Syphilis Is Killing Babies. The U.S. Government Is Failing to Stop the Disease From Spreading.

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.

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

Karmin Strohfus, the lead nurse at a South Dakota jail, punched numbers into a phone like lives depended on it. She had in her care a pregnant woman with syphilis, a highly contagious, potentially fatal infection that can pass into the womb. A treatment could cure the woman and protect her fetus, but she couldn’t find it in stock at any pharmacy she called — not in Hughes County, not even anywhere within an hour’s drive.

Most people held at the jail where Strohfus works are released within a few days. “What happens if she gets out before I’m able to treat her?” she worried. Exasperated, Strohfus reached out to the state health department, which came through with one dose. The treatment required three. Officials told Strohfus to contact the federal Centers for Disease Control and Prevention for help, she said. The risks of harm to a developing baby from syphilis are so high that experts urge not to delay treatment, even by a day.

Nearly three weeks passed from when Strohfus started calling pharmacies to when she had the full treatment in hand, she said, and it barely arrived in time. The woman was released just days after she got her last shot.

Last June, Pfizer, the lone U.S. manufacturer of the injections, notified the Food and Drug Administration of an “impending stock out” that it anticipated would last a year. The company blamed “an increase in syphilis infection rates as well as competitive shortages.”

Across the country, physicians, clinic staff and public health experts say that the shortage is preventing them from reining in a surge of syphilis and that the federal government is downplaying the crisis. State and local public health authorities, which by law are responsible for controlling the spread of infectious diseases, report delays getting medicine to pregnant people with syphilis. This emergency was predictable: There have been shortages of this drug in eight of the last 20 years.

Yet federal health authorities have not prevented the drug shortages in the past and aren’t doing much to prevent them in the future.

Syphilis, which is typically spread during sex, can be devastating if it goes untreated in pregnancy: About 40% of babies born to women with untreated syphilis can be stillborn or die as newborns, according to the CDC. Infants that survive can suffer from deformed bones, excruciating pain or brain damage, and some struggle to hear, see or breathe. Since this is entirely preventable, a baby born with syphilis is a shameful sign of a failing public health system.

In 2022, the most recent year for which the CDC has data available, more than 3,700 babies were infected with syphilis, including nearly 300 who were stillborn or died as infants. More than 50% of these cases occurred because, even though the pregnant parent was diagnosed with syphilis, they were never properly treated.

That year, there were 200,000 cases identified in the U.S., a 79% increase from five years before. Infection rates among pregnant people and babies increased by more than 250% in that time; South Dakota, where Strohfus works, had the highest rates — including a more than 400% increase among pregnant women. Statewide, the rate of babies born with the disease, a condition known as congenital syphilis, jumped more than 40-fold in just five years.

And that was before the current shortage of shots.

In Mississippi, the state with the second highest rate of syphilis in pregnant women, Dr. Caroline Weinberg started having trouble this summer finding treatments for her clinic’s patients, most of whom are uninsured, live in poverty or lack transportation. She began spending hours each month scouring medicine suppliers’ websites for available doses of the shots, a form of penicillin sold under the brand name Bicillin L-A.

“The way people do it for Taylor Swift, that’s how I’ve been with the Bicillin shortage,” Weinberg said. “Desperately checking the websites to see what I can snag.”

The shortage is driving up infection rates even further.

In a November survey by the National Coalition of STD Directors, 68% of health departments that responded said the drug shortage will cause syphilis rates in their area to increase, further crushing the nation’s most disadvantaged populations.

“This is the most basic medicine,” said Meghan O’Connell, chief public health officer for the Great Plains Tribal Leaders’ Health Board, which represents 18 tribal communities in South Dakota and three other states. “We allow ourselves to continue to not have enough, and it impacts so many people.”

ProPublica examined what the federal government has done to manage the crisis and the ways in which experts say it has fallen short.

The government could pressure Pfizer to be more transparent.

Twenty years ago, there were at least three manufacturers of the syphilis shot. Then Pfizer, one of the manufacturers, purchased the other two companies and became the lone U.S. supplier.

Pfizer’s supply has fallen short since then. In 2016, the company announced a shortage due to a manufacturing issue; it lasted two years. Even during times when Pfizer had not notified the FDA of an official shortage, clinics across the country told ProPublica, the shots were often hard to get.

Several health officials said they would like to see the government use its power as the largest purchaser of the drug to put pressure on Pfizer to produce adequate supplies and to be more transparent about how much of the drug they have on hand, when it will be widely available and how stable the supply will be going forward.

