Feminist narratives are being hijacked to market medical tests not backed by evidence
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Corporations have used feminist language to promote their products for decades. In the 1980s, companies co-opted messaging about female autonomy to encourage women’s consumption of unhealthy commodities, such as tobacco and alcohol.
Today, feminist narratives around empowerment and women’s rights are being co-opted to market interventions that are not backed by evidence across many areas of women’s health. This includes by commercial companies, industry, mass media and well-intentioned advocacy groups.
Some of these health technologies, tests and treatments are useful in certain situations and can be very beneficial to some women.
However, promoting them to a large group of asymptomatic healthy women that are unlikely to benefit, or without being transparent about the limitations, runs the risk of causing more harm than good. This includes inappropriate medicalisation, overdiagnosis and overtreatment.
In our analysis published today in the BMJ, we examine this phenomenon in two current examples: the anti-mullerian hormone (AMH) test and breast density notification.
The AMH test
The AMH test is a blood test associated with the number of eggs in a woman’s ovaries and is sometimes referred to as the “egg timer” test.
Although often used in fertility treatment, the AMH test cannot reliably predict the likelihood of pregnancy, timing to pregnancy or specific age of menopause. The American College of Obstetricians and Gynaecologists therefore strongly discourages testing for women not seeking fertility treatment.
Despite this, several fertility clinics and online companies market the AMH test to women not even trying to get pregnant. Some use feminist rhetoric promising empowerment, selling the test as a way to gain personalised insights into your fertility. For example, “you deserve to know your reproductive potential”, “be proactive about your fertility” and “knowing your numbers will empower you to make the best decisions when family planning”.
The use of feminist marketing makes these companies appear socially progressive and champions of female health. But they are selling a test that has no proven benefit outside of IVF and cannot inform women about their current or future fertility.
Our recent study found around 30% of women having an AMH test in Australia may be having it for these reasons.
Misleading women to believe that the test can reliably predict fertility can create a false sense of security about delaying pregnancy. It can also create unnecessary anxiety, pressure to freeze eggs, conceive earlier than desired, or start fertility treatment when it may not be needed.
While some companies mention the test’s limitations if you read on, they are glossed over and contradicted by the calls to be proactive and messages of empowerment.
Breast density notification
Breast density is one of several independent risk factors for breast cancer. It’s also harder to see cancer on a mammogram image of breasts with high amounts of dense tissue than breasts with a greater proportion of fatty tissue.
While estimates vary, approximately 25–50% of women in the breast screening population have dense breasts.
Stemming from valid concerns about the increased risk of cancer, advocacy efforts have used feminist language around women’s right to know such as “women need to know the truth” and “women can handle the truth” to argue for widespread breast density notification.
However, this simplistic messaging overlooks that this is a complex issue and that more data is still needed on whether the benefits of notifying and providing additional screening or tests to women with dense breasts outweigh the harms.
Additional tests (ultrasound or MRI) are now being recommended for women with dense breasts as they have the ability to detect more cancer. Yet, there is no or little mention of the lack of robust evidence showing that it prevents breast cancer deaths. These extra tests also have out-of-pocket costs and high rates of false-positive results.
Large international advocacy groups are also sponsored by companies that will financially benefit from women being notified.
While stronger patient autonomy is vital, campaigning for breast density notification without stating the limitations or unclear evidence of benefit may go against the empowerment being sought.
Ensuring feminism isn’t hijacked
Increased awareness and advocacy in women’s health are key to overcoming sex inequalities in health care.
But we need to ensure the goals of feminist health advocacy aren’t undermined through commercially driven use of feminist language pushing care that isn’t based on evidence. This includes more transparency about the risks and uncertainties of health technologies, tests and treatments and greater scrutiny of conflicts of interests.
Health professionals and governments must also ensure that easily understood, balanced information based on high quality scientific evidence is available. This will enable women to make more informed decisions about their health.
Brooke Nickel, NHMRC Emerging Leader Research Fellow, University of Sydney and Tessa Copp, NHMRC Emerging Leader Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can you drink your fruit and vegetables? How does juice compare to the whole food?
