general idea:

    Paleo includes:

    • Meat and animal fats
    • Eggs
    • Fruits and vegetables
    • Nuts and seeds
    • Herbs and spices

    Paleo excludes:

    • Processed foods
    • Dairy products
    • Refined sugar
    • Grains of any kind
    • Legumes, including any beans or peas

    Enjoyers of the Mediterranean Diet or the DASH heart-healthy diet, or those with a keen interest in nutritional science in general, may notice they went off a bit with those last couple of items at the end there, by excluding things that scientific consensus holds should be making up a substantial portion of our daily diet.

    But let’s break it down…

    First thing: is it accurate?

    Well, aside from the modern cooking techniques, the global market of goods, and the fact it does include food that didn’t exist yet (most fruits and vegetables in their modern form are the result of agricultural engineering a mere few thousand years ago, especially in the Americas)…

    …no, no it isn’t. Best current scientific consensus is that in the Paleolithic we ate mostly plants, with about 3% of our diet coming from animal-based foods. Much like most modern apes.

    Ok, so it’s not historically accurate. No biggie, we’re pragmatists. Is it healthy, though?

    Well, health involves a lot of factors, so that depends on what you have in mind. But for example, it can be good for weight loss, almost certainly because of cutting out refined sugar and, by virtue of cutting out all grains, that means having cut out refined flour products, too:

    Diet Review: Paleo Diet for Weight Loss

    Measured head-to-head with the Mediterranean diet for all-cause mortality and specific mortality, it performed better than the control (Standard American Diet, or “SAD”), probably for the same reasons we just mentioned. However, it was outperformed by the Mediterranean Diet:

    Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults

    So in lay terms: the Paleo is definitely better than just eating lots of refined foods and sugar and stuff, but it’s still not as good as the Mediterranean Diet.

    What about some of the health risk claims? Are they true or false?

    A common knee-jerk criticism of the paleo-diet is that it’s heart-unhealthy. So much red meat, saturated fat, and no grains and legumes.

    The science agrees.

    For example, a recent study on long-term adherence to the Paleo diet concluded:

    ❝Results indicate long-term adherence is associated with different gut microbiota and increased serum trimethylamine-N-oxide (TMAO), a gut-derived metabolite associated with cardiovascular disease. A variety of fiber components, including whole grain sources may be required to maintain gut and cardiovascular health.❞

    ~ Genoni et al, 2020

    Bottom line:

    The Paleo Diet is an interesting concept, and certainly can be good for short-term weight loss. In the long-term, however (and: especially for our heart health) we need less meat and more grains and legumes.

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  • Mushrooms vs Eggplant – Which is Healthier?

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    Our Verdict

    When comparing mushrooms to eggplant, we picked the mushrooms.

    Why?

    First, you may be wondering: which mushrooms? Button mushrooms? White mushrooms? Chestnut mushrooms? Portobello mushrooms? And the answer is yes. Those (and more; it represents most mushrooms that are commonly sold fresh in western supermarkets) are all the same species at different ages; namely, Agaricus bisporus—not to be mistaken for fly agaric, which despite the name, is not even a member of the Agaricus genus, and is in fact Amanita muscari. This is an important distinction, because fly agaric is poisonous, though fatality is rare, and it’s commonly enjoyed recreationally (after some preparation, which reduces its toxicity) for its psychoactive effects. It’s the famous red one with white spots. Anyway, today we will be talking instead about Agaricus bisporus, which is most popular western varieties of “edible mushroom”.

    With that in mind, let’s get down to it:

    In terms of macros, mushrooms contain more than 3x the protein, while eggplant contains nearly 2x the carbs and 3x the fiber. We’ll call this a tie for macros.

    As for vitamins, mushrooms contain more of vitamins B1, B2, B3, B5, B6, B7, B9, B12, D, and choline, while eggplant contains more of vitamins A, E, and K. Most notably for vegans, mushrooms are a good non-animal source of vitamins B12 and D, which nutrients are not generally found in plants. Mushrooms, of course, are not technically plants. In any case, the vitamins category is an easy win for mushrooms.

