Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn
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Becky Carroll was missing a few teeth, and others were stained or crooked. Ashamed, she smiled with lips pressed closed. Her dentist offered to fix most of her teeth with root canals and crowns, Carroll said, but she was wary of traveling a long road of dental work.
Then Carroll saw a TV commercial for another path: ClearChoice Dental Implant Centers. The company advertises that it can give patients “a new smile in as little as one day” by surgically replacing teeth instead of fixing them.
So Carroll saved and borrowed for the surgery, she said. In an interview and a lawsuit, Carroll said that at a ClearChoice clinic in New Jersey in 2021, she agreed to pay $31,000 to replace all her natural upper teeth with pearly-white prosthetic ones. What came next, Carroll said, was “like a horror movie.”
Carroll alleged that her anesthesia wore off during implant surgery, so she became conscious as her teeth were removed and titanium screws were twisted into her jawbone. Afterward, Carroll’s prosthetic teeth were so misaligned that she was largely unable to chew for more than two years until she could afford corrective surgery at another clinic, according to a sworn deposition from her lawsuit.
ClearChoice has denied Carroll’s claims of malpractice and negligence in court filings and did not respond to requests for comment on the ongoing case.
“I thought implants would be easier, and all at once, so you didn’t have to keep going back to the dentist,” Carroll, 52, said in an interview. “But I should have asked more questions … like, Can they save these teeth?”
Dental implants have been used for more than half a century to surgically replace missing or damaged teeth with artificial duplicates, often with picture-perfect results. While implant dentistry was once the domain of a small group of highly trained dentists and specialists, tens of thousands of dental providers now offer the surgery and place millions of implants each year in the U.S.
Amid this booming industry, some implant experts worry that many dentists are losing sight of dentistry’s fundamental goal of preserving natural teeth and have become too willing to remove teeth to make room for expensive implants, according to a months-long investigation by KFF Health News and CBS News. In interviews, 10 experts said they had each given second opinions to multiple patients who had been recommended for mouths full of implants that the experts ultimately determined were not necessary. Separately, lawsuits filed across the country have alleged that implant patients like Carroll have experienced painful complications that have required corrective surgery, while other lawsuits alleged dentists at some implant clinics have persuaded, pressured, or forced patients to remove teeth unnecessarily.
The experts warn that implants, for a single tooth or an entire mouth, expose patients to costs and surgery complications, plus a new risk of future dental problems with fewer treatment options because their natural teeth are forever gone.
“There are many cases where teeth, they’re perfectly fine, and they’re being removed unnecessarily,” said William Giannobile, dean of the Harvard School of Dental Medicine. “I really hate to say it, but many of them are doing it because these procedures, from a monetary standpoint, they’re much more beneficial to the practitioner.”
Giannobile and nine other experts say they are combating a false public perception that implants are more durable and longer-lasting than natural teeth, which some believe stems in part from advertising on TV and social media. Implants require upkeep, and although they can’t get cavities, studies have shown that patients can be susceptible to infections in the gums and bone around their implants.
“Just because somebody can afford implants doesn’t necessarily mean that they’re a good candidate,” said George Mandelaris, a Chicago-area periodontist and member of the American Academy of Periodontology Board of Trustees. “When an implant has infection, or when an implant has bone loss, an implant dies a much quicker death than do teeth.”
In its simplest form, implant surgery involves extracting a single tooth and replacing it with a metal post that is screwed into the jaw and then affixed with a prosthetic tooth commonly made of porcelain, also known as a crown. Patients can also use “full-arch” or “All-on-4” implants to replace all their upper or lower teeth — or all their teeth.
For this story, KFF Health News and CBS News sought interviews with large dental chains whose clinics offer implant surgery — ClearChoice, Aspen Dental, Affordable Care, and Dental Care Alliance — each of which declined to be interviewed or did not respond to multiple requests for comment. The Association of Dental Support Organizations, which represents these companies and others like them, also declined an interview request.
ClearChoice, which specializes in full-arch implants, did not answer more than two dozen questions submitted in writing. In an emailed statement, the company said full-arch implants “have become a well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis.”
“The use of full-arch restorations reflects the evolution of modern dentistry, offering patients a solution that restores their ability to eat, speak, and live comfortably — far beyond what traditional dentures can provide,” the company said.
Carroll said she regrets not letting her dentist try to fix her teeth and rushing to ClearChoice for implants.
“Because it was a nightmare,” she said.
‘They Are Not Teeth’
Dental implant surgery can be a godsend for patients with unsalvageable teeth. Several experts said implants can be so transformative that their invention should have contended for a Nobel Prize. And yet, these experts still worry that implants are overused, because it is generally better for patients to have their natural teeth.