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Do you struggle to eat your fruits and vegetables? You are not alone. Less than 5% of Australians eat the recommended serves of fresh produce each day (with 44% eating enough fruit but only 6% eating the recommended vegetables).
Adults should aim to eat at least five serves of vegetables (or roughly 375 grams) and two serves of fruit (about 300 grams) each day. Fruits and vegetables help keep us healthy because they have lots of nutrients (vitamins, minerals and fibre) and health-promoting bioactive compounds (substances not technically essential but which have health benefits) without having many calories.
So, if you are having trouble eating the rainbow, you might be wondering – is it OK to drink your fruits and vegetables instead in a juice or smoothie? Like everything in nutrition, the answer is all about context.
It might help overcome barriers
Common reasons for not eating enough fruits and vegetables are preferences, habits, perishability, cost, availability, time and poor cooking skills. Drinking your fruits and vegetables in juices or smoothies can help overcome some of these barriers.
Juicing or blending can help disguise tastes you don’t like, like bitterness in vegetables. And it can blitz imperfections such as bruises or soft spots. Preparation doesn’t take much skill or time, particularly if you just have to pour store-bought juice from the bottle. Treating for food safety and shipping time does change the make up of juices slightly, but unsweetened juices still remain significant sources of nutrients and beneficial bioactives.
Juicing can extend shelf life and reduce the cost of nutrients. In fact, when researchers looked at the density of nutrients relative to the costs of common foods, fruit juice was the top performer.
So, drinking my fruits and veggies counts as a serve, right?
How juice is positioned in healthy eating recommendations is a bit confusing. The Australian Dietary Guidelines include 100% fruit juice with fruit but vegetable juice isn’t mentioned. This is likely because vegetable juices weren’t as common in 2013 when the guidelines were last revised.
The guidelines also warn against having juice too often or in too high amounts. This appears to be based on the logic that juice is similar, but not quite as good as, whole fruit. Juice has lower levels of fibre compared to fruits, with fibre important for gut health, heart health and promoting feelings of fullness. Juice and smoothies also release the sugar from the fruit’s other structures, making them “free”. The World Health Organization recommends we limit free sugars for good health.
But fruit and vegetables are more than just the sum of their parts. When we take a “reductionist” approach to nutrition, foods and drinks are judged based on assumptions made about limited features such as sugar content or specific vitamins.
But these features might not have the impact we logically assume because of the complexity of foods and people. When humans eat varied and complex diets, we don’t necessarily need to be concerned that some foods are lower in fibre than others. Juice can retain the nutrients and bioactive compounds of fruit and vegetables and even add more because parts of the fruit we don’t normally eat, like the skin, can be included.
So, it is healthy then?
A recent umbrella review of meta-analyses (a type of research that combines data from multiple studies of multiple outcomes into one paper looked at the relationship between 100% juice and a range of health outcomes.
Most of the evidence showed juice had a neutral impact on health (meaning no impact) or a positive one. Pure 100% juice was linked to improved heart health and inflammatory markers and wasn’t clearly linked to weight gain, multiple cancer types or metabolic markers (such as blood sugar levels).
Some health risks linked to drinking juice were reported: death from heart disease, prostate cancer and diabetes risk. But the risks were all reported in observational studies, where researchers look at data from groups of people collected over time. These are not controlled and do not record consumption in the moment. So other drinks people think of as 100% fruit juice (such as sugar-sweetened juices or cordials) might accidentally be counted as 100% fruit juice. These types of studies are not good at showing the direct causes of illness or death.
What about my teeth?
The common belief juice damages teeth might not stack up. Studies that show juice damages teeth often lump 100% juice in with sweetened drinks. Or they use model systems like fake mouths that don’t match how people drinks juice in real life. Some use extreme scenarios like sipping on large volumes of drink frequently over long periods of time.
Juice is acidic and does contain sugars, but it is possible proper oral hygiene, including rinsing, cleaning and using straws can mitigate these risks.
Again, reducing juice to its acid level misses the rest of the story, including the nutrients and bioactives contained in juice that are beneficial to oral health.
