How Does One Test Acupuncture Against Placebo Anyway?

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Pinpointing The Usefulness Of Acupuncture

We asked you for your opinions on acupuncture, and got the above-depicted, below-described, set of answers:

  • A little under half of all respondents voted for “It’s well-backed by modern science, per neurology, cardiology, immunology, etc”
  • Slightly fewer respondents voted for “We don’t understand how it works, but it works!”
  • A little under a fifth of respondents voted for “It may have some limited clinical applications beyond placebo”
  • One (1) respondent voted for for “It’s placebo at best”

When we did a main feature about homeopathy, a couple of subscribers wrote to say that they were confused as to what homeopathy was, so this time, we’ll start with a quick definition first.

First, what is acupuncture? For the convenience of a quick definition so that we can move on to the science, let’s borrow from Wikipedia:

❝Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine in which thin needles are inserted into the body.

Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery.❞

~ Wikipedia

Now, that’s not a promising start, but we will not be deterred! We will instead examine the science itself, rather than relying on tertiary sources like Wikipedia.

It’s worth noting before we move on, however, that there is vigorous debate behind the scenes of that article. The gist of the argument is:

  • On one side: “Acupuncture is not pseudoscience/quackery! This has long been disproved and there are peer-reviewed research papers on the subject.”
  • On the other: “Yes, but only in disreputable quack journals created specifically for that purpose”

The latter counterclaim is a) potentially a “no true Scotsman” rhetorical ploy b) potentially true regardless

Some counterclaims exhibit specific sinophobia, per “if the source is Chinese, don’t believe it”. That’s not helpful either.

Well, the waters sure are muddy. Where to begin? Let’s start with a relatively easy one:

It may have some clinical applications beyond placebo: True or False?

True! Admittedly, “may” is doing some of the heavy lifting here, but we’ll take what we can get to get us going.

One of the least controversial uses of acupuncture is to alleviate chronic pain. Dr. Vickers et al, in a study published under the auspices of JAMA (a very respectable journal, and based in the US, not China), found:

❝Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.

However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture❞

Source: Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis

If you’re feeling sharp today, you may be wondering how the differences are described as “significant” and “relatively modest” in the same text. That’s because these words have different meanings in academic literature:

  • Significant = p<0.05, where p is the probability of the achieved results occurring randomly
  • Modest = the differences between the test group and the control group were small

In other words, “significant modest differences” means “the sample sizes were large, and the test group reliably got slightly better results than placebo”

We don’t understand how it works, but it works: True or False

Broadly False. When it works, we generally have an idea how.

Placebo is, of course, the main explanation. And even in examples such as the above, how is placebo acupuncture given?

By inserting acupuncture needles off-target rather than in accord with established meridians and points (the lines and dots that, per Traditional Chinese Medicine, indicate the flow of qi, our body’s vital energy, and welling-points of such).

So, if a patient feels that needles are being inserted randomly, they may no longer have the same confidence that they aren’t in the control group receiving placebo, which could explain the “modest” difference, without there being anything “to” acupuncture beyond placebo. After all, placebo works less well if you believe you are only receiving placebo!

Indeed, a (Korean, for the record) group of researchers wrote about this—and how this confounding factor cuts both ways:

❝Given the current research evidence that sham acupuncture can exert not only the originally expected non-specific effects but also sham acupuncture-specific effects, it would be misleading to simply regard sham acupuncture as the same as placebo.

Therefore, researchers should be cautious when using the term sham acupuncture in clinical investigations.❞

Source: Sham Acupuncture Is Not Just a Placebo

It’s well-backed by modern science, per neurology, cardiology, immunology, etc: True or False?

False, for the most part.

While yes, the meridians and points of acupuncture charts broadly correspond to nerves and vasculature, there is no evidence that inserting needles into those points does anything for one’s qi, itself a concept that has not made it into Western science—as a unified concept, anyway…

Note that our bodies are indeed full of energy. Electrical energy in our nerves, chemical energy in every living cell, kinetic energy in all our moving parts. Even, to stretch the point a bit, gravitational potential energy based on our mass.

All of these things could broadly be described as qi, if we so wish. Indeed, the ki in the Japanese martial art of aikido is the latter kinds; kinetic energy and gravitational potential energy based on our mass. Same goes, therefore for the ki in kiatsu, a kind of Japanese massage, while the ki in reiki, a Japanese spiritual healing practice, is rather more mystical.