Paul Rosen, a Pennsylvania periodontist who said he has worked with implants for more than three decades, said many patients believe a “fallacy” that implants are “bulletproof.”
“You can’t just have an implant placed and go off riding into the sunset,” Rosen said. “In many instances, they need more care than teeth because they are not teeth.”
Generally, a single implant costs a few thousand dollars while full-arch implants cost tens of thousands. Neither procedure is well covered by dental insurance, so many clinics partner with credit companies that offer loans for implant surgeries. At ClearChoice, for example, loans can be as large as $65,000 paid off over 10 years, according to the company’s website.
Despite the price, implants are more popular than ever. Sales increased by more than 6% on average each year since 2010, culminating in more than 3.7 million implants sold in the U.S. in 2022, according to a 2023 report produced by iData Research, a health care market research firm.
Some worry implant dentistry has gone too far. In 10 interviews, dentists and dental specialists with expertise in implants said they had witnessed the overuse of implants firsthand. Each expert said they’d examined multiple patients in recent years who were recommended for full-arch implants by other dentists despite their teeth being treatable with conventional dentistry.
Giannobile, the Harvard dean, said he had given second opinions to “dozens” of patients who were recommended for implants they did not need.
“I see many of these patients now that are coming in and saying, ‘I’ve been seen, and they are telling me to get my entire dentition — all of my teeth — extracted.’ And then I’ll take a look at them and say that we can preserve most of your teeth,” Giannobile said.
Tim Kosinski, who is a representative of the Academy of General Dentistry and said he has placed more than 19,000 implants, said he examines as many as five patients a month who have been recommended for full-arch implants that he deems unnecessary.
“There is a push in the profession to remove teeth that could be saved,” Kosinski said. “But the public isn’t aware.”
Luiz Gonzaga, a periodontist and prosthodontist at the University of Florida, said he, too, had turned away patients who wanted most or all their teeth extracted. Gonzaga said some had received implant recommendations that he considered “an atrocity.”
“You don’t go to the hospital and tell them ‘I broke my finger a couple of times. This is bothering me. Can you please cut my finger off?’ No one will do that,” Gonzaga said. “Why would I extract your tooth because you need a root canal?”
Jaime Lozada, director of an elite dental implant residency program at Loma Linda University, said he’d not only witnessed an increase in dentists extracting “perfectly healthy teeth” but also treated a rash of patients with mouths full of ill-fitting implants that had to be surgically replaced.
Lozada said in August that he’d treated seven such patients in just three months.
“When individuals just make a decision of extracting teeth to make it simple and make money quick, so to speak, that’s where I have a problem,” Lozada said. “And it happens quite often.”
When full-arch implants fail, patients sometimes don’t have enough jawbone left to anchor another set. These patients have little choice but to get implants that reach into cheekbones, said Sohail Saghezchi, an oral and maxillofacial surgeon at the University of California-San Francisco.
“It’s kind of like a last resort,” Saghezchi said. “If those fail, you don’t have anywhere else to go.”
‘It Was Horrendous Dentistry’
Most of the experts interviewed for this article said their rising alarm corresponded with big changes in the availability of dental implants. Implants are now offered by more than 70,000 dental providers nationwide, two-thirds of whom are general dentists, according to the iData Research report.
Dentists are not required to learn how to place implants in dental school, nor are they required to complete implant training before performing the surgery in nearly all states. This year, Oregon started requiring dentists to complete 56 hours of hands-on training before placing any implants. Stephen Prisby, executive director of the Oregon Board of Dentistry, said the requirement — the first and only of its kind in the U.S. — was a response to dozens of investigations in the state into botched surgeries and other implant failures, split evenly between general dentists and specialists.
“I was frankly stunned at how bad some of these dentists were practicing,” Prisby said. “It was horrendous dentistry.”
Many dental clinics that offer implants have consolidated into chains owned by private equity firms that have bought out much of implant dentistry. In health care, private equity investment is sometimes criticized for overtreatment and prioritizing short-term profit over patients.
Private equity firms have spent about $5 billion in recent years to buy large dental chains that offer implants at hundreds of clinics owned by individual dentists and dental specialists. ClearChoice was bought for an estimated $1.1 billion in 2020 by Aspen Dental, which is owned by three private equity firms, according to PitchBook, a research firm focused on the private equity industry. Private equity firms also bought Affordable Care, whose largest clinic brand is Affordable Dentures & Implants, for an estimated $2.7 billion in 2021, according to PitchBook. And the private equity wing of the Abu Dhabi government bought Dental Care Alliance, which offers implants at many of its affiliated clinics, for an estimated $1 billion in 2022, according to PitchBook.
ClearChoice and Aspen Dental each said in email statements that the companies’ private equity owners “do not have influence or control over treatment recommendations.” Both companies said dentists or dental specialists make all clinical decisions.