So, what should I do?
Comparing whole fruit (a food) to juice (a drink) can be problematic. They serve different culinary purposes, so aren’t really interchangeable.
The Australian Guide to Healthy Eating recommends water as the preferred beverage but this assumes you are getting all your essential nutrients from eating.
Where juice fits in your diet depends on what you are eating and what other drinks it is replacing. Juice might replace water in the context of a “perfect” diet. Or juice might replace alcohol or sugary soft drinks and make the relative benefits look very different.
On balance
Whether you want to eat your fruits and vegetables or drink them comes down to what works for you, how it fits into the context of your diet and your life.
Smoothies and juices aren’t a silver bullet, and there is no evidence they work as a “cleanse” or detox. But, with society’s low levels of fruit and vegetable eating, having the option to access nutrients and bioactives in a cheap, easy and tasty way shouldn’t be discouraged either.
Emma Beckett, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation – School of Health Sciences, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To Set Anxiety Aside
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How To Set Anxiety Aside
We’ve talked previously about how to use the “release” method to stop your racing mind.
That’s a powerful technique, but sometimes we need to be calm enough to use it. So first…
Breathe
Obviously. But, don’t underestimate the immediate power of focusing on your breath, even just for a moment.
There are many popular breathing exercises, but here’s one of the simplest and most effective, “4–4 breathing”:
- Breathe in for a count of four
- Hold for a count four
- Breathe out for a count of four
- Hold for a count of four
- Repeat
Depending on your lung capacity and what you’re used to, it may be that you need to count more quickly or slowly to make it feel right. Experiment with what feels comfortable for you, but the general goal should breathing deeply and slowly.
Identify the thing that’s causing you anxiety
We’ve also talked previously about how to use the RAIN technique to manage difficult emotions, and that’s good for handling anxiety too.
Another powerful tool is journaling.
Read: How To Use Journaling to Challenge Anxious Thoughts
If you don’t want to use any of those (very effective!) methods, that’s fine too—journaling isn’t for everyone.
You can leverage some of the same benefits by simply voicing your worries, even to yourself:
There’s an old folk tradition of “worry dolls”; these are tiny little dolls so small they can be kept in a pocket-size drawstring purse. Last thing at night, the user whispers their worries to the dolls and puts them back in their bag, where they will work on the person’s problem overnight.
We’re a health and productivity newsletter, not a dealer of magic and spells, but you can see how it works, right? It gets the worries out of one’s head, and brings about a helpful placebo effect too.
Focus on what you can control
- Most of what you worry about will not happen.
- Some of what you worry about may happen.
- Worrying about it will not help.
In fact, in some cases it may bring about what you fear, by means of the nocebo effect (like the placebo effect, but bad). Additionally, worrying drains your body and makes you less able to deal with whatever life does throw at you.
So while “don’t worry; be happy” may seem a flippant attitude, sometimes it can be best. However, don’t forget the other important part, which is actually focusing on what you can control.
- You can’t control whether your car will need expensive maintenance…
- …but you can control whether you budget for it.
- You can’t control whether your social event will go well or ill…
- …but you can control how you carry yourself.
- You can’t control whether your loved one’s health will get better or worse…
- …but you can control how you’re there for them, and you can help them take what sensible precautions they may.
…and so forth.
Look after your body as well!
Your body and mind are deeply reliant on each other. In this case, just as anxiety can drain your body’s resources, keeping your body well-nourished, well-exercised, and well-rested and can help fortify you against anxiety. For example, when it comes to diet, exercise, and sleep:
- Read: Fruit and vegetable intake is inversely associated with perceived stress across the adult lifespan
- Read: Exercise and anxiety: physical activity appears to be protective against anxiety disorders in clinical and non-clinical populations
- Read: Sleep problems predict and are predicted by generalized anxiety/depression
Don’t know where to start? How about the scientifically well-researched, evidence-based, 7-minute workout?
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What causes food cravings? And what can we do about them?
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Many of us try to eat more fruits and vegetables and less ultra-processed food. But why is sticking to your goals so hard?
