All In Your Head (Which Is Where It’s Supposed To Be)

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Today’s news is all about things above the neck, and mostly in the brain. From beating depression to beating cognitive decline, from mindfulness against pain to dentistry nightmares to avoid:

Transcranial ultrasound stimulation

Transcranial magnetic stimulation is one of those treatments that sounds like it’s out of a 1950s sci-fi novel, and yet, it actually works (it’s very well-evidenced against treatment-resistant depression, amongst other things). However, a weakness of it is that it’s difficult to target precisely, making modulation of most neurological disorders impossible. Using ultrasound instead of a magnetic field allows for much more finesse, with very promising initial results across a range of neurological disorders

Read in full: Transcranial ultrasound stimulation: a new frontier in non-invasive brain therapy

Related: Antidepressants: Personalization Is Key!

This may cause more pain and damage, but at least it’s more expensive too…

While socialized healthcare systems sometimes run into the problem of not wanting to spend money where it actually is needed, private healthcare systems have the opposite problem: there’s a profit incentive to upsell to more expensive treatments. Here’s how that’s played out in dentistry:

Read in full: Dentists are pulling healthy and treatable teeth to profit from implants, experts warn

Related: Tooth Remineralization: How To Heal Your Teeth Naturally

Mindfulness vs placebo, for pain

It can be difficult with some “alternative therapies” to test against placebo, for example “and control group B will merely believe that they are being pierced with needles”, etc. However, in this case, mindfulness meditation was tested as an analgesic vs sham meditation (just deep breathing) and also vs placebo analgesic cream, vs distraction (listening to an audiobook). Mindfulness meditation beat all of the other things:

Read in full: Mindfulness meditation outperforms placebo in reducing pain

Related: No-Frills, Evidence-Based Mindfulness

Getting personal with AI doctors

One of the common reasons that people reject AI doctors is the “lack of a human touch”. However, human and AI doctors may be meeting in the middle nowadays, as humans are pressed to see more patients in less time, and AI is trained to be more personal—not just a friendlier affect, but also, such things as remembering the patient’s previous encounters (again, something with which overworked human doctors sometimes struggle). This makes a big difference to patient satisfaction:

Read in full: Personalization key to patient satisfaction with AI doctors

Related: AI: The Doctor That Never Tires?

Combination brain therapy against cognitive decline

This study found that out of various combinations trialled, the best intervention against cognitive decline was a combination of 1) cognitive remediation (therapeutic interventions designed to improve cognitive functioning, like puzzles and logic problems), and 2) transcranial direct current stimulation (tDCS), a form of non-invasive direct brain stimulation, similar to the magnetic or ultrasound methods we mentioned earlier today. Here’s how it worked:

Read in full: Study reveals effective combination therapy to slow cognitive decline in older adults

Related: How To Reduce Your Alzheimer’s Risk

Take care!

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  • Survival of the Prettiest – by Dr. Nancy Etcoff

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    Beauty is in the eye of the beholder, right? And what does it matter, in this modern world, especially if we are already in a happy stable partnership?

    The science of it, as it turns out, is less poetic. Not only is evolutionary psychology still the foundation of our perception of human beauty (yes, even if we have zero possibility of further procreation personally), but also, its effects are far, far wider than partner selection.

    From how nice people are to you, to how much they trust you, to how easily they will forgive a (real or perceived) misdeed, to what kind of medical care you get (or don’t), your looks shape your experiences.

    In this very easy-reading work that nevertheless contains very many references, Dr. Etcoff explores the science of beauty. Not just what traits are attractive and why, but also, what they will do for (or against) us—in concrete terms, with numbers.

    Bottom line: if you’d like to better understand the subconscious biases held by yourself and others, this book is a top-tier primer.

    Click here to check out Survival of the Prettiest, and learn more about how this blessing/curse affects you and those around you!

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  • Is Chiropractic All It’s Cracked Up To Be?

    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.

    Is Chiropractic All It’s Cracked Up To Be?

    Yesterday, we asked you for your opinions on chiropractic medicine, and got the above-depicted, below-described set of results:

    • 38% of respondents said it keeps us healthy, and everyone should do it as maintenance
    • 33% of respondents said it can correct some short-term skeletal issues, but that’s all
    • 16% of respondents said that it’s a dangerous pseudoscience and can cause serious harm
    • 13% of respondents said that it’s mostly just a combination of placebo and endorphins

    Respondents also shared personal horror stories of harm done, personal success stories of things cured, and personal “it didn’t seem to do anything for me” stories.