Private equity deals involving dental practices increased ninefold from 2011 to 2021, according to an American Dental Association study published in August. The study also said investors showed an interest in oral surgery, possibly because of the “high prices” of implants.
“Some argue this is a negative thing,” said Marko Vujicic, vice president of the association’s Health Policy Institute, who co-authored the study. “On the other hand, some would argue that involvement of private equity and outside capital brings economies of scale, it brings efficiency.”
Edwin Zinman, a San Francisco dental malpractice attorney and former periodontist who has filed hundreds of dental lawsuits over four decades, said he believed many of the worst fears about private equity owners had already come true in implant dentistry.
“They’ve sold a lot of [implants], and some of it unnecessarily, and too often done negligently, without having the dentists who are doing it have the necessary training and experience,” Zinman said. “It’s for five simple letters: M-O-N-E-Y.”
Hundreds of Implant Clinics With No Specialists
For this article, journalists from KFF Health News and CBS News analyzed the webpages for more than 1,000 clinics in the nation’s largest private equity-owned dental chains, all of which offer some implants. The analysis found that more than 70% of those clinics listed only general dentists on their websites and did not appear to employ the specialists — oral surgeons, periodontists, or prosthodontists — who traditionally have more training with implants.
Affordable Dentures & Implants listed specialists at fewer than 5% of its more than 400 clinics, according to the analysis. The rest were staffed by general dentists, most of whom did not list credentialing from implant training organizations, according to the analysis.
ClearChoice, on the other hand, employs at least one oral surgeon or prosthodontist at each of its more than 100 centers, according to the analysis. But its new parent company, Aspen Dental, which offers implants in many of its more than 1,100 clinics, does not list any specialists at many of those locations.
Not everyone is worried about private equity in implant dentistry. In interviews arranged by the American Academy of Implant Dentistry, which trains dentists to use implants, two other implant experts did not express concerns about private equity firms.
Brian Jackson, a former academy president and implant specialist in New York, said he believed dentists are too ethical and patients are too smart to be pressured by private equity owners “who will never see a patient.”
Jumoke Adedoyin, a chief clinical officer for Affordable Care, who has placed implants at an Affordable Dentures & Implants clinic in the Atlanta suburbs for 15 years, said she had never felt pressure from above to sell implants.
“I’ve actually felt more pressure sometimes from patients who have gone around and been told they need to take their teeth out,” she said. “They come in and, honestly, taking a look at them, maybe they don’t need to take all their teeth out.”
Still, lawsuits filed across the country have alleged that dentists at implant clinics have extracted patients’ teeth unnecessarily.
For example, in Texas, a patient alleged in a 2020 lawsuit that an Affordable Care dentist removed “every single tooth from her mouth when such was not necessary,” then stuffed her mouth with gauze and left her waiting in the lobby as he and his staff left for lunch. In Maryland, a patient alleged in a 2021 lawsuit that ClearChoice “convinced” her to extract “eight healthy upper teeth,” by “greatly downplay[ing] the risks.” In Florida, a patient alleged in a 2023 lawsuit that ClearChoice provided her with no other treatment options before extracting all her teeth, “which was totally unnecessary.”
ClearChoice and Affordable Care denied wrongdoing in their respective lawsuits, then privately settled out of court with each patient. ClearChoice and Affordable Care did not respond to requests for comment submitted to the companies or attorneys. Lawyers for all three plaintiffs declined to comment on these lawsuits or did not respond to requests for comment.
Fred Goldberg, a Maryland dental malpractice attorney who said he has represented at least six clients who sued ClearChoice, said each of his clients agreed to get implants after meeting with a salesperson — not a dentist.
“Every client I’ve had who has gone to ClearChoice has started off meeting a salesperson and actually signing up to get their financing through ClearChoice before they ever meet with a dentist,” Goldberg said. “You meet with a salesperson who sells you on what they like to present as the best choice, which is almost always that they’re going to take out all your natural teeth.”
Becky Carroll, the ClearChoice patient from New Jersey, told a similar story.
Carroll said in her lawsuit that she met first with a ClearChoice salesperson referred to as a “patient education consultant.” In an interview, Carroll said the salesperson encouraged her to borrow money from family members for the surgery and it was not until after she agreed to a loan and passed a credit check that a ClearChoice dentist peered into her mouth.
“It seems way backwards,” Carroll said. “They just want to know you’re approved before you get to talk to a dentist.”
CBS News producer Nicole Keller contributed to this report.
