From Strength to Strength – by Dr. Arthur Brooks

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For most professions, there are ways in which performance can be measured, and the average professional peak varies by profession, but averages are usually somewhere in the 30–45 range, with a pressure to peak between 25–35.

With a peak by age 45 or perhaps 50 at the latest (aside from some statistical outliers, of course), what then to expect at age 50+? Not long after that, there’s a reason for mandatory retirement ages in some professions.

Dr. Brooks examines the case for accepting that rather than fighting it, and/but making our weaknesses into our strengths as we go. If our fluid intelligence slows, our accumulated crystal intelligence (some might call it “wisdom“) can make up for it, for example.

But he also champions the idea of looking outside of ourselves; of the importance of growing and fostering connections; giving to those around us and receiving support in turn; not transactionally, but just as a matter of mutualism of the kind found in many other species besides our own. Indeed, Dr. Brooks gives the example of a grove of aspen trees (hence the cover art of this book) that do exactly that.

The style is very accessible in terms of language but with frequent scientific references, so very much a “best of both worlds” in terms of readability and information-density.

Bottom line: if ever you’ve wondered at what age you might outlive your usefulness, this book will do as the subtitle suggests, and help you carve out your new place.

Click here to check out From Strength To Strength, and find yours!

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    TV chef De Laurentis brings a touch of celebrity lifestyle to her cookbook “Eat Better, Feel Better” with clear recipes and a focus on cutting out rather than including.

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  • Reasons to Stay Alive – by Matt Haig

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    We’ve previously reviewed Matt Haig’s (excellent) The Comfort Book, and now it’s time for his more famous book: Reasons To Stay Alive. So, what’s this one, beyond the obvious?

    It narrates the experience of anxiety, depression, and suicidality, and discovering how to find beauty and joy in the world despite it all. It’s not that the author found a magical cure—he still experiences depression and anxiety (cannot speak for suicidality) but he knows now how to manage it, and live his life.

    You may be wondering: is this book instructional; is it reproducible, or is it just an autobiography? It’s centered around his own experience and learnings, but it gives a huge sense of not feeling alone, of having hope, and it gives a template for making sense of one’s own experience, even if every person will of course have some points of differences, the commonalities are nonetheless of immense value.

    The writing style is similar to The Comfort Book; it’s lots of small chapters, and all very easy-reading. Well, the subject matter is sometimes rather heavy, but the language is easy-reading! In other words, just the thing for when one is feeling easily overwhelmed, or not feeling up to reading a lot.

    Bottom line: whether or not you suffer with anxiety and/or depression, whether or not you sometimes feel suicidal, the contents of this book are important, valuable insights for everyone.

    Click here to check out Reasons To Stay Alive, and see through the highs and lows of life.

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  • Vision for Life, Revised Edition – by Dr. Meir Schneider

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The “ten steps” would be better called “ten exercises”, as they’re ten things that one can (and should) continue to do on an ongoing basis, rather than steps to progress through and then forget about.

    We can’t claim to have tested the ten exercises for improvement (this reviewer has excellent eyesight and merely hopes to maintain such as she gets older) but the rationale is compelling, and the public testimonials abundant.

    Dr. Schneider also talks about improving and correcting errors of refraction—in other words, doing the job of any corrective lenses you may currently be using. While he doesn’t claim miracles, it turns out there is a lot that can be done for common issues such as near-sightedness and far-sightedness, amongst others.

    There’s a large section on managing more chronic pathological eye conditions than this reviewer previously knew existed; in some cases it’s a matter of making sure things don’t get worse, but in many others, there’s a recurring of theme of “and here’s an exercise for correcting that”.

    The writing style is a little more “narrative prose” than we’d have liked, but the quality of the content more than makes up for any style preference issues.

    Bottom line: the human body is a highly adaptive organism, and sometimes it just needs a little help to correct itself. This book can help with that.

    Click here to check out Vision for Life, and take good care of yours!

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  • A New $16,000 Postpartum Depression Drug Is Here. How Will Insurers Handle It?