    When it comes to minerals, mushrooms have more copper, iron, phosphorus, potassium, selenium, and zinc, while eggplant has more calcium, magnesium, and manganese. Another easy win for mushrooms.

    One final thing worth noting is that mushrooms are a rich source of the amino acid ergothioneine, which has been called a “longevity vitamin” for its healthspan-increasing effects (see our article below).

    Meanwhile, in the category of mushrooms vs eggplant, mushrooms don’t leave much room for doubt and are the clear winner here.

    Want to learn more?

    You might like to read:

    The Magic of Mushrooms: “The Longevity Vitamin” (That’s Not A Vitamin)

    Take care!

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  • Ear Candling: Is It Safe & Does It Work?

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    Does This Practice Really Hold A Candle To Evidence-Based Medicine?

    In Tuesday’s newsletter, we asked you your opinion of ear candling, and got the above-depicted, below-described set of responses:

    • Exactly 50% said “Under no circumstances should you put things in your ear and set fire to them”
    • About 38% said “It is a safe, drug-free way to keep the ears free from earwax and pathogens”
    • About 13% said “Done correctly, thermal-auricular therapy is harmless and potentially beneficial”

    This means that if we add the two positive-to-candling answers together, it’s a perfect 50:50 split between “do it” and “don’t do it”.

    (Yes, 38%+13%=51%, but that’s because we round to the nearest integer in these reports, and more precisely it was 37.5% and 12.5%)

    So, with the vote split, what does the science say?

    First, a quick bit of background: nobody seems keen to admit to having invented this. One of the major manufacturers of ear candles refers to them as “Hopi” candles, which the actual Hopi tribe has spent a long time asking them not to do, as it is not and never has been used by the Hopi people. Other proposed origins offered by advocates of ear candling include Traditional Chinese Medicine (not used), Ancient Egypt (no evidence of such whatsoever), and Atlantis:

    Quackwatch | Why Ear Candling Is Not A Good Idea

    It is a safe, drug-free way to keep the ears free from earwax and pathogens: True or False?

    False! In a lot of cases of alternative therapy claims, there’s an absence of evidence that doesn’t necessarily disprove the treatment. In this case, however, it’s not even an open matter; its claims have been actively disproven by experimentation:

    In a medium-sized survey (n=122), the following injuries were reported:

    • 13 x burns
    • 7 x occlusion of the ear canal
    • 6 x temporary hearing loss
    • 3 x otitis externa (this also called “swimmer’s ear”, and is an inflammation of the ear, accompanied by pain and swelling)
    • 1 x tympanic membrane perforation

    Indeed, authors of one paper concluded:

    ❝Ear candling appears to be popular and is heavily advertised with claims that could seem scientific to lay people. However, its claimed mechanism of action has not been verified, no positive clinical effect has been reliably recorded, and it is associated with considerable risk.

    No evidence suggests that ear candling is an effective treatment for any condition. On this basis, we believe it can do more harm than good and we recommend that GPs discourage its use

    ~ Dr. Joy Rafferty et al.

    Source: Canadian Family Physician | Ear Candling

    Under no circumstances should you put things in your ear and set fire to them: True or False?

    True! It’s generally considered good advice to not put objects in general in your ears.

    Inserting flaming objects is a definite no-no. Please leave that for the Cirque du Soleil.

    You may be thinking, “but I have done this and suffered no ill effects”, which seems reasonable, but is an example of survivorship bias in action—it doesn’t make the thing in question any safer, it just means you were one of the one of the ones who got away unscathed.

    If you’re wondering what to do instead… Ear oils can help with the removal of earwax (if you don’t want to go get it sucked out at a clinic—the industry standard is to use a suction device, which actually does what ear candles claim to do). For information on safely getting rid of earwax, see our previous article:

    Ear Today, Gone Tomorrow

    Take care!

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