In response to questions, Pfizer said there are two reasons its supply is falling short. One, the company said, was a surge in use of the pediatric form of the drug after a shortage of a different antibiotic last winter. Pfizer also blamed a 70% increase in demand for the adult shots since last February, which it described as unexpected.

Public health experts say the increase in cases and subsequent rise in demand was easy to see coming. Officials have been raising the alarm about skyrocketing syphilis cases for years. “If Pfizer was truly caught completely off guard, it raises significant questions about the competency of the company to forecast obvious infectious disease trends,” a coalition of organizations wrote to the White House Drug Shortage Task Force in September.

Pfizer said it is consistently communicating with the CDC and FDA about its supply and that it has been transparent with public health groups and policymakers.

The FDA has a group dedicated to addressing drug shortages. But Valerie Jensen, associate director of that staff, said the FDA can’t force manufacturers to make more of a drug. “It is up to manufacturers to decide how to respond to that increased demand.” she said. “What we’re here to do is help with those plans.”

Pfizer said it had a target of increasing production by about 20% in 2023 but faced delays toward the end of the year. The company did not explain the reason for those delays.

The company said it has invested $38 million in the last five years in the Michigan facility where it makes the shots and that it is increasing production capacity. It also said it is adding evening shifts at the facility and actively recruiting and training new workers. Pfizer said it also reduced manufacturing time from 110 to 50 days. By the end of June, the company expects the supply to recover, which it described as having eight weeks of inventory based on its forecast demands with no disruptions in sight.

The government could manufacture the drug itself.

Having only one supplier for a drug, especially one of public health importance, makes the country vulnerable to shortages. With just one manufacturer, any disruption — contamination at a plant, a shortage of raw materials, a severe weather event or a flawed prediction of demand — can put lives at risk. What’s ultimately needed, public health experts say, is another manufacturer.

Congressional Democrats recently introduced a bill that would authorize the U.S. Department of Health and Human Services to manufacture generic drugs in exactly this scenario, when there are few manufacturers and regular shortages. Called the Affordable Drug Manufacturing Act, it would also establish an office of drug manufacturing.

This same bill was introduced in 2018, but it didn’t have bipartisan support and was never taken up for a vote. Sen. Elizabeth Warren, the Massachusetts Democrat who introduced the bill in the Senate, said she’s hopeful this time will be different. Lawmakers from both parties understand the risks created by drug shortages, and COVID-19 helped everyone understand the role the government can play to boost manufacturing.

Still, it’s unlikely to be passed with the current gridlock in Congress.

The government could reserve syphilis drugs for infected patients.

Responding to the shortage of shots to treat the disease, the CDC in July asked health care providers nationwide to preserve the scarce remaining doses for people who are pregnant. The shots are considered the gold standard treatment for anyone with syphilis, faster and with fewer side effects than an alternative pill regimen. And for people who are pregnant, the pills are not an option; the shots are the only safe treatment.

Despite that call, the military is giving shots to new recruits who don’t have syphilis, to prevent outbreaks of severe bacterial respiratory infections. The Army has long administered this treatment at boot camps held at Fort Leonard Wood, Fort Moore and Fort Sill. The Army has been unable to obtain the shots several times in the past few years, according to the U.S. Army Center for Initial Military Training. But the Defense Health Agency’s pharmacy operations center has been working with Pfizer to ensure military sites can get them, a spokesperson for the Defense Health Agency said.

“Until we think about public health the way we think about our military, we’re not going to see a difference,” said Dr. John Vanchiere, chief of pediatric infectious diseases at Louisiana State University Health Shreveport.

Some public health officials, including Alaska’s chief medical officer, Dr. Anne Zink, questioned whether the military should be using scarce shots for prevention.

“We should ask if that’s the best use,” she said.

Using antibiotics to prevent streptococcal outbreaks is a well-established, evidence-based public health practice that’s also used by other branches of the armed services, said Lt. Col. Randy Ready, a public affairs officer with the Army’s Initial Military Training center. “The Army continues to work with the CDC and the entire medical community in regards to public health while also taking into account the unique missions and training environments our Soldiers face,” including basic training, Ready said in a written statement.

The government isn’t stockpiling syphilis drugs.

In rare instances, the federal government has created stockpiles of drugs considered key to public health. In 2018, confronting shortages of various drugs to treat tuberculosis, the CDC created a small stockpile of them. And the federal Administration for Strategic Preparedness and Response keeps a national stockpile of supplies necessary for public health emergencies, including vaccines, medical supplies and antidotes needed in case of a chemical warfare attack.

In November, the Biden administration announced it was creating a new syphilis task force. When asked why the federal government doesn’t stockpile syphilis treatments, Adm. Rachel Levine, the HHS official who leads the task force, said officials don’t routinely stockpile drugs, because they have expiration dates.