    What does the science say?

    It’s a dangerous pseudoscience and can cause harm: True or False?

    False and True, respectively.

    That is to say, chiropractic in its simplest form that makes the fewest claims, is not a pseudoscience. If somebody physically moves your bones around, your bones will be physically moved. If your bones were indeed misaligned, and the chiropractor is knowledgeable and competent, this will be for the better.

    However, like any form of medicine, it can also cause harm; in chiropractic’s case, because it more often than not involves manipulation of the spine, this can be very serious:

    ❝Twenty six fatalities were published in the medical literature and many more might have remained unpublished.

    The reported pathology usually was a vascular accident involving the dissection of a vertebral artery.

    Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.❞

    Source: Deaths after chiropractic: a review of published cases

    From this, we might note two things:

    1. The abstract doesn’t note the initial sample size; we would rather have seen this information expressed as a percentage. Unfortunately, the full paper is not accessible, and nor are many of the papers it cites.
    2. Having a vertebral artery fatally dissected is nevertheless not an inviting prospect, and is certainly a very reasonable cause for concern.

    It’s mostly just a combination of placebo and endorphins: True or False?

    True or False, depending on what you went in for:

    • If you went in for a regular maintenance clunk-and-click, then yes, you will get your clunk-and-click and feel better for it because you had a ritualized* experience and endorphins were released.
    • If you went in for something that was actually wrong with your skeletal alignment, to get it corrected, and this correction was within your chiropractor’s competence, then yes, you will feel better because a genuine fault was corrected.

    *this is not implying any mysticism, by the way. Rather it means simply that placebo effect is strongest when there is a ritual associated with it. In this case it means going to the place, sitting in a pleasant waiting room, being called in, removing your shoes and perhaps some other clothes, getting the full attention of a confident and assured person for a while, this sort of thing.

    With regard to its use to combat specifically spinal pain (i.e., perhaps the most obvious thing to treat by chiropractic spinal manipulation), evidence is slightly in favor, but remains unclear:

    ❝Due to the low quality of evidence, the efficacy of chiropractic spinal manipulation compared with a placebo or no treatment remains uncertain. ❞

    Source: Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain

    It can correct some short-term skeletal issues, but that’s all: True or False?

    Probably True.

    Why “probably”? The effectiveness of chiropractic treatment for things other than short-term skeletal issues has barely been studied. From this, we may wish to keep an open mind, while also noting that it can hardly claim to be evidence-based—and it’s had hundreds of years to accumulate evidence. In all likelihood, publication bias has meant that studies that were conducted and found inconclusive or negative results were simply not published—but that’s just a hypothesis on our part.

    In the case of using chiropractic to treat migraines, a very-related-but-not-skeletal issue, researchers found:

    ❝Pre-specified feasibility criteria were not met, but deficits were remediable. Preliminary data support a definitive trial of MCC+ for migraine.❞

    Translating this: “it didn’t score as well as we hoped, but we can do better. We got some positive results, and would like to do another, bigger, better trial; please fund it”

    Source: Multimodal chiropractic care for migraine: A pilot randomized controlled trial

    Meanwhile, chiropractors’ claims for very unrelated things have been harshly criticized by the scientific community, for example:

    Misinformation, chiropractic, and the COVID-19 pandemic

    About that “short-term” aspect, one of our subscribers put it quite succinctly:

    ❝Often a skeletal correction is required for initial alignment but the surrounding fascia and muscles also need to be treated to mobilize the joint and release deep tissue damage surrounding the area. In combination with other therapies chiropractic support is beneficial.❞

    This is, by the way, very consistent with what was said in the very clinically-dense book we reviewed yesterday, which has a chapter on the short-term benefits and limitations of chiropractic.

    A truism that holds for many musculoskeletal healthcare matters, holds true here too:

    ❝In a battle between muscle and bone, muscle will always win❞

    In other words…

    Chiropractic can definitely help put misaligned bones back where they should be. However, once they’re there, if the cause of their misalignment is not treated, they will just re-misalign themselves shortly after you walking out of your session.

    This is great for chiropractors, if it keeps you coming back for endless appointments, but it does little for your body beyond give you a brief respite.

    So, by all means go to a chiropractor if you feel so inclined (and you do not fear accidental arterial dissection etc), but please also consider going to a physiotherapist, and potentially other medical professions depending on what seems to be wrong, to see about addressing the underlying cause.

    Take care!