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    A much-awaited treatment for postpartum depression, zuranolone, hit the market in December, promising an accessible and fast-acting medication for a debilitating illness. But most private health insurers have yet to publish criteria for when they will cover it, according to a new analysis of insurance policies.

    The lack of guidance could limit use of the drug, which is both novel — it targets hormone function to relieve symptoms instead of the brain’s serotonin system, as typical antidepressants do — and expensive, at $15,900 for the 14-day pill regimen.

    Lawyers, advocates, and regulators are watching closely to see how insurance companies will shape policies for zuranolone because of how some handled its predecessor, an intravenous form of the same drug called brexanolone, which came on the market in 2019. Many insurers required patients to try other, cheaper medications first — known as the fail-first approach — before they could be approved for brexanolone, which was shown in early trials reviewed by the FDA to provide relief within days. Typical antidepressants take four to six weeks to take effect.

    “We’ll have to see if insurers cover this drug and what fail-first requirements they put in” for zuranolone, said Meiram Bendat, a licensed psychotherapist and an attorney who represents patients.

    Most health plans have yet to issue any guidelines for zuranolone, and maternal health advocates worry that the few that have are taking a restrictive approach. Some policies require that patients first try and fail a standard antidepressant before the insurer will pay for zuranolone.

    In other cases, guidelines require psychiatrists to prescribe it, rather than obstetricians, potentially delaying treatment since OB-GYN practitioners are usually the first medical providers to see signs of postpartum depression.

    Advocates are most worried about the lack of coverage guidance.

    “If you don’t have a published policy, there is going to be more variation in decision-making that isn’t fair and is less efficient. Transparency is really important,” said Joy Burkhard, executive director of the nonprofit Policy Center for Maternal Mental Health, which commissioned the study.

    With brexanolone, which was priced at $34,000 for the three-day infusion, California’s largest insurer, Kaiser Permanente, had such rigorous criteria for prescribing it that experts said the policy amounted to a blanket denial for all patients, according to an NPR investigation in 2021.

    KP’s written guidelines required patients to try and fail four medications and electroconvulsive therapy before they would be eligible for brexanolone. Because the drug was approved only for up to six months postpartum, and trials of typical antidepressants take four to six weeks each, the clock would run out before a patient had time to try brexanolone.

    An analysis by NPR of a dozen other health plans at the time showed Kaiser Permanente’s policy on brexanolone to be an outlier. Some did require that patients fail one or two other drugs first, but KP was the only one that recommended four.

    Miriam McDonald, who developed severe postpartum depression and suicidal ideation after giving birth in late 2019, battled Kaiser Permanente for more than a year to find effective treatment. Her doctors put her on a merry-go-round of medications that didn’t work and often carried unbearable side effects, she said. Her doctors refused to prescribe brexanolone, the only FDA-approved medication specifically for postpartum depression at the time.

    “No woman should suffer like I did after having a child,” McDonald said. “The policy was completely unfair. I was in purgatory.”

    One month after NPR published its investigation, KP overhauled its criteria to recommend that women try just one medication before becoming eligible for brexanolone.

    Then, in March 2023, after the federal Department of Labor launched an investigation into the insurer — citing NPR’s reporting — the insurer revised its brexanolone guidelines again, removing all fail-first recommendations, according to internal documents recently obtained by NPR. Patients need only decline a trial of another medication.

    “Since brexanolone was first approved for use, more experience and research have added to information about its efficacy and safety,” the insurer said in a statement. “Kaiser Permanente is committed to ensuring brexanolone is available when physicians and patients determine it is an appropriate treatment.”

    “Kaiser basically went from having the most restrictive policy to the most robust,” said Burkhard of the Policy Center for Maternal Mental Health. “It’s now a gold standard for the rest of the industry.”

    McDonald is hopeful that her willingness to speak out and the subsequent regulatory actions and policy changes for brexanolone will lead Kaiser Permanente and other health plans to set patient-friendly policies for zuranolone.

    “This will prevent other women from having to go through a year of depression to find something that works,” she said.