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.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Keep Cellulite At Bay
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
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 😎
❝Does anything actually get rid of cellulite? Nothing seems to❞
Let’s get the bad news over with in one go:
Nothing (that the scientific world currently knows of) can get rid of cellulite permanently, nor completely guard against it proactively. Which, given that it affects up to 98% of women to some degree, and often shows up not long after puberty (though it can appear at any time and often increases later in life), any pre-emptive health regime would need to be started as a child in any case.
As with many things that predominantly affect women, the world of medicine isn’t entirely sure what causes it, let alone how to effectively treat it.
Obviously hormones are implicated, namely estrogen.
Obviously adiposity is implicated, because one can’t have dimples in one’s fat if one doesn’t have enough fat to dimple.
Other hypothesized contributory factors include genetics, poor diet, inactivity, unhealthy lifestyle (in ways not previously mentioned, e.g. use of alcohol, tobacco, etc), accumulated toxins, and pregnancy.
Here’s an old paper (from 2004); today’s reviews say pretty much the same thing, but we love how succinctly (albeit, somewhat depressingly) this abstract states how little we know and how little we can do:
Cellulite: a review of its physiology and treatment
However, all is not lost!
There are some things that can affect how much cellulite we get, and there are some things that can reduce it, and even some things that can get rid of it completely—albeit temporarily.
First, a quick refresher on what it actually is, physiologically speaking: cellulite occurs when connective tissue bands pull the skin down in places, where fat tissue has been able to squeeze through. One of the reasons it is hypothesized women get this more than men is because our fat is not merely different in distribution and overall percentage, but also in how the fat cells stack up; we generally have have of a vertical stacking structure going on, while men generally have a more horizontal structure. This means that it can be easier for ours to get moved about differently, causing the connective tissue to pull on the skin unevenly in places.
With that in mind…
Prevention is, as we say, probably impossible if your body is running on estrogen. However, those contributory factors we mentioned above? Most of those are modifiable, including these things that it is hypothesized can reduce it:
Diet: as it seems to be worsened by inflammation (what isn’t?), an anti-inflammatory diet is recommended.
Exercise: there are three things here: 1) exercises to improve circulation and thus the body’s ability to sort things out by itself 2) HIIT exercise to reduce body fat percentage, if one has a high enough starting body fat percentage for that to be a healthy goal 3) mobility exercises, to ensure our connective tissues are the right amount of mobile.
Creams and lotions
These reduce the superficial appearance of cellulite, without actually treating the thing itself. Mostly they are caffeine-based, which when used topically increases blood flow and works as a local diuretic, reducing the water content of the fat cells, diminishing the appearance of the cellulite by making each fat cell physically smaller (while still containing the same amount of fat, and it’ll bounce back in size as soon as the body can restore osmotic balance).
Medical procedures
There are too many of these to discuss them all separately, but they all work on the principle of breaking up the tough bands of connective tissue to eliminate the dimpling of cellulite.
The methods they use vary from ultrasound to cryolipolysis to lasers to “vacuum-assisted precise tissue release”, which involves a suction pump and a multipronged robotic assembly with needles to administer anaesthetic as it goes and small blades to cut the connective tissues under the skin:
Tissue Stabilized–Guided Subcision for the Treatment of Cellulite
That last one definitely sounds like the least fun, but it’s also the only one that doesn’t take months to maybe see results.
Cellulite can and almost certainly will come back after all of these.
Home remedies
Aside from at-home versions of the above (not the robots with vacuum pumps and needles and microblades, hopefully, but for example homemade caffeine creams), and of course diet and exercise which can be considered “home remedies”, there are two more things worth mentioning:
Dry brushing: using a body brush to, as the name suggests, simply brush one’s skin. The “dry” aspect here is simply that it’s not done in the bath or shower; it’s done while dry. It can improve local circulation of blood and lymph, allowing for better detoxification and redistribution of needed bodily resources.
Here’s an example dry brushing body brush on Amazon; this writer has one and hates it, but I’ve also tried with other kinds of brush and hate them too, so it seems to be a me thing rather than a brush thing, and I have desisted in trying, now. Maybe you will like it better; many people do.
Self-massage: or massage by someone else, if that’s an option for you and you prefer. In this case, it works by a different mechanism than dry brushing; this time it’s working by the same principle as the medical techniques described in the previous section; it’s physically breaking down the toughened bits of connective tissue.
Here’s an example wooden massage roller on Amazon; this writer has one and loves it; it’s sooooooo good. I got it as a matter of general maintenance for my fascia, but it’s also very good if I get a muscular pain now and again. As for cellulite, I personally get just a little cellulite sometimes (in the backs of my thighs), and whenever I use this regularly, it goes away for at least a while.
A quick note in closing
Cellulite is normal for women and is not unhealthy. Much like gray hair for example, it’s something that can be increased by poor health, but the thing itself isn’t intrinsically unhealthy, and most of us get it to some degree at some point.