In a written statement, an HHS spokesperson said that Bicillin has a shelf life of two years and that the Strategic National Stockpile “does not deploy products that are commercially available.” In general, the spokesperson wrote, stockpiles are most effective before a national shortage begins and can’t overcome the problems of limited suppliers or fragile supply chains. “There is also a risk that stockpiles can exacerbate shortages, particularly when supply is already low, by removing drugs from circulation that would have otherwise been available,” the spokesperson wrote.

Stephanie Pang, a senior director with the coalition of STD directors, said that given the critical role of this drug and the severe access concerns, she thinks a stockpile is necessary. “I don’t have another solution that actually gets drugs to patients,” Pang said.

The government could declare a federal emergency.

Some public health officials say the federal government needs to treat the syphilis crisis the way it did Ebola or monkeypox.

Declare a federal emergency, said Dr. Michael Dube, an infectious disease specialist for more than 30 years. That would free up money for more public health staff and fund more creative approaches that could lead to a long-term solution to the near-constant shortages, he said. “I’d hate to have to wait for some horrible anecdotes to get out there in order to get the public’s and the policymakers’ minds on it,” said Dube, who oversees medical care for AIDS Healthcare Foundation wellness clinics across the country.

Citing an alarming surge in syphilis cases, the Great Plains Tribes wrote to the HHS secretary last week asking that the agency declare a public health emergency in their areas. In the request, they asked HHS to work globally to find adequate syphilis treatment and send the needed medicine to the Great Plains region.

During the 2014 outbreak of Ebola in West Africa, Congress gave hundreds of millions of dollars to HHS to help develop new rapid tests and vaccines. Facing a global outbreak of monkeypox in 2022, a White House task force deployed more than a million vaccines, regularly briefed the public and sent extra resources to Pride parades and other places where people at risk were gathered.

Levine, leader of the federal syphilis task force, countered that declaring an emergency wouldn’t make much of a difference. The government, she said, already has a “dramatic and coordinated response” involving several agencies.

The FDA recently approved an emergency import of a similar syphilis treatment made by a French manufacturer that had plenty on hand. According to the company, Provepharm, the imported shots are enough to cover approximately one or two months of typical use by all people in the U.S. (The FDA would not say how many doses Provepharm sent, and the company said it was not allowed to reveal that number under the federal rules governing such emergency imports.)

Clinics applaud that development. But many of them can’t afford the imported shots.

The government could do more to rein in the cost.

Clinics and hospitals that primarily serve low-income patients often qualify for a federal program that allows them to purchase drugs at steeply discounted prices. Pharmaceutical companies that want Medicaid to cover their outpatient drugs must participate in the program.

One factor in determining the discount price is whether a pharmaceutical company has raised the price of a drug by more than the rate of inflation. Because Pfizer has hiked the price of its Bicillin shots significantly over the years, the government requires that it be sold to qualifying clinics for just pennies a dose. Otherwise, a single Pfizer shot can retail for upwards of $500. The French shots are comparable in retail price and not eligible for the discount program.

Several clinic directors also said they worried that drug distributors were reserving the limited supply of the Pfizer shot for organizations that could pay full price. For several days in January, for example, the website of Henry Schein, a medical supplier, showed doses of the shot available at full price, while doses at the penny pricing were out of stock, according to screenshots shared with ProPublica. When asked whether it was only selling shots at full price, a spokesperson for Henry Schein did not respond to the question.

Local health departments that qualify for the discount program told ProPublica they’ve had to pay full price at other distributors, because it was the only stock available.

The Health Resources and Services Administration, the federal agency that regulates the discount program, said that a drug manufacturer is ultimately responsible for ensuring that when supplies are available, they are available at the discounted price. When asked about this, Pfizer said that it has “one inventory that is distributed to our trade partners” and that hospitals and clinics that qualify for the discount program are “responsible for ensuring compliance with the program and orders through the wholesaler accordingly.” The company added, “Pfizer plays no part in this process.”

In October, on Weinberg’s regular search for shots for her Mississippi clinic, she found doses of Bicillin for sale at the discounted price and purchased 40. “The idea that we’re supposed to be hoarding treatment is a horrific compact,” she said. Word got out that the clinic, called Plan A, has some shots, and other clinics began sending pregnant patients there.

The clinic’s supply is dwindling. Weinberg is happy to get the shots to patients who need them. But she’s not sure how much longer her reserve will last — or if she’ll be able to find more when they’re gone.