    Clinicians were excited when the FDA approved zuranolone last August, believing the pill form, taken once a day at home over two weeks, will be more accessible to women compared with the three-day hospital stay for the IV infusion. Many perinatal psychiatrists told NPR it is imperative to treat postpartum depression as quickly as possible to avoid negative effects, including cognitive and social problems in the baby, anxiety or depression in the father or partner, or the death of the mother to suicide, which accounts for up to 20% of maternal deaths.

    So far, only one of the country’s six largest private insurers, Centene, has set a policy for zuranolone. It is unclear what criteria KP will set for the new pill. California’s Medicaid program, known as Medi-Cal, has not yet established coverage criteria.

    Insurers’ policies for zuranolone will be written at a time when the regulatory environment around mental health treatment is shifting. The U.S. Department of Labor is cracking down on violations of the Mental Health Parity and Addiction Equity Act of 2008, which requires insurers to cover psychiatric treatments the same as physical treatments.

    Insurers must now comply with stricter reporting and auditing requirements intended to increase patient access to mental health care, which advocates hope will compel health plans to be more careful about the policies they write in the first place.

    In California, insurers must also comply with an even broader state mental health parity law from 2021, which requires them to use clinically based, expert-recognized criteria and guidelines in making medical decisions. The law was designed to limit arbitrary or cost-driven denials for mental health treatments and has been hailed as a model for the rest of the country. Much-anticipated regulations for the law are expected to be released this spring and could offer further guidance for insurers in California setting policies for zuranolone.

    In the meantime, Burkhard said, patients suffering from postpartum depression should not hold back from asking their doctors about zuranolone. Insurers can still grant access to the drug on a case-by-case basis before they formalize their coverage criteria.

    “Providers shouldn’t be deterred from prescribing zuranolone,” Burkhard said. 

    This article is from a partnership that includes KQEDNPR and KFF Health News.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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Related Posts

  • Fitness Walking and Bodyweight Exercises – by Frank S. Ring
  • Healthy Kids, Happy Kids – by Dr. Elisa Song

    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.

    If you have young children or perhaps grandchildren, you probably care deeply about those children and their wellbeing, but there can often be a lot more guesswork than would be ideal, when it comes to ensuring they be and remain healthy.

    Nevertheless, a lot of common treatments for children are based (whether parents know it or not—and often they dont) on what is most convenient for the parent, not necessarily what is best for the child. Dr. Song looks to correct that.

    Rather than dosing kids with acetaminophen or even antibiotics, assuming eczema can be best fixed with a topical cream (treating the symptom rather than the cause, much?), and that some things like asthma “just are”, and “that’s unfortunate”, Dr. Song takes us on a tour of pediatric health, centered around the gut.

    Why the gut? Well, it’s pretty central to us as adults, and it’s the same for kids, except one difference: their gut microbiome is changing even more quickly than ours (along with the rest of their body), and as such, is even more susceptible to little nudges for better or for worse, having a big impact in either direction. So, might as well make it a good one!

    After an explanatory overview, most of the book is given over to recognizing and correcting what things can go wrong, including the top 25 acute childhood conditions, and the most critical chronic ones, and how to keep things on-track as a team (the child is part of the team! An important part!).

    The style of the book is very direct and instructional; easy to understand throughout. It’s a lot like being in a room with a very competent pediatrician who knows her stuff and explains it well, thus neither patronizing nor mystifying.

    Bottom line: if there are kids in your life, be they yours or your grandkids or someone else, this is a fine book for giving them the best foundational health.

    Click here to check out Healthy Kids, Happy Kids, and take care of yours!

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  • Tasty Tofu Scramble

    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.

    If you’re trying to eat more plant-based, this is a great way to enjoy a culinary experience that hits the same notes as scrambled egg, with many similar nutritional benefits too, and some of its own!