Nevertheless, aesthetic factors can also have a role to play in mental health, and we tend to feel best when we like the way our body looks. If for you that means wanting less/no cellulite, then the above are some ways towards that.
As a bonus, most of the nonmedical options are directly good for the physical health anyway, so doing them is of course good.
In particular that last one (the wooden massage roller), because that connective tissue we talked about? It matters for a lot more than just cellulite, and is heavily implicated in a lot of kinds of chronic pain, so it pays to keep it in good health:
Fascia: Why (And How) You Should Take Care Of Yours
(that article, also written by this same writer by the way, suggests a vibrating foam roller—those are very popular; I just really love my wooden one, and find it more effective)
Take care!
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Signs Of Lupus Not To Miss (Butterfly Rash Is Just One Thing Of Many)
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.
Different kinds of lupus can look quite different:
Things to recognize
Lupus is a chronic autoimmune inflammatory disease where your immune system attacks your own body. In the case of systemic lupus, it usually affects your skin, joints, kidneys, lungs, heart, brain, and other organs, while cutaneous lupus refers specifically to lupus affecting your skin.
No matter what kind of lupus it is, though, the skin is the first likely place to notice the signs, so, let’s get into it:
- Lupus in general: lupus can cause a butterfly-shaped facial rash over your cheeks and nose, round scaly plaques, painful mouth or nose sores, widespread flaky rashes, purple-red bumps on your fingers or toes, deep painful nodules under your skin, and scarring hair loss on your scalp.
- Discoid lupus: the most common skin-only form causes thick round scaly lesions on your face or scalp that can scar permanently, leave dark or light patches, and cause permanent hair loss if untreated.
- Tumid lupus: a rarer skin-only form causing firm raised plaques, often on your chest, that heal without scars or pigment changes.
- Chilblain lupus: causes itchy dusky-purple bumps on your fingers, toes, ears, elbows, knees, or nose after cold damp exposure.
- Lupus profundus: a deeper form affecting the fat under your skin, causing painful nodules that can heal with permanent hollows or indentations.
- Subacute cutaneous lupus: produces ring-shaped, scaly, sun-triggered rashes that can resemble eczema or psoriasis, and are more associated with systemic disease.
- Acute cutaneous lupus: includes the classic butterfly or malar rash triggered by sun exposure and is strongly associated with systemic lupus erythematosus.
One other thing to bear in mind is that many other conditions can mimic a lupus butterfly rash, including rosacea and seborrheic dermatitis, so facial redness alone doesn’t confirm lupus.
Since there is no proven cure for lupus yet, lupus generally requires long-term treatment to manage inflammation, prevent organ damage, reduce scarring, and limit permanent hair loss or other unwanted aesthetic effects.
Avoiding common lupus triggers where possible is good in general, for example UV light from the sun or tanning beds, smoking, vaping, infections, stress, surgery, illness, and some medications (always read labels and check for contraindications).
For more on all of this plus visual illustrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
For a much more in-depth treatment of lupus management, you might like this excellent book we reviewed a while back:
The “et al.” in question? Jemima Albayda, MD; Divya Angra, MD; Alan N. Baer, MD; Sasha Bernatsky, MD, PhD; George Bertsias, MD, PhD; Ashira D. Blazer, MD; Ian Bruce, MD; Jill Buyon, MD; Yashaar Chaichian, MD; Maria Chou, MD; Sharon Christie, Esq; Angelique N. Collamer, MD; Ashté Collins, MD; Caitlin O. Cruz, MD; Mark M. Cruz, MD; Dana DiRenzo, MD; Jess D. Edison, MD; Titilola Falasinnu, PhD; Andrea Fava, MD; Cheri Frey, MD; Neda F. Gould, PhD; Nishant Gupta, MD; Sarthak Gupta, MD; Sarfaraz Hasni, MD; David Hunt, MD; Mariana J. Kaplan, MD; Alfred Kim, MD; Deborah Lyu Kim, DO; Rukmini Konatalapalli, MD; Fotios Koumpouras, MD; Vasileios C. Kyttaris, MD; Jerik Leung, MPH; Hector A. Medina, MD; Timothy Niewold, MD; Julie Nusbaum, MD; Ginette Okoye, MD; Sarah L. Patterson, MD; Ziv Paz, MD; Darryn Potosky, MD; Rachel C. Robbins, MD; Neha S. Shah, MD; Matthew A. Sherman, MD; Yevgeniy Sheyn, MD; Julia F. Simard, ScD; Jonathan Solomon, MD; Rodger Stitt, MD; George Stojan, MD; Sangeeta Sule, MD; Barbara Taylor, CPPM, CRHC; George Tsokos, MD; Ian Ward, MD; Emma Weeding, MD; Arthur Weinstein, MD; Sean A. Whelton, MD
The reason we mention this is to render it clear that this isn’t one man’s opinions (as happens with many books about certain topics), but rather, a panel of that many doctors all agreeing that this is correct and good, evidence-based, up-to-date (as of the publication of this latest revised edition all so recently) information.