The qi in Chinese qigong is mostly about oxygen, thus indirectly chemical energy, and the electrical energy of the nerves that are receiving oxygenated blood at higher or lower levels.

On the other hand, the efficacy of the use of acupuncture for various kinds of pain is well-enough evidenced. Indeed, even the UK’s famously thrifty NHS (that certainly would not spend money on something it did not find to work) offers it as a complementary therapy for some kinds of pain:

❝Western medical acupuncture (dry needling) is the use of acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles.

This results in the body producing natural substances, such as pain-relieving endorphins. It’s likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.❞

Source: NHS | Acupuncture

Meanwhile, the NIH’s National Cancer Institute recommends it… But not as a cancer treatment.

Rather, they recommend it as a complementary therapy for pain management, and also against nausea, for which there is also evidence that it can help.

Frustratingly, while they mention that there is lots of evidence for this, they don’t actually link the studies they’re citing, or give enough information to find them. Instead, they say things like “seven randomized clinical trials found that…” and provide links that look reassuring until one finds, upon clicking on them, that it’s just a link to the definition of “randomized clinical trial”:

Source: NIH | Nactional Cancer Institute | Acupuncture (PDQ®)–Patient Version

However, doing our own searches finds many studies (mostly in specialized, potentially biased, journals such as the Journal of Acupuncture and Meridian Studies) finding significant modest outperformance of [what passes for] placebo.

Sometimes, the existence of papers with promising titles, and statements of how acupuncture might work for things other than relief of pain and nausea, hides the fact that the papers themselves do not, in fact, contain any evidence to support the hypothesis. Here’s an example:

❝The underlying mechanisms behind the benefits of acupuncture may be linked with the regulation of the hypothalamic-pituitary-gonadal (adrenal) axis and activation of the Wnt/β-catenin and OPG/RANKL/RANK signaling pathways.

In summary, strong evidence may still come from prospective and well-designed clinical trials to shed light on the potential role of acupuncture in preserving bone loss❞

Source: Acupuncture for Osteoporosis: a Review of Its Clinical and Preclinical Studies

So, here they offered a very sciencey hypothesis, and to support that hypothesis, “strong evidence may still come”.

“We must keep faith” is not usually considered evidence worthy of inclusion in a paper!

PS: the above link is just to the abstract, because the “Full Text” link offered in that abstract leads to a completely unrelated article about HIV/AIDS-related cryptococcosis, in a completely different journal, nothing to do with acupuncture or osteoporosis).

Again, this is not the kind of professionalism we expect from peer-reviewed academic journals.

Bottom line:

Acupuncture reliably performs slightly better than sham acupuncture for the management of pain, and may also help against nausea.

Beyond placebo and the stimulation of endorphin release, there is no consistently reliable evidence that is has any other discernible medical effect by any mechanism known to Western science—though there are plenty of hypotheses.

That said, absence of evidence is not evidence of absence, and the logistical difficulty of testing acupuncture against placebo makes for slow research. Maybe one day we’ll know more.

For now:

  • If you find it helps you: great! Enjoy
  • If you think it might help you: try it! By a licensed professional with a good reputation, please.
  • If you are not inclined to having needles put in you unnecessarily: skip it! Extant science suggests that at worst, you’ll be missing out on slight relief of pain/nausea.

Take care!

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  • Federal Panel Prescribes New Mental Health Strategy To Curb Maternal Deaths

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    BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.

    When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”

    Aquino has lots of company.

    Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.

    Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.

    “This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.

    Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.

    Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.

    For Aquino, it wasn’t until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.

    Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.

    The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.

    This week, the Maternal Mental Health Task Force — co-led by the Office on Women’s Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.

    The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.

    Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”

    There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.

    “All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.

    Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.

    In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.

    To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana’s population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.

    Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”

    Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.

    Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino’s recovery. Aquino said she couldn’t have imagined going through such a “dark time alone.” With Carrizo’s support, “I could make it,” she said.

    Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.

    Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.

    Without warning, “a dark cloud came over me,” she said.

    Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don’t want that stigma of not being a good mom,” she said.

    In recent years, programs around the country have started to help doctors recognize mothers’ mood disorders and learn how to help them before any harm is done.