    You will need

    • 1 cup (10oz) silken tofu
    • ¼ bulb garlic, crushed
    • 1 tbsp nutritional yeast
    • 2 tsp chia seeds
    • 2 tsp dried thyme, or 1 tsp fresh thyme, stripped (i.e. pulled off the stalks)
    • 2 tsp turmeric
    • 2 tsp black pepper, coarse ground
    • 1 tsp red chili flakes
    • ½ tsp MSG, or 1 tsp low-sodium salt
    • Extra virgin olive oil, for frying

    Method

    (we suggest you read everything at least once before doing anything)

    1) Heat a skillet with olive oil in it; if you want a low-calorie option, you can use quite little oil here; the tofu is a lot more forgiving than egg in this regard and is almost impossible to burn unless you actively try. If you don’t want a low-calorie option, feel free to be generous with the oil if you prefer; it’ll go into the tofu and make it fattier, much like egg.

    2) Add the tofu. You can just drop it (carefully) straight in; you don’t need to press it or anything.

    3) Scramble it with a spatula, just the same as you would if it were egg.

    4) Add the rest of the ingredients, mixing them in as you continue to scramble it, until it reaches the desired consistency.

    5) Serve! Serving it on wholegrain toast is a great option—but this dish can also be enjoyed any other way you might use scrambled eggs (including for making egg-fried tofu-fried rice; just stir it into our Tasty Versatile Rice recipe!)

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • With Only Gloves To Protect Them, Farmworkers Say They Tend Sick Cows Amid Bird Flu

    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.

    GREELEY, Colo. — In early August, farmworkers gathered under a pavilion at a park here for a picnic to celebrate Farmworker Appreciation Day. One sign that this year was different from the others was the menu: Beef fajitas, tortillas, pico de gallo, chips, beans — but no chicken.

    Farms in Colorado had culled millions of chickens in recent months to stem the transmission of bird flu. Organizers filled out the spread with hot dogs.

    No matter the menu, some dairy workers at the event said they don’t exactly feel appreciated. They said they haven’t received any personal protective equipment beyond gloves to guard against the virus, even as they or colleagues have come down with conjunctivitis and flu-like symptoms that they fear to be bird flu.

    “They should give us something more,” one dairy worker from Larimer County said in Spanish. He spoke on the condition of anonymity out of fear he’d lose his job for speaking out. “What if something happens to us? They act as if nothing is wrong.”

    Agricultural health and safety experts have been trying to get the word out about how to protect against bird flu, including through bilingual videos on TikTok showing the proper way to gear up with respirators, eye protection, gloves, and coveralls. And Colorado’s health and agriculture departments have offered a free month’s supply of protective equipment to any producer who requests it.

    But so far, many farms aren’t taking them up on it: According to numbers provided by the state health department in late August, fewer than 13% of the state’s dairies had requested and received such PPE.

    The virus is known to infect mammals — from skunks, bears, and cows to people and house pets. It began showing up in dairy cattle in recent months, and Colorado has been in the thick of it. Ten of the 13 confirmed human cases in the U.S. this year have occurred in Colorado, where it continues to circulate among dairy cows. It isn’t a risk in cooked meat or pasteurized milk but is risky for those who come into contact with infected animals or raw milk.

    Weld County, where the farmworker event was held, is one of the nation’s top milk producers, supplying enough milk each month this year to fill about 45 Olympic-size swimming pools, according to U.S. Department of Agriculture data. Neighboring counties are notable producers, too.

    Concerns are growing about undiagnosed illness among farmworkers because of a lack of testing and safety precautions. One reason for concern: Bird flu and seasonal flu are capable of gene trading, so if they ended up in the same body at the same time, bird flu might end up with genes that boost its contagiousness. The virus doesn’t appear to be spreading easily between people yet. That could change, and if people aren’t being tested then health officials may be slow to notice.

    Strains of seasonal flu already kill some 47,000 people in the U.S. a year. Public health officials fear the havoc a new form of the flu could wreak if it spreads among people.

    The Centers for Disease Control and Prevention recommends that dairy workers don a respirator and goggles or a face shield, among other protections, whether they are working with sick animals or not.