Don’t Forget…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

Recommended

  • The Sweetener That Interferes With Hunger/Satiety Signals
  • Live Long, Die Short – by Dr. Roger Landry
    Live longer and healthier with Dr. Landry’s 10 tips to increase healthspan, combining pop-science and engaging tales for a practical approach to aging well.

Learn to Age Gracefully

Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Never Too Late To Start Over: Finding Purpose At Any Age

    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.

    Dana Findwell’s late 50s were not an easy time, but upon now hitting 60 (this week, at time of writing), she’s enthusiastically throwing herself into the things that bring her purpose, and so can you.

    Start where you are

    Findwell was already no stranger to starting again, having been married and divorced twice, and having moved frequently, requiring constant “life resets”.

    Nevertheless, she always had her work to fall back on; she was a graphic designer and art director for 30 years… Until burnout struck.

    And when burnout struck, so did COVID, resulting in the loss of her job. Her job wasn’t the only thing she lost though, as her mother died around the same time. All in all, it was a lot, and not the fun kind of “a lot”.

    Struggling to find a new career direction, she ended up starting a small business for herself, so that she could direct the pace; pressing forwards as and when she had the energy. This became her new “ikigai“, the main thing that brings a sense of purpose to her life, but getting one part of her life back into order brought her attention to the rest; she realized she’d neglected her health, so she joined a gym. And a weightlifting class. And a hip-hop class. And she took up the practice of Japanese drumming (for the unfamiliar, this can be a rather athletic ability; it’s not a matter of sitting at a drum kit).

    And now? Her future is still not clear, but that’s ok, because she’s making it as she goes, and she’s doing it her way, trusting in her ability to handle what may come up, and doing the things now that future-her will be glad of having done (e.g. laying the groundwork of both financial security and good health).

    Change can sometimes be triggered by adverse circumstances, but there’s always the opportunity to find something better. For more on all of this, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

    You might also like to read:

    Our Resources About Ikigai

    Take care!

    Share This Post

  • A Surprisingly Powerful Tool: Eye Movement Desensitization & Reprocessing

    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.

    Eye Movement Desensitization & Reprocessing (EMDR)

    What skeletons are in your closet? As life goes on, most of accumulate bad experiences as well as good ones, to a greater or lesser degree. From clear cases of classic PTSD, to the widely underexamined many-headed beast that is C-PTSD*, our past does affect our present. Is there, then, any chance for our future being different?

    *PTSD is typically associated with military veterans, for example, or sexual assault survivors. There was a clear, indisputable, Bad Thing™ that was experienced, and it left a psychological scar. When something happens to remind us of that—say, there are fireworks, or somebody touches us a certain way—it’ll trigger an immediate strong response of some kind.

    These days the word “triggered” has been popularly misappropriated to mean any adverse emotional reaction, often to something trivial.

    But, not all trauma is so clear. If PTSD refers to the result of that one time you were smashed with a sledgehammer, C-PTSD (Complex PTSD) refers to the result of having been hit with a rolled-up newspaper every few days for fifteen years, say.

    This might have been…

    • childhood emotional neglect
    • a parent with a hair-trigger temper
    • bullying at school
    • extended financial hardship as a young adult
    • “just” being told or shown all too often that your best was never good enough
    • the persistent threat (real or imagined) of doom of some kind
    • the often-reinforced idea that you might lose everything at any moment

    If you’re reading this list and thinking “that’s just life though”, you might be in the estimated 1 in 5 people with (often undiagnosed) C-PTSD.

    For more on C-PTSD, see our previous main feature:

    PTSD, But, Well…. Complex

    So, what does eye movement have to do with this?

    Eye Movement Desensitization & Reprocessing (EMDR) is a therapeutic technique whereby a traumatic experience (however small or large; it could be the memory of that one time you said something very regrettable, or it could be some horror we couldn’t describe here) is recalled, and then “detoothed” by doing a bit of neurological jiggery-pokery.

    How the neurological jiggery-pokery works:

    By engaging the brain in what’s called bilateral stimulation (which can be achieved in various ways, but a common one is moving the eyes rapidly from side to side, hence the name), the event can be re-processed, in much the same way that we do when dreaming, and relegated safely to the past.

    This doesn’t mean you’ll forget the event; you’d need to do different exercises for that.

    See also our previous main feature:

    The Dark Side Of Memory (And How To Make Your Life Better)

    That’s not the only aspect of EMDR, though…

    EMDR is not just about recalling traumatic events while moving your eyes from side-to-side. What an easy fix that would be! There’s a little more to it.