Want to learn less?
If the aforementioned 848-page opus seems a little too overwhelming, then you might prefer:
The Lupus Solution – by Dr. Tiffany Caplan & Dr. Brent Caplan ← a much slimmer tome; just 182 pages 🙂
Take care!
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Breast Cancer and Birth Control: A Huge New Study Shows How Science Can Be Distorted
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As misinformation about women’s health spreads faster than ever, doctors say new research on the risks of hormonal birth control underscores the challenge of communicating nuance in the social media age.
The massive study, which was conducted in Sweden and tracked more than 2 million teenage girls and women under age 50 for more than a decade, found that hormonal contraception remains safe overall, but also found small differences in breast cancer risk based on the hormones used in the formulation. In addition, the researchers observed a small, short-term rise in breast cancer diagnoses among current or recent users. Those findings are consistent with prior large studies, including a 2017 Danish registry analysis and a 2023 meta-analysis.
It was published online Oct. 30 in JAMA Oncology.
Doctors say these study results won’t change how they advise patients and that women should not stop using their birth control.
Still, TikTok is flooded with factually incomplete warnings that contraceptives cause cancer and are as dangerous as smoking. Reproductive health advocates warn that studies like this can easily be taken out of context online and be reduced to a single alarming number.
Case in point: The study reported that women who had used hormonal birth control had about a 24% higher rate of breast cancer than women who hadn’t. But because breast cancer is still uncommon in younger women, that works out to an increase from roughly 54 to 67 breast cancer cases per 100,000 women per year — about 13 extra cases per 100,000 women, or about one extra case per 7,800 users of hormonal contraceptives per year.
Co-authors Åsa Johansson and Fatemeh Hadizadeh, epidemiologists at Uppsala University, said the rise is modest and short-term, with risk highest during current use and fading within five to 10 years after stopping.
Rachel Fey — interim co-CEO of Power to Decide, a group whose mission is to provide accurate information on sexual health and contraceptive methods — said that kind of nuance is exactly what tends to disappear on social media. “I get really angry at this because it’s designed to scare people like me away from birth control, which has made my life so much better in so many ways,” she said. “It’s really frustrating … especially when it’s given without context. And then in this era of social media, it can just take off without anybody who knows what they’re talking about providing that context.”
The researchers also found the risk was slightly higher with certain progestins such as desogestrel — found in combined oral contraceptives like Cyred EQ, Reclipsen, Azurette, and Pimtrea — but did not increase with others, such as medroxyprogesterone acetate injections, sold under the brand name Depo‑Provera.
(Moment/Getty Images) How To Interpret the Findings
Some experts say the results should be viewed with care because the study counted both invasive breast cancers and early, noninvasive lesions known as in situ tumors, growths that may never become life-threatening. Including these precancerous cases could make the overall risk of clinically significant disease appear higher than it is.
“A substantial proportion of the ‘cases’ would never have progressed to invasive breast cancer,” said Lina S. Mørch, a senior researcher and team leader at the Danish Cancer Institute. Mørch was not associated with the Swedish study. She added that experts should wait for more data separating early-stage and advanced cancers before making new rules or warnings about specific hormones.
The Doctor-Patient Conversation
Even as scientists debate how to interpret the finer points of the data, physicians emphasize that for most patients, the study reinforces what they already discuss in the exam room: that hormonal birth control is broadly safe, and decisions should be tailored to each woman’s needs and values.
Katharine White, chief of Obstetrics and Gynecology at Boston Medical Center, said this study won’t change how she talks to her patients.
“When counseling patients about their contraceptive options, I focus on their past experiences with birth control, their medical history, and what’s important to them about their birth control method and pregnancy planning (if applicable),” White wrote in an email. “Side effects and risks of methods are already a key part of my counseling about both hormonal and non-hormonal methods.”
Other doctors noted there are other contraceptive options.
Eleanor Bimla Schwarz, chief of General Internal Medicine at Zuckerberg San Francisco General Hospital, said, “For those who prefer hormone-free contraception, the copper IUD offers safe, convenient, highly effective contraception for over a decade after placement, and is rapidly reversible when pregnancy is desired,” referring to a type of long-acting intrauterine device.
Mary Rosser, director of Integrated Women’s Health at Columbia University Irving Medical Center, said this was a large, high-quality study that looked at many types of hormones over many years. But she added that doctors shouldn’t change their advice yet.