    One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.

    But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.

    The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.

    In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.

    Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.

    About 50 health care providers have signed up for Ell’s program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.

    The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.

    A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists’ ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study’s authors.

    Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.

    “I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.

    Cheryl Platzman Weinstock’s reporting is supported by a grant from the National Institute for Health Care Management 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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  • Brazil Nuts vs Pecans – Which is Healthier?

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    Our Verdict

    When comparing Brazil nuts to pecans, we picked the pecans.

    Why?

    In terms of macros, Brazil nuts have more protein while pecans have more fiber. Both of these nuts are equally fatty, though Brazil nuts have much more saturated fat per 100g, which still isn’t terrible, but it does make pecans’ profile (mostly monounsaturated with some polyunsaturated) the healthier. They’re about equal in carbs. All in all, a win for pecans here.

    In the category of vitamins, Brazil nuts have more vitamin E, while pecans have more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, K, and choline. An easy win for pecans.

    The category of minerals is an interesting one. Brazil nuts have more calcium, copper, magnesium, phosphorus, potassium, and selenium, while pecans have more iron, manganese, and zinc. Before we crown Brazil nuts with the win in this category, though, let’s take a closer look at those selenium levels:

    • A cup of pecans contains 21% of the RDA of selenium. Your hair will be luscious and shiny.
    • A cup of Brazil nuts contains 10,456% of the RDA of selenium. This is way past the point of selenium toxicity, and your (luscious, shiny) hair will fall out.

    For this reason, it’s recommended to eat no more than 3–4 Brazil nuts per day.

    We consider that a point against Brazil nuts.

    Adding up the sections makes for an overall win for pecans; of course, enjoy either or both, just be sure to practise moderation when it comes to the Brazil nuts!

    Want to learn more?

    You might like:

    Why You Should Diversify Your Nuts

    Enjoy!

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  • Kiwi vs Passion Fruit – Which is Healthier?

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    Our Verdict

    When comparing kiwi to passion fruit, we picked the passion fruit.

    Why?

    This fruit is so passionate about delivery nutrient-dense goodness, that at time of writing, nothing has beaten it yet!

    In terms of macros, passion fruit has a little more protein, as well as 50% more carbs, and/but more than 3x the fiber. That last stat is particularly impressive, and also results in passion fruit having a much lower glycemic index, too. In short, a clear win for passion fruit in the macros category.

    In the category of vitamins, kiwi has more of vitamins B9, C, E, and K, while passion fruit has more of vitamins A, B2, B3, and B6, making for a tie this time.

    As for minerals, kiwi has more calcium, copper, manganese, and zinc, while passion fruit has more iron, magnesium, phosphorus, potassium, and selenium, resulting in a modest, marginal win for passion fruit in this category.

    Adding up the categories gives a convincing win for passion fruit, but by all means enjoy either or both; diversity is good! And kiwi has its merits too (for example, it’s particularly high in vitamin K, appropriately enough).

    Want to learn more?

    You might like to read:

    Top 8 Fruits That Prevent & Kill Cancer

    Enjoy!

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Related Posts

  • Ear Candling: Is It Safe & Does It Work?
  • Fat’s Real Barriers To Health

    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.

    Fat Justice In Healthcare

    This is Aubrey Gordon, an author, podcaster, and fat justice activist. What does that mean?

    When it comes to healthcare, we previously covered some ideas very similar to her work, such as how…

    There’s a lot of discrimination in healthcare settings

    In this case, it often happens that a thin person goes in with a medical problem and gets treated for that, while a fat person can go in with the same medical problem and be told “you should try losing some weight”.

    Top tip if this happens to you… Ask: “what would you advise/prescribe to a thin person with my same symptoms?”

    Other things may be more systemic, for example:

    When a thin person goes to get their blood pressure taken, and that goes smoothly, while a fat person goes to get their blood pressure taken, and there’s not a blood pressure cuff to fit them, is the problem the size of the person or the size of the cuff? It all depends on perspective, in a world built around thin people.

    That’s a trivial-seeming example, but the same principle has far-reaching (and harmful) implications in healthcare in general, e.g:

    • Surgeons being untrained (and/or unwilling) to operate on fat people
    • Getting a one-size-fits-all dose that was calculated using average weight, and now doesn’t work
    • MRI machines are famously claustrophobia-inducing for thin people; now try not fitting in it in the first place

    …and so forth. So oftentimes, obesity will be correlated with a poor healthcare outcome, where the problem is not actually the obesity itself, but rather the system having been set up with thin people in mind.