    The process also involves (ideally with the help of a trained professional) examining what other memories, thoughts, feelings, come to mind while doing that. Sometimes, a response we have today associated with, for example, a feeling of helplessness, or rage in conflict, or shame, or anything really, can be connected to previous instances of feeling the same thing. And, each of those events will reinforce—and be reinforced by—the others.

    An example of this could be an adult who struggles with substance abuse (perhaps alcohol, say), using it as a crutch to avoid feelings of [insert static here; we don’t know what the feelings are because they’re being avoided], that were first created by, and gradually snowballed from, some adverse reaction to something they did long ago as a child, then reinforced at various times later in life, until finally this adult doesn’t know what to do, but they do know they must hide it at all costs, or suffer the adverse reaction again. Which obviously isn’t a way to actually overcome anything.

    EMDR, therefore, seeks to not just “detooth” a singular traumatic memory, but rather, render harmless the whole thread of memories.

    Needless to say, this kind of therapy can be quite an emotionally taxing experience, so again, we recommend trying it only under the guidance of a professional.

    Is this an evidence-based approach?

    Yes! It’s not without its controversy, but that’s how it is in the dog-eat-dog world of academia in general and perhaps psychotherapy in particular. To give a note to some of why it has some controversy, here’s a great freely-available paper that presents “both sides” (it’s more than two sides, really); the premises and claims, the criticisms, and explanations for why the criticisms aren’t necessarily actually problems—all by a wide variety of independent research teams:

    Research on Eye Movement Desensitization & Reprocessing (EMDR) as a Treatment for PTSD

    To give an idea of the breadth of applications for EMDR, and the evidence of the effectiveness of same, here are a few additional studies/reviews (there are many):

    As for what the American Psychiatric Association says about it:

    ❝After assessing the 120 outcome studies pertaining to the focus areas, we conclude that for two of the areas (i.e., PTSD in children and adolescents and EMDR early interventions research) the strength of the evidence is rated at the highest level, whereas the other areas obtain the second highest level.❞

    Source: The current status of EMDR therapy, specific target areas, and goals for the future

    Want to learn more?

    To learn a lot more than we could include here, check out the APA’s treatment guidelines (they are written in a fashion that is very accessible to a layperson):

    APA | Eye Movement Desensitization and Reprocessing (EMDR) Therapy

    Take care!

    Share This Post

  • 7 Healthy Gut Habits For Women Over 40 – by Lara West

    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.

    With regard to the titular 7 healthy gut habits for women over 40, a chapter is devoted to each one of those habits, and she goes into quite some detail in each category, more than you might expect.

    As for the 7 things, we’ll not keep them a mystery; they are:

    1. Intermittent fasting
    2. Prebiotics & probiotics
    3. Mindful eating
    4. Understanding ingredients
    5. Movement
    6. Sleep
    7. Stress management

    Of course, all of these things are good regardless of one’s age or gender, but West is writing with women over 40 in mind, and as such, she will focus on things that are especially relevant to those of us who are indeed women over 40.

    You may be wondering: what if I’m a long way over 40, and menopause is a distant memory? In that case, 90% of this will still be relevant to you; the only parts that won’t be, are those that pertain specifically to the menopausal transitional phase itself, rather than the post-menopause state.

    You may also be wondering: what if I’m a man, and menopause is just not in the cards for me? In that case, maybe about 70% of this will still be relevant to you, because of the broad applicability of most of the advice. That said, if it’s just for yourself, you’d probably do better with a book of which 100% is relevant to you, rather than this one.

    The style is conversational pop-science, with personal anecdotes mixed in with references to science. It’s definitely on the light/easy-reading end of books that we’ve reviewed on the topic.

    Bottom line: if you’re a woman over 40 who would like to improve your gut health, this book was written for you.

    Click here to check out 7 Healthy Gut Habits For Women Over 40, and rediscover vitality!

    Share This Post

Related Posts

  • The Sweetener That Interferes With Hunger/Satiety Signals
  • Ramadan is almost here. 5 tips to boost your wellbeing and energy levels if you’re fasting

    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.

    Ramadan is one of the most significant months of the Islamic lunar calendar. It marks the time when the Quran was revealed to Prophet Mohammed (peace be upon him).

    Almost 2 billion Muslims worldwide observe this month of prayer and reflection, which includes fasting between two prayers, Fajr at dawn and Maghrib at sunset.

    Ramadan is about purifying the mind, body and soul, and practising self-restraint. It’s a time for spiritual growth and dedication to God (or Allah in Arabic). Ramadan also brings people together for meals and celebrations, with a focus on helping those less fortunate.

    Depending on where you live, Ramadan can mean going 12 to 19 hours without eating or drinking anything, including water.