Johansson and Hadizadeh stressed that the results should guide shared decision-making, not cause alarm. “It may be reasonable to consider formulations associated with lower observed risk in our data,” they said. They noted that products containing medroxyprogesterone acetate, drospirenone, or levonorgestrel were linked to lower risk, while long-term use of desogestrel-only contraceptives might be best avoided when other options fit.
Keeping the Risk in Perspective
Hormonal birth control provides many health benefits beyond pregnancy prevention. It can lighten heavy periods, ease pain from endometriosis, and lower the risk of ovarian and uterine cancers for years after stopping. Mørch noted that even small risks are worth discussing but said decisions should be guided by women’s “values and preferences.”
White said it’s important to see the big picture. “The risk of an unintended pregnancy is 85% for people who do not use contraception—so any risks of birth control need to be weighed against the risk of an unexpected pregnancy,” she wrote.
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.
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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What is psychosocial therapy? And why is the government thinking about adding it to Medicare for kids?
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The government is considering new, bulk-billed health checks for three-year-olds, to pick up developmental concerns and refer kids that might need additional support.
The detail was buried in the announcement of the new “Thriving Kids” program which aims to provide foundational support for autistic children and those with developmental concerns.
The government announced it is also considering creating new Medicare items to provide for children that health checks identify as needing additional support. These would be provided by allied health practitioners and include speech pathology and occupational therapy, but also a type of therapy you might be less familiar with: psychosocial therapy.
So, what is psychosocial therapy? Health and disability minister Mark Butler said it will support social and emotional functioning.
Let’s take a look at what psychosocial therapy is, which children might benefit from it, and the evidence for offering these kinds of support.
Catherine Delahaye/Getty Developmental milestones
Brain development in the first five years of life is faster than at any other point in a human’s life. We can measure this rapid growth against developmental milestones. These are key indicators parents can use to respond to their child’s changing needs, and can be observed across motor, language, speech, behavioural, and emotional skills.
The way a child develops involves a dynamic series of processes that are a complex interplay of genetics and environmental factors. So there are natural variations between children in the timing of these developments.
There are guides for roughly expected age ranges we would generally expect certain skills to emerge.
Examples of these early milestones include seeking connection with trusted caregivers, crawling, jumping, counting and communicating. These all emerge by the time children are around two years old.
When parents, early childhood educators or health professionals identify an unmet need that is delaying the child’s development, it can indicate the need for supportive services, including psychosocial therapy.
What is psychosocial therapy?
Psychosocial therapies are treatments that focus on the psychological factors (emotions, thoughts and behaviours) and social factors (relationships, community and environmental) that affect a person’s wellbeing and mental health.
For example, for a three-year-old who is anxious at daycare drop-off, changing social interactions with educators or adjusting the physical environment may help reduce their anxiety.
By definition, psychosocial supports consider both the child and their environment – their family and their community. This is sometimes called a nested wellbeing approach.
There is good evidence that psychosocial therapies are effective and are considered best practice treatment for health professionals working with children.
These are sometimes called biopsychosocial therapies as they recognise the interaction of biological factors, such as genetics, as well as psychological and social factors that impact the child’s development.
Approaches that are suitable for very young children involve their family or caregivers. For instance, behavioural family therapy and parent training are programs that teach parents effective strategies to manage children’s behaviour and improve parent-child relationships.
These would be delivered by psychologists and/or occupational therapists.
For older children, psychosocial support could include cognitive behaviour therapy (which focuses on reframing thinking and behaviour) and interpersonal therapy (which focuses on improving relationships with others to alleviate mental health symptoms).
The evidence for psychosocial therapies
Psychosocial supports are not new to Medicare and are already part of the allied health items for those eligible disabilities, such as autism or other neurodevelopment conditions, such as attention-deficit hyperactivity disorder.
For young children, there is good evidence that early psychosocial interventions (like those above) can lead to significant improvements. These include improvements in developmental delays and behaviour, and self-regulation and executive functioning.
The evidence shows that early psychosocial supports work when parents are also supported to facilitate responsive caregiving that is “good enough” (not perfect).
In some instances, this might include training and education for parents to better understand their child’s cues and preferences. In other instances, it might look like practical caregiver supports, such as in-home support, peer support or help navigating care options.
The evidence shows if young children need more targeted and tailored support, including parents and caregivers in these interventions lead to the best outcomes for children, family and community wellbeing.
However, in the current discussion about new supports and NDIS, early intervention should not be seen as a substitute or alternative for ongoing disability support. Some people may continue to need support for day-to-day living in later childhood and as adults.