    It would be like saying “Having O- blood type results in higher risks when receiving blood transfusions”, while omitting to add “…because we didn’t stock O- blood”.

    Read more on this topic: Shedding Some Obesity Myths

    Does she have practical advice about this?

    If she could have you understand one thing, it would be:

    You deserve better.

    Or if you are not fat: your fat friends deserve better.

    How this becomes useful is: do not accept being treated as the problem!

    Demand better!

    If you meekly accept that you “just need to lose weight” and that thus you are the problem, you take away any responsibility from your healthcare provider(s) to actually do their jobs and provide healthcare.

    See also Gordon’s book, which we’ve not reviewed yet but probably will one of these days:

    “You Just Need to Lose Weight”: And 19 Other Myths About Fat People – by Aubrey Gordon

    Are you saying fat people don’t need to lose weight?

    That’s a little like asking “would you say office workers don’t need to exercise more?”; there are implicit assumptions built into the question that are going unaddressed.

    Rather: some people might benefit healthwise from losing weight, some might not.

    In fact, over the age of 65, being what is nominally considered “overweight” reduces all-cause mortality risk.

    For details of that and more, see: When BMI Doesn’t Measure Up

    But what if I do want/need to lose weight?

    Gordon’s not interested in helping with that, but we at 10almonds are, so…

    Check out: Lose Weight, But Healthily

    Where can I find more from Aubrey Gordon?

    You might enjoy her blog:

    Aubrey Gordon | Your Fat Friend

    Or her other book, which we reviewed previously:

    What We Don’t Talk About When We Talk About Fat – by Aubrey Gordon

    Enjoy!

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  • The 7-Minute Morning Routine That Eliminates Stiffness

    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.

    The video title says “65+”, but honestly, if you are younger than that, and wait until you are 65 to attend to such things as mobility maintenance, then you’ll wish you’d started a long time previously!

    So, today is always a good day to start, whatever your age.

    A good way to start the day

    The exercises do not, in fact, include the forwards bend depicted in the thumbnail. Rather, they are:

    Exercise 1: toe wiggles (1 minute):

    • while lying in bed, open and close your toes to improve foot mobility.
    • this may seem silly and/or trivial, but it’s vital for overall mobility as foot health impacts daily movement, and your toes are responsible for a surprising amount when it comes to your posture, gait, etc.

    Exercise 2: calf and hamstring stretch (1 minute):

    • use a rolled-up towel (or similar non-stretchy long thing) to pull one foot towards you while straightening your leg.
    • hold the stretch for 30 seconds per leg to relieve tightness in the calf or hamstring.

    Exercise 3: knee flexion (1 minute):

    • bend your knee as much as possible and pull your shin towards you.
    • perform for 30 seconds per leg, gently easing into stiffness if necessary to improve knee mobility (i.e. if this is difficult at first).

    Exercise 4: knee extension (1 minute):

    • straighten one leg on the bed and press your knee down while pulling the toes up.
    • hold for 5 seconds, repeat six times per leg, improving knee extension and strengthening the quads.

    Exercise 5: hip flexion mobilization (1 minute):

    • with your knees bent, pull one knee towards your chest and release in a rhythmic motion (see video for differences from #3)
    • do 30 seconds per leg to improve hip mobility and loosen stiffness, especially beneficial for those with hip arthritis.

    exercise 6: cat-cow stretch (1 minute):

    • on all fours, alternate between arching your back (cat) and dipping it (cow).
    • improves mobility in the neck, mid-back, and lower back.

    exercise 7: shoulder and upper back stretch (1 minute):

    • stand facing a wall, place your hands on the wall, and hinge at the hips to drop your torso between your arms.
    • stretches lats, shoulders, and the upper back; do two 30-second holds..

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like:

    Over 50? Do These 3 Stretches Every Morning To Avoid Pain

    Take care!

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  • Four Thousand Weeks – by Oliver Burkeman

    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.

    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:

    1. how was your last week?
    2. how will your next week be?
    3. 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!

    Don’t Forget…

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    Learn to Age Gracefully

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