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.
Anastasia Vityukova/Unsplash
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.
Tyler Olsen/Shutterstock
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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Awakening Your Ikigai – by Dr. Ken Mogi
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It’s been well-established in supercentenarian studies that one of the key factors beyond diet or exercise or suchlike (important as those things definitely are), is having a purpose to one’s life.
Neuroscientist Dr. Ken Mogi explains in this very easy-to-read book, how we can bring ikigai into our lives.
From noticing the details of the small things in life, to reorienting one’s life around what’s most truly most important to us, Dr. Mogi gives us not just a “this is ikigai” exposé, but rather, a practical and readily applicable how-to guide.
Bottom line: if you’ve so far been putting off ikigai as “I’ll get to that”, the time to start is today.
Click here to check out Awakening Your Ikigai, and actually awaken yours!
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Carbonated Water: For Weight Loss, Satiety, Or Just Gas?
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There are two main mechanisms of action by which sparkling water is considered to help satiety and/or weight loss; they are:
- It “fills us up” such that we feel fuller sooner, and thus eat less, and thus (all other things being equal) perhaps lose weight
- The carbon dioxide is absorbed into the bloodstream, where (as a matter of chemistry) it improves glucose metabolism, thus lowering blood sugars and indirectly leading (potentially) to weight loss, but even if not, lowered blood sugars are good for most people most of the time, right?
However, there are just a few problems:
Full of gas?
Many people self-report enjoying sparkling water as a way to feel fuller while fasting (or even while eating). However, the plural of “anecdote” is not “data”, so, here be data… Ish:
❝In order to determine whether such satiating effects occur through oral carbonic stimulation alone, we conducted modified sham-feeding (SF) tests (carbonated water ingestion (CW), water ingestion (W), carbonated water sham-feeding (CW-SF), and water sham-feeding (W-SF)), employing an equivalent volume and standardized temperature of carbonated and plain water, in a randomized crossover design.
Thirteen young women began fasting at 10 p.m. on the previous night and were loaded with each sample (15ºC, 250 mL) at 9 a.m. on separate days. Electrogastrography (EGG) recordings were obtained from 20 min before to 45 min after the loading to determine the power and frequency of the gastric myoelectrical activity. Appetite was assessed using visual analog scales. After ingestion, significantly increased fullness and decreased hunger ratings were observed in the CW group. After the load, transiently but significantly increased fullness as well as decreased hunger ratings were observed in the CW-SF group. The powers of normogastria (2-4 cpm) and tachygastria (4-9 cpm) showed significant increases in the CW and W groups, but not in the CW-SF and W-SF groups. The peak frequency of normogastria tended to shift toward a higher band in the CW group, whereas it shifted toward a lower band in the CW-SF group, indicating a different EGG rhythm.
Our results suggest that CO2-induced oral stimulation is solely responsible for the feeling of satiety.❞
~ Dr. Maki Suzuki et al.
Now, that’s self-reported, and a sample size of 13, so it’s not the most airtight science ever, but it is at least science. Here’s the paper, by the way:
Oral Carbonation Attenuates Feeling of Hunger and Gastric Myoelectrical Activity in Young Women
Here’s another small study with 8 people, which found that still and sparkling water had the exact same effect:
Effect of carbonated water on gastric emptying and intragastric meal distribution
However, drinking water (still or sparkling) with a meal will not have anywhere near the same effect for satiety as consuming food that has a high water-content.
See also: Some Surprising Truths About Hunger And Satiety ← our main feature in which we examine the science of volumetrics, including a study that shows how water incorporated into a food (but not served with a food) decreases caloric intake.
As an aside, one difference that carbonation can make is to increase ghrelin levels—that’s the hunger hormone (the satiety hormone is leptin, by the way). This one’s a rat study, but it seems reasonable that the same will be true of humans:
…which is worth bearing in mind even if you yourself are not, in fact, a male rat.
The glucose guzzler?
This one has simply been the case of a study being misrepresented, for example here:
Fizzy water might aid weight loss by providing a small boost to glucose uptake and metabolism
The idea is that higher levels of carbon dioxide in the blood mean faster glucose metabolism, which is technically true. Now, often “technically true” is the best kind of true, but not here, because it’s simply not useful.
In short, we produce so much carbon dioxide as part of our normal respiratory processes, that any carbon dioxide we might consume in a carbonated water is barely a blip in the graph.
Oh, and that article we just linked? Even within the article, despite running with that headline, the actual scientists quoted are saying such things as:
❝While there is a hypothetical link between carbonated water and glucose metabolism, this has yet to be tested in well-designed human intervention studies❞
~ Professor Sumantra Ray
Note: the word “hypothetical” means “one level lower than theoretical”. This is very far from being a conclusion.