High-fat, sugar-rich and salty foods are simply so enjoyable to eat. And it’s not just you – we’ve evolved that way. These foods activate the brain’s reward system because in the past they were rare.
Now, they’re all around us. In wealthy modern societies we are bombarded by advertising which intentionally reminds us about the sight, smell and taste of calorie-dense foods. And in response to these powerful cues, our brains respond just as they’re designed to, triggering an intense urge to eat them.
Here’s how food cravings work and what you can do if you find yourself hunting for sweet or salty foods.
What causes cravings?
A food craving is an intense desire or urge to eat something, often focused on a particular food.
We are programmed to learn how good a food tastes and smells and where we can find it again, especially if it’s high in fat, sugar or salt.
Something that reminds us of enjoying a certain food, such as an eye-catching ad or delicious smell, can cause us to crave it.
The cue triggers a physical response, increasing saliva production and gastric activity. These responses are relatively automatic and difficult to control.
What else influences our choices?
While the effect of cues on our physical response is relatively automatic, what we do next is influenced by complex factors.
Whether or not you eat the food might depend on things like cost, whether it’s easily available, and if eating it would align with your health goals.But it’s usually hard to keep healthy eating in mind. This is because we tend to prioritise a more immediate reward, like the pleasure of eating, over one that’s delayed or abstract – including health goals that will make us feel good in the long term.
Stress can also make us eat more. When hungry, we choose larger portions, underestimate calories and find eating more rewarding.
Looking for something salty or sweet
So what if a cue prompts us to look for a certain food, but it’s not available?
Previous research suggested you would then look for anything that makes you feel good. So if you saw someone eating a doughnut but there were none around, you might eat chips or even drink alcohol.
But our new research has confirmed something you probably knew: it’s more specific than that.
If an ad for chips makes you look for food, it’s likely a slice of cake won’t cut it – you’ll be looking for something salty. Cues in our environment don’t just make us crave food generally, they prompt us to look for certain food “categories”, such as salty, sweet or creamy.
Food cues and mindless eating
Your eating history and genetics can also make it harder to suppress food cravings. But don’t beat yourself up – relying on willpower alone is hard for almost everyone.
Food cues are so powerful they can prompt us to seek out a certain food, even if we’re not overcome by a particularly strong urge to eat it. The effect is more intense if the food is easily available.
This helps explain why we can eat an entire large bag of chips that’s in front of us, even though our pleasure decreases as we eat. Sometimes we use finishing the packet as the signal to stop eating rather than hunger or desire.
Is there anything I can do to resist cravings?
We largely don’t have control over cues in our environment and the cravings they trigger. But there are some ways you can try and control the situations you make food choices in.
- Acknowledge your craving and think about a healthier way to satisfy it. For example, if you’re craving chips, could you have lightly-salted nuts instead? If you want something sweet, you could try fruit.
- Avoid shopping when you’re hungry, and make a list beforehand. Making the most of supermarket “click and collect” or delivery options can also help avoid ads and impulse buys in the aisle.
- At home, have fruit and vegetables easily available – and easy to see. Also have other nutrient dense, fibre-rich and unprocessed foods on hand such as nuts or plain yoghurt. If you can, remove high-fat, sugar-rich and salty foods from your environment.
- Make sure your goals for eating are SMART. This means they are specific, measurable, achievable, relevant and time-bound.
- Be kind to yourself. Don’t beat yourself up if you eat something that doesn’t meet your health goals. Just keep on trying.
Gabrielle Weidemann, Associate Professor in Psychological Science, Western Sydney University and Justin Mahlberg, Research Fellow, Pyschology, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What is PMDD?
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Premenstrual dysphoric disorder (PMDD) is a mood disorder that causes significant mental health changes and physical symptoms leading up to each menstrual period.
Unlike premenstrual syndrome (PMS), which affects approximately three out of four menstruating people, only 3 percent to 8 percent of menstruating people have PMDD. However, some researchers believe the condition is underdiagnosed, as it was only recently recognized as a medical diagnosis by the World Health Organization.
Read on to learn more about its symptoms, the difference between PMS and PMDD, treatment options, and more.