    A recent study found that not all infected cows show symptoms, so workers could be interacting with contagious animals without realizing it. Even when it is known that animals are infected, farmworkers often still have to get in close contact with them, sometimes under grueling conditions, such as during a recent heat wave when Colorado poultry workers collected hundreds of chickens by hand for culling because of the outbreak. At least six of the workers became infected with bird flu.

    One dairy worker in Weld County, who spoke on the condition of anonymity for fear of losing his job, said his employer has not offered any protective equipment beyond gloves, even though he works with sick cows and raw milk.

    His bosses asked the workers to separate sick cows from the others after some cows produced less milk, lost weight, and showed signs of weakness, he said. But the employer didn’t say anything about the bird flu, he said, or suggest they take any precautions for their own safety.

    He said he bought protective goggles for himself at Walmart when his eyes became itchy and red earlier this summer. He recalled experiencing dizziness, headaches, and low appetite around the same time. But he self-medicated and pushed through, without missing work or going to a doctor.

    “We need to protect ourselves because you never know,” he said in Spanish. “I tell my wife and son that the cows are sick, and she tells me to leave, but it will be the same wherever I go.”

    He said he’d heard that his employers were unsympathetic when a colleague approached them about feeling ill. He’d even seen someone affiliated with management remove a flyer about how people can protect themselves from the bird flu and throw it in a bin.

    The dairy worker in neighboring Larimer County said he, too, has had just gloves as protection, even when he has worked with sick animals — close enough for saliva to wipe off on him. He started working with them when a colleague missed work because of his flu-like symptoms: fever, headache, and red eyes.

    “I only wear latex gloves,” he said. “And I see that those who work with the cows that are sick also only wear gloves.”

    He said he doesn’t have time to wash his hands at work but puts on hand sanitizer before going home and takes a shower once he arrives. He has not had symptoms of infection.

    Such accounts from dairy workers echo those from farmworkers in Texas, as reported by KFF Health News in July.

    “Employers who are being proactive and providing PPE seem to be in the minority in most states,” said Bethany Boggess Alcauter with the National Center for Farmworker Health, a not-for-profit organization based in Texas that advocates for improving the health of farmworkers and their families. “Farmworkers are getting very little information.”

    But Zach Riley, CEO of the Colorado Livestock Association, said he thinks such scenarios are the exception, not the rule.

    “You would be hard-pressed to find a dairy operation that isn’t providing that PPE,” he said. Riley said dairies typically have a stockpile of PPE ready to go for situations like this and that, if they don’t, it’s easily accessed through the state. “All you have to do is ask.”

    Producers are highly motivated to keep infections down, he said, because “milk is their life source.” He said he has heard from some producers that “their family members who work on the farm are doing 18-to 20-hour days just to try to stay ahead of it, so that they’re the first line between everything, to protect their employees.”

    Colorado’s health department is advertising a hotline that ill dairy workers can call for help getting a flu test and medicine.

    Project Protect Food Systems Workers, an organization that emerged early in the covid-19 pandemic to promote farmworker health across Colorado, is distributing PPE it received from the state so promotoras — health workers who are part of the community they serve — can distribute masks and other protections directly to workers if employers aren’t giving them out.

    Promotora Tomasa Rodriguez said workers “see it as another virus, another covid, but it is because they don’t have enough information.”

    She has been passing out flyers about symptoms and protective measures, but she can’t access many dairies. “And in some instances,” she said, “a lot of these workers don’t know how to read, so the flyers are not reaching them, and then the employers are not doing any kind of talks or trainings.”

    The CDC’s Nirav Shah said during an Aug. 13 call with journalists that awareness about bird flu among dairy workers isn’t as high as officials would like it to be, despite months of campaigns on social media and the radio.

    “There’s a road ahead of us that we still need to go down to get awareness on par with, say, what it might be in the poultry world,” he said. “We’re using every single messenger that we can.”

    KFF Health News correspondents Vanessa G. Sánchez and Amy Maxmen contributed to this report.

    Healthbeat is a nonprofit newsroom covering public health published by Civic News Company and KFF Health News. Sign up for its newsletters here.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

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