And the study itself? Wasn’t even about carbonated water, it was about kidney dialysis and how the carbon dioxide content can result in hypoglycemia:
The mechanism of hypoglycemia caused by hemodialysis
…which got referenced in this paper (not a study):
Can carbonated water support weight loss?
…and even that concluded:
❝CO2 in carbonated water may promote weight loss by enhancing glucose uptake and metabolism in red blood cells.
However, the amount is so small that it is difficult to expect weight loss effects solely from the CO2 in carbonated water.
Drinking carbonated water may also affect blood glucose measurements.❞
Note: the word “may”, when used by a scientist and in the absence of any stronger claims, means “we haven’t ruled out the possibility”.
What breaking news that is.
Stop the press! No, really, stop it!
So… What does work?
There are various ways of going about actually hacking hunger (and they stack; i.e. you can use multiple methods and get cumulative results), and we wrote about them here:
Enjoy!
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The Conquest of Happiness – by Bertrand Russell
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When we have all our physical needs taken care of, why are we often still not happy, and what can we do about that?
Mathematician, philosopher, and Nobel prizewinner Bertrand Russell has answers. And, unlike many of “the great philosophers”, his writing style is very clear and accessible.
His ideas are simple and practical, yet practised by few. Rather than taking a “be happy with whatever you have” approach, he does argue that we should strive to find more happiness in some areas and ways—and lays out guidelines for doing so.
Areas to expand, areas to pull back on, areas to walk a “virtuous mean”. Things to be optimistic about; things to not get our hopes up about.
Applying Russell’s model, there’s no more “should I…?” moments of wondering which way to jump.
Bottom line: if you’ve heard enough about “how to be happy” from wishy-washier sources, you might find the work of this famous logician refreshing.
Click here to check out The Conquest of Happiness, and see how much happier you might become!
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Waist Size Worries: Age-Appropriate Solutions
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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
❝My BMI is fine, but my waist is too big. What do I do about that? I am 5′ 5″ tall and 128 pounds and 72 years old.❞
It’s hard to say without knowing about your lifestyle (and hormones, for that matter)! But, extra weight around the middle in particular is often correlated with high levels of cortisol, so you might find this of benefit:
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What will aged care look like for the next generation? More of the same but higher out-of-pocket costs
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Aged care financing is a vexed problem for the Australian government. It is already underfunded for the quality the community expects, and costs will increase dramatically. There are also significant concerns about the complexity of the system.
In 2021–22 the federal government spent A$25 billion on aged services for around 1.2 million people aged 65 and over. Around 60% went to residential care (190,000 people) and one-third to home care (one million people).
The final report from the government’s Aged Care Taskforce, which has been reviewing funding options, estimates the number of people who will need services is likely to grow to more than two million over the next 20 years. Costs are therefore likely to more than double.
The taskforce has considered what aged care services are reasonable and necessary and made recommendations to the government about how they can be paid for. This includes getting aged care users to pay for more of their care.
But rather than recommending an alternative financing arrangement that will safeguard Australians’ aged care services into the future, the taskforce largely recommends tidying up existing arrangements and keeping the status quo.
No Medicare-style levy
The taskforce rejected the aged care royal commission’s recommendation to introduce a levy to meet aged care cost increases. A 1% levy, similar to the Medicare levy, could have raised around $8 billion a year.
The taskforce failed to consider the mix of taxation, personal contributions and social insurance which are commonly used to fund aged care systems internationally. The Japanese system, for example, is financed by long-term insurance paid by those aged 40 and over, plus general taxation and a small copayment.
Instead, the taskforce puts forward a simple, pragmatic argument that older people are becoming wealthier through superannuation, there is a cost of living crisis for younger people and therefore older people should be required to pay more of their aged care costs.
Separating care from other services
In deciding what older people should pay more for, the taskforce divided services into care, everyday living and accommodation.
The taskforce thought the most important services were clinical services (including nursing and allied health) and these should be the main responsibility of government funding. Personal care, including showering and dressing were seen as a middle tier that is likely to attract some co-payment, despite these services often being necessary to maintain independence.
The task force recommended the costs for everyday living (such as food and utilities) and accommodation expenses (such as rent) should increasingly be a personal responsibility.
Aged care users will pay more of their share for cooking and cleaning.
Lizelle Lotter/ShutterstockMaking the system fairer
The taskforce thought it was unfair people in residential care were making substantial contributions for their everyday living expenses (about 25%) and those receiving home care weren’t (about 5%). This is, in part, because home care has always had a muddled set of rules about user co-payments.
But the taskforce provided no analysis of accommodation costs (such as utilities and maintenance) people meet at home compared with residential care.
To address the inefficiencies of upfront daily fees for packages, the taskforce recommends means testing co-payments for home care packages and basing them on the actual level of service users receive for everyday support (for food, cleaning, and so on) and to a lesser extent for support to maintain independence.
It is unclear whether clinical and personal care costs and user contributions will be treated the same for residential and home care.