What are the symptoms of PMDD?
People with PMDD typically experience both mood changes and physical symptoms during each menstrual cycle’s luteal phase—the time between ovulation and menstruation. These symptoms typically last seven to 14 days and resolve when menstruation begins.
Mood symptoms may include:
- Irritability
- Anxiety and panic attacks
- Extreme or sudden mood shifts
- Difficulty concentrating
- Depression and suicidal ideation
Physical symptoms may include:
- Fatigue
- Insomnia
- Headaches
- Changes in appetite
- Body aches
- Bloating
- Abdominal cramps
- Breast swelling or tenderness
What is the difference between PMS and PMDD?
Both PMS and PMDD cause emotional and physical symptoms before menstruation. Unlike PMS, PMDD causes extreme mood changes that disrupt daily life and may lead to conflict with friends, family, partners, and coworkers. Additionally, symptoms may last longer than PMS symptoms.
In severe cases, PMDD may lead to depression or suicide. More than 70 percent of people with the condition have actively thought about suicide, and 34 percent have attempted it.
What is the history of PMDD?
PMDD wasn’t added to the Diagnostic and Statistical Manual of Mental Disorders until 2013. In 2019, the World Health Organization officially recognized it as a medical diagnosis.
References to PMDD in medical literature date back to the 1960s, but defining it as a mental health and medical condition initially faced pushback from women’s rights groups. These groups were concerned that recognizing the condition could perpetuate stereotypes about women’s mental health and capabilities before and during menstruation.
Today, many women-led organizations are supportive of PMDD being an official diagnosis, as this has helped those living with the condition access care.
What causes PMDD?
Researchers don’t know exactly what causes PMDD. Many speculate that people with the condition have an abnormal response to fluctuations in hormones and serotonin—a brain chemical impacting mood— that occur throughout the menstrual cycle. Symptoms fully resolve after menopause.
People who have a family history of premenstrual symptoms and mood disorders or have a personal history of traumatic life events may be at higher risk of PMDD.
How is PMDD diagnosed?
Health care providers of many types, including mental health providers, can diagnose PMDD. Providers typically ask patients about their premenstrual symptoms and the amount of stress those symptoms are causing. Some providers may ask patients to track their periods and symptoms for one month or longer to determine whether those symptoms are linked to their menstrual cycle.
Some patients may struggle to receive a PMDD diagnosis, as some providers may lack knowledge about the condition. If your provider is unfamiliar with the condition and unwilling to explore treatment options, find a provider who can offer adequate support. The International Association for Premenstrual Disorders offers a directory of providers who treat the condition.
How is PMDD treated?
There is no cure for PMDD, but health care providers can prescribe medication to help manage symptoms. Some medication options include:
- Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants that regulate serotonin in the brain and may improve mood when taken daily or during the luteal phase of each menstrual cycle.
- Hormonal birth control to prevent ovulation-related hormonal changes.
- Over-the-counter pain medication like Tylenol, which can ease headaches, breast tenderness, abdominal cramping, and other physical symptoms.
Providers may also encourage patients to make lifestyle changes to improve symptoms. Those lifestyle changes may include:
- Limiting caffeine intake
- Eating meals regularly to balance blood sugar
- Exercising regularly
- Practicing stress management using breathing exercises and meditation
- Having regular therapy sessions and attending peer support groups
For more information, talk to your health care provider.
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Being Mortal – by Dr. Atul Gawande
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Maybe you want to “live forever or die trying”, and that’s an understandable goal… But are you prepared for “or die trying” being the outcome?
This is not a cheerful book, if you’re anything like this reviewer, you will need a little towel or something to mop up the tears while you read. But it’s worth it.
Dying is one thing; fighting for life is even generally considered a noble endeavor. Suffering alone isn’t fun, losing independence can feel humiliating, and seeing someone who was always a tower of strength, now a frail shadow of their former self, reduced to begging for something that they’re “not allowed”, can be worse.
Do we want that for ourselves? For our loved ones? Can there be a happy medium between that, and the alternative to indeed “go gentle into that good night”?