Shawna Mastro Campbell, Assistant Professor in Clinical Psychology, Bond University and Susan Rowe, Associate Professor in Clinical Psychology, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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10 Tips for Better Sleep: Starting In The Morning
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Dr. Siobhan Deshauer advises:
Checklist
You’ll probably have heard similar advice before (including from us), but it’s always good to do a quick rundown and check which ones you are actually doing, as opposed to merely know you should be doing:
- Wake up at the same time every day, including weekends, to maintain a consistent sleep schedule and avoid “social jet lag.”
- Expose yourself to bright light in the morning, either sunlight or light therapy, to regulate your circadian rhythm and melatonin production.
- Avoid caffeine late in the day to maintain natural sleep pressure, experimenting with a cutoff time based on your sensitivity (e.g. 6–10 hours before bedtime)*.
- Limit naps to under 30 minutes and take them early in the afternoon to avoid disrupting sleep pressure.
- Exercise regularly but avoid strenuous activity 2 hours before bed. Optimal exercise time is 4–6 hours before bedtime.
- Avoid alcohol, as it disrupts sleep quality and may worsen conditions like sleep apnea. If drinking, have your last drink early in the evening—but honestly, it’s better to not drink at all.
- Establish a wind-down routine 1–2 hours before bed, including dimming lights and engaging in relaxing activities to signal your body to prepare for sleep.
- Keep your bedroom cool (below 68°F/20°C) and ensure your hands and feet stay warm to aid in natural body temperature regulation.
- Limit device use before bed. If unavoidable, reduce blue light exposure and avoid mentally stimulating content. Set boundaries, such as placing your phone out of reach.
- Ensure complete darkness in your sleeping environment using blackout curtains, covering light-emitting devices, or wearing a sleep mask.
*we imagine she picked 6–10 hours because, depending on whether you have the fast or slow caffeine metabolizer gene, the biological halflife of caffeine in your body will be around 4 or 8 hours (that’s not a range, that’s two distinct and non-overlapping options). However, if we use 4 or 8 hours depending on which gene version we have, then that will mean that 4 or 8 hours later, respectively, we’ll have half the caffeine in us that we did 4 or 8 hours ago (that’s what a halflife means). So for example if you had a double espresso that number of hours before bedtime, then congratulations, you have the caffeine of a single espresso in your body by bedtime. Which, for most people**, is not an ideal nightcap. Hence, adding on a few more hours. Again, earlier is better though, so consider limiting caffeine to the morning only.
**we say “most people”, because if you have ADHD or a similar condition, your brain’s relationship with caffeine is a bit different, and—paradoxically—stimulants can help you to relax. Do speak with your doctor though, as individual cases vary widely, and it also may make a difference depending on what relevant meds (if any) you’re on, too.
For more on all of those things, enjoy:
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Want to learn more?
You might also like to read:
- How Regularity Of Sleep Can Be Even More Important Than Duration ← here’s why you should still get up at the same regular (and ideally, early) hour, even if you didn’t sleep well
- Early Bird Or Night Owl? Genes vs Environment ← and here’s why that regular hour should ideally be early, even if it’s not your genetic predisposition to be a “morning lark”; see also the study linked there that mentions “Gene distinguishes early birds from night owls and helps predict time of death”
Take care!
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What I Wish People Knew About Dementia – by Dr. Wendy Mitchell
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We hear a lot from doctors who work with dementia patients; sometimes we hear from carers too. In this case, the author spent 20 years working for the NHS, before being diagnosed with young-onset dementia, at the age of 58. Like many health industry workers who got a life-changing diagnosis, she quickly found it wasn’t fun being on the other side of things, and vowed to spend her time researching, and raising awareness about, dementia.
Many people assume that once a person has dementia, they’re basically “gone before they’re gone”, which can rapidly become a self-fulfilling prophecy as that person finds themself isolated and—though this word isn’t usually used—objectified. Talked over, viewed (and treated) more as a problem than a person. Cared for hopefully, but again, often more as a patient than a person. If doctors struggle to find the time for the human side of things with most patients most of the time, this is only accentuated when someone needs more time and patience than average.
Instead, Dr. Mitchell—an honorary doctorate, by the way, awarded for her research—writes about what it’s actually like to be a human with dementia. Everything from her senses, how she eats, the experience of eating in care homes, the process of boiling an egg… To relationships, how care changes them, to the challenges of living alone. And communication, confusion, criticism, the language used by professionals, or how things are misrepresented in popular media. She also talks about the shifting sense of self, and brings it all together with gritty optimism.
The style is deeply personal, yet lucid and clear. While dementia is most strongly associated with memory loss and communication problems, this hasn’t affected her ability to write well (7 years into her diagnosis, in case you were wondering).
Bottom line: if you’d like to read a first-person view of dementia, then this is an excellent opportunity to understand it from the view of, as the subtitle goes, someone who knows.
Click here to check out What I Wish People Knew About Dementia, and then know those things!
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