    Our research shows choosing balanced, nutrient-dense foods and drinks can result in better wellbeing and greater energy levels than following your usual diet during Ramadan.

    Here’s what to consider if you’re fasting for Ramadan.

    Drazen Zigic/Shutterstock

    Do you have any health issues?

    Healthy Muslims are expected to fast during Ramadan once they have reached puberty.

    Frail older adults are exempt from fasting, as are pregnant, breastfeeding and menstruating women. Anyone who cannot participate in fasting can make up for the missed fasting days later.

    People with chronic illness or mental health may be exempt if fasting poses a risk to their health. If you suffer from chronic illness, such as diabetes, heart disease or kidney problems, and want to fast, consult your GP first.

    Fasting can have severe health consequences for people with certain medical conditions and those who rely on prescription medication. Some medications need to be taken at a specific time (and some with food) to be safe and effective.

    If you’re not drinking enough water during Ramadan, your body might also handle some medications differently: they may not work as well or cause side effects.

    For people who can safely fast, here are five tips to maintain your wellbeing during Ramadan.

    1. Plan ahead

    In preparation for Ramadan, stock up on essentials. Plan your meals and hydration in advance, to stay on top of your nutritional intake.

    Start reducing your caffeine gradually in the week leading to Ramadan, so your body can adjust. This can help prevent or reduce the fasting headaches that many experience at the beginning of Ramadan.

    Move your meals gradually towards Suhoor and Iftar times, so your body gets used to the new mealtimes.

    Man shops for groceries
    Plan your meals ahead of time. Ground Picture/Shutterstock

    2. Stay hydrated

    Staying hydrated is important during Ramadan. Women should aim to drink 2.1 litres of water or fluids (such as coconut water, clear soups, broths or herbal teas) each day. Men should aim for 2.6 litres.

    Limit the intake of sugary or artificially sweetened drinks and enjoy fresh fruit juice only in moderation. Sugary drinks cause a rapid increase in blood sugar levels. The body responds by releasing insulin, causing a drop in blood sugar, which can leave you feeling fatigued, irritable and hungry.

    Increase your hydration by including water-rich foods, such as cucumbers and watermelon, in your diet.

    3. Get your nutrients early

    Before dawn, have a nutrient-rich, slow-digesting meal, along with plenty of water.

    Select healthy nutrient-dense food with proteins and fats from lean meats, fish, chickpeas, tofu, nuts and seeds.

    Choose whole grain products, a variety of vegetables and fruits, and fermented foods, such as kimchi and pickles, which can support your digestion.

    When you prepare your meals, consider grilling, steaming or air frying instead of deep frying.

    Stay away from processed foods such as cakes, ice cream, chips and chocolates, as they often lack essential nutrients and are high in sugar, salt and fat. Processed foods also tend to be low in fibre and protein, which are crucial for maintaining a feeling of fullness.

    4. Avoid the temptation to overeat in the evening

    At sunset, many Muslims come together with family and friends for the fast-breaking evening meal (Iftar). During these occasions, it may be tempting to overindulge in sweets, salty snacks and fatty dishes.

    But overeating can strain the digestive system, cause discomfort and disrupt sleep.

    Person picks up a date
    Start with something small. Tekkol/Shutterstock

    Instead, listen to your body’s signals, control your portions, and eat mindfully – this means slowly and without distractions.

    Start with something small, such as a date and a glass of water. You may choose to complete the Maghrib prayer before returning for your main meal and more fluids.

    5. Keep moving

    Finally, try to include some light exercise into your schedule, to maintain your fitness and muscle mass, and promote sleep.

    But avoid heavy workouts, sauna and intensive sports while fasting, as these may increase dehydration, which can increase your risk of feeling faint and falling.

    Romy Lauche, Deputy Director (Research), National Centre for Naturopathic Medicine, Southern Cross University; Fatima El-Assaad, Senior Research Fellow, Microbiome Research Centre, UNSW Sydney, and Jessica Bayes, Postdoctoral Research Fellow at the National Centre for Naturopathic Medicine, Southern Cross University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • In This Oklahoma Town, Most Everyone Knows Someone Who’s Been Sued by the Hospital

    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.

    McALESTER, Okla. — It took little more than an hour for Deborah Hackler to dispense with the tall stack of debt collection lawsuits that McAlester Regional Medical Center recently brought to small-claims court in this Oklahoma farm community.

    Hackler, a lawyer who sues patients on behalf of the hospital, buzzed through 51 cases, all but a handful uncontested, as is often the case. She bantered with the judge as she secured nearly $40,000 in judgments, plus 10% in fees for herself, according to court records.