Dr. Gawande, a surgeon well-acquainted with death and dying, thinks so. But it involves work on our part, and being prepared for hard decisions.
- What is most important to us, and what tradeoffs are we willing to make for it?
- What, even, is actually an option to us with the resources available?
- Can we make peace with a potentially bad lot? And… Should we?
- When is fighting important, and when is it self-destructive?
These (and others) are all difficult questions posed by Dr. Gawande, but critical ones.
We don’t usually quote other people’s reviews when reviewing books here, but let’s consider the following words from the end of a long review on Amazon:
❝If “dying as we lived” is some kind of standard for how we should go, then maybe alone and medicalized makes some sense right now after all.❞
Bottom line: we all deserve better than that. And if we don’t take the time to think about what’s most important, then time will take it from us. This very insightful book may not have all the answers, but it has the questions, and it can help a lot in exploring them and deciding what matters most to us in the end, really.
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You’re Not Forgetful: How To Remember Everything
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Elizabeth Filips, medical student busy learning a lot of information, explains how in today’s video:
Active processing
An important thing to keep in mind is that forgetting is an active process, not passive as once believed. It has its own neurotransmitters and pathways, and as such, to improve memory, it’s essential to understand and manage forgetting.
So, how does forgetting occur? Memories are stored with cues or tags, which help retrieve information. However, overloading cues with too much information can cause “transient forgetting”—that is to say, the information is still in there somewhere; you just don’t have the filing system required to retrieve the data. This is the kind of thing that you will try hard to remember at some point in the day when you need it, fail, and then wake up at 3am with an “Aha!” because your brain finally found what you were looking for. So, to avoid that, use unique and strong cues to help improve recall (mnemonics are good for this, as are conceptual anchors).
While memory does not appear to actually be finite, there is some practical truth in the “finite storage” model insofar as learning new information can overwrite previous knowledge, iff your brain mistakes it for an update rather than addition. So for that reason, it’s good to periodically go over old information—in psychology this is called rehearsal, which may conjure theatrical images, but it can be as simple as mentally repeating a phone number, a mnemonic, or visually remembering a route one used to take to go somewhere.
Self-perception affects memory performance. Negative beliefs about one’s memory can worsen performance (so don’t say “I have a bad memory”, even to yourself, and in contrast, find more positive affirmations to make about your memory), and mental health in general plays a significant role in memory. For example, if you have ever had an extended period of depression, then chances are good you have some huge gaps in your memory for that time in your life.
A lot of what we learned in school was wrong—especially what we learned about learning. Traditional (vertical) learning is harder to retain, whereas horizontal learning (connecting topics through shared characteristics) creates stronger, interconnected memories. In short, your memories should tell contextual stories, not be isolated points of data.
Embarking on a new course of study? Yes? (If not, then why not? Pick something!)
It may be difficult at first, but experts memorize things more quickly due to built-up intuition in their field. For example a chess master can glance at a chess board for about 5 seconds and memorize the position—but only if the position is one that could reasonably arise in a game; if the pieces are just placed at random, then their memorization ability plummets to that of the average person, because their expertise has been nullified.
What this means in practical terms: building a “skeleton” framework before learning can enhance memorization through logical connections. For this reason, if embarking on a serious course of study, getting a good initial overview when you start is critical, so that you have a context for the rest of what you learn to go into. For example, let’s say you want to learn a language; if you first quickly do a very basic bare-bones course, such as from Duolingo or similar, then even though you’ll have a very small vocabulary and a modest grasp of grammar and make many mistakes and have a lot of holes in your knowledge, you now have somewhere to “fit” every new word or idea you learn. Same goes for other fields of study; for example, a doctor can be told about a new drug and remember everything about it immediately, because they understand the systems it interacts with, understand how it does what it does, and can compare it mentally to similar drugs, and they thus have a “place” in that overall system for the drug information to reside. But for someone who knows nothing about medicine, it’s just a lot of big words with no meaning. So: framework first, details later.
For more on all this, enjoy:
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Want to learn more?
You might also like to read:
How To Boost Your Memory Immediately (Without Supplements)
Take care!
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