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  • ADHD For Smart Ass Women – by Tracy Otsuka

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    We’ve reviewed books about ADHD in adults before, what makes this one different? It’s the wholly female focus. Which is not to say some things won’t apply to men too, they will.

    But while most books assume a male default unless it’s “bikini zone” health issues, this one is written by a woman for women focusing on the (biological and social) differences in ADHD for us.

    A strength of the book is that it neither seeks to:

    • over-medicalize things in a way that any deviation from the norm is inherently bad and must be fixed, nor
    • pretend that everything’s a bonus, that we are superpowered and beautiful and perfect and capable and have no faults that might ever need addressing actually

    …instead, it gives a good explanation of the ins and outs of ADHD in women, the strengths and weaknesses that this brings, and good solid advice on how to play to the strengths and reduce (or at least work around) the weaknesses.

    Bottom line: this book has been described as “ADHD 2.0 (a very popular book that we’ve reviewed previously), but for women”, and it deserves that.

    Click here to check out ADHD for Smart Ass Women, and fall in love with your neurodivergent brain!

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  • 4 Ways Vaccine Skeptics Mislead You on Measles and More

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    Measles is on the rise in the United States. In the first quarter of this year, the number of cases was about 17 times what it was, on average, during the same period in each of the four years before, according to the Centers for Disease Control and Prevention. Half of the people infected — mainly children — have been hospitalized.

    It’s going to get worse, largely because a growing number of parents are deciding not to get their children vaccinated against measles as well as diseases like polio and pertussis. Unvaccinated people, or those whose immunization status is unknown, account for 80% of the measles cases this year. Many parents have been influenced by a flood of misinformation spouted by politicians, podcast hosts, and influential figures on television and social media. These personalities repeat decades-old notions that erode confidence in the established science backing routine childhood vaccines. KFF Health News examined the rhetoric and explains why it’s misguided:

    The No-Big-Deal Trope

    A common distortion is that vaccines aren’t necessary because the diseases they prevent are not very dangerous, or too rare to be of concern. Cynics accuse public health officials and the media of fear-mongering about measles even as 19 states report cases.

    For example, an article posted on the website of the National Vaccine Information Center — a regular source of vaccine misinformation — argued that a resurgence in concern about the disease “is ‘sky is falling’ hype.” It went on to call measles, mumps, chicken pox, and influenza “politically incorrect to get.”

    Measles kills roughly 2 of every 1,000 children infected, according to the CDC. If that seems like a bearable risk, it’s worth pointing out that a far larger portion of children with measles will require hospitalization for pneumonia and other serious complications. For every 10 measles cases, one child with the disease develops an ear infection that can lead to permanent hearing loss. Another strange effect is that the measles virus can destroy a person’s existing immunity, meaning they’ll have a harder time recovering from influenza and other common ailments.

    Measles vaccines have averted the deaths of about 94 million people, mainly children, over the past 50 years, according to an April analysis led by the World Health Organization. Together with immunizations against polio and other diseases, vaccines have saved an estimated 154 million lives globally.

    Some skeptics argue that vaccine-preventable diseases are no longer a threat because they’ve become relatively rare in the U.S. (True — due to vaccination.) This reasoning led Florida’s surgeon general, Joseph Ladapo, to tell parents that they could send their unvaccinated children to school amid a measles outbreak in February. “You look at the headlines and you’d think the sky was falling,” Ladapo said on a News Nation newscast. “There’s a lot of immunity.”

    As this lax attitude persuades parents to decline vaccination, the protective group immunity will drop, and outbreaks will grow larger and faster. A rapid measles outbreak hit an undervaccinated population in Samoa in 2019, killing 83 people within four months. A chronic lack of measles vaccination in the Democratic Republic of the Congo led to more than 5,600 people dying from the disease in massive outbreaks last year.

    The ‘You Never Know’ Trope

    Since the earliest days of vaccines, a contingent of the public has considered them bad because they’re unnatural, as compared with nature’s bounty of infections and plagues. “Bad” has been redefined over the decades. In the 1800s, vaccine skeptics claimed that smallpox vaccines caused people to sprout horns and behave like beasts. More recently, they blame vaccines for ailments ranging from attention-deficit/hyperactivity disorder to autism to immune system disruption. Studies don’t back the assertions. However, skeptics argue that their claims remain valid because vaccines haven’t been adequately tested.