    It’s a payday the hospital and Hackler have shared frequently over the past three decades, records show. The records indicate McAlester Regional Medical Center and an affiliated clinic have filed close to 5,000 debt collection cases since the early 1990s, most often represented by the father-daughter law firm of Hackler & Hackler.

    Some of McAlester’s 18,000 residents have been taken to court multiple times. A deputy at the county jail and her adult son were each sued recently, court records show. New mothers said they compare stories of their legal run-ins with the medical center.

    “There’s a lot that’s not right,” Sherry McKee, a dorm monitor at a tribal boarding school outside McAlester, said on the courthouse steps after the hearing. The hospital has sued her three times, most recently over a $3,375 bill for what she said turned out to be vertigo.

    In recent years, major health systems in Virginia, North Carolina, and elsewhere have stopped suing patients following news reports about lawsuits. And several states, such as Maryland and New York, have restricted the legal actions hospitals can take against patients.

    But with some 100 million people in the U.S. burdened by health care debt, medical collection cases still clog courtrooms across the country, researchers have found. In places like McAlester, a hospital’s debt collection machine can hum away quietly for years, helped along by powerful people in town. An effort to limit hospital lawsuits failed in the Oklahoma Legislature in 2021.

    In McAlester, the lawsuits have provided business for some, such as the Adjustment Bureau, a local collection agency run out of a squat concrete building down the street from the courthouse, and for Hackler, a former president of the McAlester Area Chamber of Commerce. But for many patients and their families, the lawsuits can take a devastating toll, sapping wages, emptying retirement accounts, and upending lives.

    McKee said she wasn’t sure how long it would take to pay off the recent judgment. Her $3,375 debt exceeds her monthly salary, she said.

    “This affects a large number of people in a small community,” said Janet Roloff, an attorney who has spent years assisting low-income clients with legal issues such as evictions in and around McAlester. “The impact is great.”

    Settled more than a century ago by fortune seekers who secured land from the Choctaw Nation to mine coal in the nearby hills, McAlester was once a boom town. Vestiges of that era remain, including a mammoth, 140-foot-tall Masonic temple that looms over the city.

    Recent times have been tougher for McAlester, now home by one count to 12 marijuana dispensaries and the state’s death row. The downtown is pockmarked by empty storefronts, including the OKLA theater, which has been dark for decades. Nearly 1 in 5 residents in McAlester and the surrounding county live below the federal poverty line.

    The hospital, operated by a public trust under the city’s authority, faces its own struggles. Paint is peeling off the front portico, and weeds poke up through the parking lots. The hospital has operated in the red for years, according to independent audit reports available on the state auditor’s website.

    “I’m trying to find ways to get the entire community better care and more care,” said Shawn Howard, the hospital’s chief executive. Howard grew up in McAlester and proudly noted he started his career as a receptionist in the hospital’s physical therapy department. “This is my hometown,” he said. “I am not trying to keep people out of getting care.”

    The hospital operates a clinic for low-income patients, whose webpage notes it has “limited appointments” at no cost for patients who are approved for aid. But data from the audits shows the hospital offers very little financial assistance, despite its purported mission to serve the community.

    In the 2022 fiscal year, it provided just $114,000 in charity care, out of a total operating budget of more than $100 million, hospital records show. Charity care totaling $2 million or $3 million out of a $100 million budget would be more in line with other U.S. hospitals.

    While audits show few McAlester patients get financial aid, many get taken to court.

    Renee Montgomery, the city treasurer in an adjoining town and mother of a local police officer, said she dipped into savings she’d reserved for her children and grandchildren after the hospital sued her last year for more than $5,500. She’d gone to the emergency room for chest pain.

    Dusty Powell, a truck driver, said he lost his pickup and motorcycle when his wages were garnished after the hospital sued him for almost $9,000. He’d gone to the emergency department for what turned out to be gastritis and didn’t have insurance, he said.

    “Everyone in this town probably has a story about McAlester Regional,” said another former patient who spoke on the condition she not be named, fearful to publicly criticize the hospital in such a small city. “It’s not even a secret.”

    The woman, who works at an Army munitions plant outside town, was sued twice over bills she incurred giving birth. Her sister-in-law has been sued as well.

    “It’s a good-old-boy system,” said the woman, who lowered her voice when the mayor walked into the coffee shop where she was meeting with KFF Health News. Now, she said, she avoids the hospital if her children need care.

    Nationwide, most people sued in debt collection cases never challenge them, a response experts say reflects widespread misunderstanding of the legal process and anxiety about coming to court.

    At the center of the McAlester hospital’s collection efforts for decades has been Hackler & Hackler.