Making residential aged care sustainable
The taskforce was concerned residential care operators were losing $4 per resident day on “hotel” (accommodation services) and everyday living costs.
The taskforce recommends means tested user contributions for room services and everyday living costs be increased.
It also recommends that wealthier older people be given more choice by allowing them to pay more (per resident day) for better amenities. This would allow providers to fully meet the cost of these services.
Effectively, this means daily living charges for residents are too low and inflexible and that fees would go up, although the taskforce was clear that low-income residents should be protected.
Moving from buying to renting rooms
Currently older people who need residential care have a choice of making a refundable up-front payment for their room or to pay rent to offset the loans providers take out to build facilities. Providers raise capital to build aged care facilities through equity or loan financing.
However, the taskforce did not consider the overall efficiency of the private capital market for financing aged care or alternative solutions.
Instead, it recommended capital contributions be streamlined and simplified by phasing out up-front payments and focusing on rental contributions. This echoes the royal commission, which found rent to be a more efficient and less risky method of financing capital for aged care in private capital markets.
It’s likely that in a decade or so, once the new home care arrangements are in place, there will be proportionally fewer older people in residential aged care. Those who do go are likely to be more disabled and have greater care needs. And those with more money will pay more for their accommodation and everyday living arrangements. But they may have more choice too.
Although the federal government has ruled out an aged care levy and changes to assets test on the family home, it has yet to respond to the majority of the recommendations. But given the aged care minister chaired the taskforce, it’s likely to provide a good indication of current thinking.
Hal Swerissen, Emeritus Professor, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Super-Nutritious Shchi
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Today we have a recipe we’ve mentioned before, but now we have standalone recipe pages for recipes, so here we go. The dish of the day is shchi—which is Russian cabbage soup, which sounds terrible, and looks as bad as it sounds. But it tastes delicious, is an incredible comfort food, and is famous (in Russia, at least) for being something one can eat for many days in a row without getting sick of it.
It’s also got an amazing nutritional profile, with vitamins A, B, C, D, as well as lots of calcium, magnesium, and iron (amongst other minerals), and a healthy blend of carbohydrates, proteins, and fats, plus an array of anti-inflammatory phytochemicals, and of course, water.
You will need
- 1 large white cabbage, shredded
- 1 cup red lentils
- ½ lb tomatoes, cut into eighths (as in: halve them, halve the halves, and halve the quarters)
- ½ lb mushrooms sliced (or halved, if they are baby button mushrooms)
- 1 large onion, chopped finely
- 1 tbsp rosemary, chopped finely
- 1 tbsp thyme, chopped finely
- 1 tbsp black pepper, coarse ground
- 1 tsp cumin, ground
- 1 tsp yeast extract
- 1 tsp MSG, or 2 tsp low-sodium salt
- A little parsley for garnishing
- A little fat for cooking; this one’s a tricky and personal decision. Butter is traditional, but would make this recipe impossible to cook without going over the recommended limit for saturated fat. Avocado oil is healthy, relatively neutral in taste, and has a high smoke point for caramelizing the onions. Extra virgin olive oil is also a healthy choice, but not as neutral in flavor and does have a lower smoke point. Coconut oil has far too strong a taste and a low smoke point. Seed oils are very heart-unhealthy. All in all, avocado oil is a respectable choice from all angles except tradition.
Note: with regard to the seasonings, the above is a basic starting guide; feel free to add more per your preference—however, we do not recommend adding more cumin (it’ll overpower it) or more salt (there’s enough sodium in here already).
Method
(we suggest you read everything at least once before doing anything)
1) Cook the lentils until soft (a rice cooker is great for this, but a saucepan is fine); be generous with the water; we are making a soup, after all. Set them aside without draining.
2) Sauté the cabbage, and put it in a big stock pot or similar large pan (not yet on the heat)
3) Fry the mushrooms, and add them to the big pot (still not yet on the heat)
4) Use a stick blender to blend the lentils in the water you cooked them in, and then add to the big pot too.
5) Turn the heat on low, and if necessary, add more water to make it into a rich soup
6) Add the seasonings (rosemary, thyme, cumin, black pepper, yeast extract, MSG-or-salt) and stir well. Keep the temperature on low; you can just let it simmer now because the next step is going to take a while:
7) Caramelize the onion (keep an eye on the big pot, stirring occasionally) and set it aside
8) Fry the tomatoes quickly (we want them cooked, but just barely) and add them to the big pot
9) Serve! The caramelized onion is a garnish, so put a little on top of each bowl of shchi. Add a little parsley too.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- The Magic Of Mushrooms: “The Longevity Vitamin” (That’s Not A Vitamin)
- Easily Digestible Vegetarian Protein Sources
- The Bare-Bones Truth About Osteoporosis
- Some Surprising Truths About Hunger And Satiety
Take care!
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