    In fact, vaccines are among the most studied medical interventions. Over the past century, massive studies and clinical trials have tested vaccines during their development and after their widespread use. More than 12,000 people took part in clinical trials of the most recent vaccine approved to prevent measles, mumps, and rubella. Such large numbers allow researchers to detect rare risks, which are a major concern because vaccines are given to millions of healthy people.

    To assess long-term risks, researchers sift through reams of data for signals of harm. For example, a Danish group analyzed a database of more than 657,000 children and found that those who had been vaccinated against measles as babies were no more likely to later be diagnosed with autism than those who were not vaccinated. In another study, researchers analyzed records from 805,000 children born from 1990 through 2001 and found no evidence to back a concern that multiple vaccinations might impair children’s immune systems.

    Nonetheless, people who push vaccine misinformation, like candidate Robert F. Kennedy Jr., dismiss massive, scientifically vetted studies. For example, Kennedy argues that clinical trials of new vaccines are unreliable because vaccinated kids aren’t compared with a placebo group that gets saline solution or another substance with no effect. Instead, many modern trials compare updated vaccines with older ones. That’s because it’s unethical to endanger children by giving them a sham vaccine when the protective effect of immunization is known. In a 1950s clinical trial of polio vaccines, 16 children in the placebo group died of polio and 34 were paralyzed, said Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and author of a book on the first polio vaccine.

    The Too-Much-Too-Soon Trope

    Several bestselling vaccine books on Amazon promote the risky idea that parents should skip or delay their children’s vaccines. “All vaccines on the CDC’s schedule may not be right for all children at all times,” writes Paul Thomas in his bestselling book “The Vaccine-Friendly Plan.” He backs up this conviction by saying that children who have followed “my protocol are among the healthiest in the world.”

    Since the book was published, Thomas’ medical license was temporarily suspended in Oregon and Washington. The Oregon Medical Board documented how Thomas persuaded parents to skip vaccines recommended by the CDC, and reported that he “reduced to tears” a mother who disagreed.  Several children in his care came down with pertussis and rotavirus, diseases easily prevented by vaccines, wrote the board. Thomas recommended fish oil supplements and homeopathy to an unvaccinated child with a deep scalp laceration, rather than an emergency tetanus vaccine. The boy developed severe tetanus, landing in the hospital for nearly two months, where he required intubation, a tracheotomy, and a feeding tube to survive.

    The vaccination schedule recommended by the CDC has been tailored to protect children at their most vulnerable points in life and minimize side effects. The combination measles, mumps, and rubella vaccine isn’t given for the first year of a baby’s life because antibodies temporarily passed on from their mother can interfere with the immune response. And because some babies don’t generate a strong response to that first dose, the CDC recommends a second one around the time a child enters kindergarten because measles and other viruses spread rapidly in group settings.

    Delaying MMR doses much longer may be unwise because data suggests that children vaccinated at 10 or older have a higher chance of adverse reactions, such as a seizure or fatigue.

    Around a dozen other vaccines have discrete timelines, with overlapping windows for the best response. Studies have shown that MMR vaccines may be given safely and effectively in combination with other vaccines.

    ’They Don’t Want You to Know’ Trope

    Kennedy compares the Florida surgeon general to Galileo in the introduction to Ladapo’s new book on transcending fear in public health. Just as the Roman Catholic inquisition punished the renowned astronomer for promoting theories about the universe, Kennedy suggests that scientific institutions oppress dissenting voices on vaccines for nefarious reasons.

    “The persecution of scientists and doctors who dare to challenge contemporary orthodoxies is not a new phenomenon,” Kennedy writes. His running mate, lawyer Nicole Shanahan, has campaigned on the idea that conversations about vaccine harms are censored and the CDC and other federal agencies hide data due to corporate influence.

    Claims like “they don’t want you to know” aren’t new among the anti-vaccine set, even though the movement has long had an outsize voice. The most listened-to podcast in the U.S., “The Joe Rogan Experience,” regularly features guests who cast doubt on scientific consensus. Last year on the show, Kennedy repeated the debunked claim that vaccines cause autism.

    Far from ignoring that concern, epidemiologists have taken it seriously. They have conducted more than a dozen studies searching for a link between vaccines and autism, and repeatedly found none. “We have conclusively disproven the theory that vaccines are connected to autism,” said Gideon Meyerowitz-Katz, an epidemiologist at the University of Wollongong in Australia. “So, the public health establishment tends to shut those conversations down quickly.”

    Federal agencies are transparent about seizures, arm pain, and other reactions that vaccines can cause. And the government has a program to compensate individuals whose injuries are scientifically determined to result from them. Around 1 to 3.5 out of every million doses of the measles, mumps, and rubella vaccine can cause a life-threatening allergic reaction; a person’s lifetime risk of death by lightning is estimated to be as much as four times as high.

    “The most convincing thing I can say is that my daughter has all her vaccines and that every pediatrician and public health person I know has vaccinated their kids,” Meyerowitz-Katz said. “No one would do that if they thought there were serious risks.”

    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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  • Migraine Mythbusting

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    Migraine: When Headaches Are The Tip Of The Neurological Iceberg

    Yesterday, we asked you “What is a migraine?” and got the above-depicted, below-described spread of responses:

    • Just under 46% said “a headache, but above a certain level of severity”
    • Just under 23% said “a headache, but caused by a neurological disorder”
    • Just over 21% said “a neurological disorder that can cause headaches”
    • Just under 10% said “a headache, but with an attention-grabbing name”

    So… What does the science say?

    A migraine is a headache, but above a certain level of severity: True or False?

    While that’s usually a very noticeable part of it… That’s only one part of it, and not a required diagnostic criterion. So, in terms of defining what a migraine is, False.

    Indeed, migraine may occur without any headache, let alone a severe one, for example: Abdominal Migraine—though this is much less well-researched than the more common with-headache varieties.

    Here are the defining characteristics of a migraine, with the handy mnemonic 5-4-3-2-1:

    • 5 or more attacks
    • 4 hours to 3 days in duration
    • 2 or more of the following:
      • Unilateral (affects only one side of the head)
      • Pulsating
      • Moderate or severe pain intensity
      • Worsened by or causing avoidance of routine physical activity
    • 1 or more of the following:
      • Nausea and/or vomiting
      • Sensitivity to both light and sound

    Source: Cephalalgia | ICHD-II Classification: Parts 1–3: Primary, Secondary and Other

    As one of our subscribers wrote:

    ❝I have chronic migraine, and it is NOT fun. It takes away from my enjoyment of family activities, time with friends, and even enjoying alone time. Anyone who says a migraine is just a bad headache has not had to deal with vertigo, nausea, loss of balance, photophobia, light sensitivity, or a host of other symptoms.❞

    Migraine is a neurological disorder: True or False?

    True! While the underlying causes aren’t known, what is known is that there are genetic and neurological factors at play.

    ❝Migraine is a recurrent, disabling neurological disorder. The World Health Organization ranks migraine as the most prevalent, disabling, long-term neurological condition when taking into account years lost due to disability.

    Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease❞

    Source: JHP | Mechanisms of migraine as a chronic evolutive condition

    Migraine is just a headache with a more attention-grabbing name: True or False?

    Clearly, False.

    As we’ve already covered why above, we’ll just close today with a nod to an old joke amongst people with chronic illnesses in general:

    “Are you just saying that because you want attention?”

    “Yes… Medical attention!”

    Want to learn more?

    You can find a lot of resources at…

    NIH | National Institute of Neurological Disorders & Stroke | Migraine

    and…

    The Migraine Trust ← helpfully, this one has a “Calm mode” to tone down the colorscheme of the website!

    Particularly useful from the above site are its pages:

    Take care!

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  • Can Home Tests Replace Check-Ups?

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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

    ❝I recently hit 65 and try to get regular check-ups, but do you think home testing can be as reliable as a doctor visit? I try to keep as informed as I can and am a big believer in taking responsibility for my own health if I can, but I don’t want to miss something important either. Best as a supplemental thing, perhaps?❞

    Depends what’s being tested! And your level of technical knowledge, though there’s always something to be said for ongoing learning.

    • If you’re talking blood tests, urine tests, etc per at-home test kits that get sent off to a lab, then provided they’re well-sourced (and executed correctly by you), they should be as accurate as what a doctor will give, since they are basically doing the same thing (taking a sample and sending it off to a lab).
    • If you’re talking about checking for lumps etc, then a dual approach is best: check yourself at home as often as you feel is reasonable (with once per month being advised at a minimum, especially if you’re aware of an extra risk factor for you) and check-ups with the doctor per their recommendations.
    • If you’re talking about general vitals (blood pressure, heart rate, heart rate variability, VO₂ max, etc), then provided you have a reliable way of testing them, then doing them very frequently at home, to get the best “big picture” view. In contrast, getting them done once a year at your doctor’s could result in a misleading result, if you just ate something different that day or had a stressful morning, for example.

    Enjoy

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