    Donald Hackler was city attorney in McAlester for 13 years in the ’70s and ’80s and a longtime member of the local Lions Club and the Scottish Rite Freemasons.

    Daughter Deborah Hackler, who joined the family firm 30 years ago, has been a deacon at the First Presbyterian Church of McAlester and served on the board of the local Girl Scouts chapter, according to the McAlester News-Capital newspaper, which named her “Woman of the Year” in 2007. Since 2001, she also has been a municipal judge in McAlester, hearing traffic cases, including some involving people she has sued on behalf of the hospital, municipal and county court records show.

    For years, the Hacklers’ debt collection cases were often heard by Judge James Bland, who has retired from the bench and now sits on the hospital board. Bland didn’t respond to an inquiry for interview.

    Hackler declined to speak with KFF Health News after her recent court appearance. “I’m not going to visit with you about a current client,” she said before leaving the courthouse.

    Howard, the hospital CEO, said he couldn’t discuss the lawsuits either. He said he didn’t know the hospital took its patients to court. “I had to call and ask if we sue people,” he said.

    Howard also said he didn’t know Deborah Hackler. “I never heard her name before,” he said.

    Despite repeated public records requests from KFF Health News since September, the hospital did not provide detailed information about its financial arrangement with Hackler.

    McAlester Mayor John Browne, who appoints the hospital’s board of trustees, said he, too, didn’t know about the lawsuits. “I hadn’t heard anything about them suing,” he said.

    At the century-old courthouse in downtown McAlester, it’s not hard to find the lawsuits, though. Every month or two, another batch fills the docket in the small-claims court, now presided over by Judge Brian McLaughlin.

    After court recently, McLaughlin, who is not from McAlester, shook his head at the stream of cases and patients who almost never show up to defend themselves, leaving him to issue judgment after judgment in the hospital’s favor.

    “All I can do is follow the law,” said McLaughlin. “It doesn’t mean I like it.”

    About This Project

    “Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.

    The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country. 

    Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.

    The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability. 

    KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.

    Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.

    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.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Creatine, Genomic Screening, & More

    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.

    In this week’s health news…

    Creatine: no difference vs control at 5g/day

    A study found, as the title suggests, no difference between creatine and placebo, at the usual dose of 5g/day, while doing a supervised resistance training program.

    This was a 12-week trial, and in the first week, the creatine group put on an average of 0.5kg more lean (i.e. not fat) body mass than the control group, however, as this quickly equalized after the first week, it is assumed that the brief extra weight gain was water weight (creatine promotes water retention, especially in the initial phase).

    However, it is still possible that it may promote weight gain at higher doses.

    This study was done with adult participants under the age of 50; we’ve noted before that it is generally young people who use creatine for bodybuilding, so in principle, this should have been ideal for that, but it wasn’t.

    Read in full: Sports supplement creatine makes no difference to muscle gains, trial finds

    Related: Creatine’s Brain Benefits Increase With Age ← this, on the other hand, does work—but only for older adults.

    Genomics & disease risk: what to know

    In a recent study evaluation, 175,500 participants were screened, and 1 in 30 received medically important genetic results. More than 90% of those found to have a genetic risk were previously unaware of it.

    This is important, because most current genetic risk assessment for patients is based on personal and family history, which often misses a lot of data due to barriers to care or lack of family history.

    Genomic screening helps close these gaps:

    Read in full: Genomic screening is important in identifying disease risk, study finds

    Related: Do You Have A Personalized Health Plan? (Here’s How)

    FDA-Approved Antivirals (Not Vaccines) Ineffective Against H5N1

    The H5N1 avian influenza outbreak is now rife amongst dairy farms, with the virus found in cows’ milk and infecting farmworkers. Researchers studied potential treatments, revealing two FDA-approved antivirals (baloxavir and oseltamivir) were generally ineffective in treating severe H5N1 infections.

    Oral infections per raw milk consumption, were the most severe and hardest to treat, and the virus spread quickly to the blood and brain (when the infection is respiratory, it is much slower to spread from the respiratory tract).

    It wasn’t a complete loss, though:

    • Eye infections were better controlled with baloxavir, achieving a 100% survival rate compared to 25% with oseltamivir.
    • For nasal infections, baloxavir reduced viral levels better but still allowed the virus to reach the brain. Survival rates were 75% for baloxavir and 50% for oseltamivir.

    The researchers in question are urging preventative measures as being of critical importance, given the difficulty of treatment:

    Read in full: Current antivirals likely less effective against severe infection caused by bird flu virus in cows’ milk

    Related: Bird Flu: Children At High Risk; Older Adults Not So Much

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: