HRT: Bioidentical vs Animal
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HRT: A Tale Of Two Approaches
In yesterday’s newsletter, we asked you for your assessment of menopausal hormone replacement therapy (HRT).
- A little over a third said “It can be medically beneficial, but has some minor drawbacks”
- A little under a third said “It helps, but at the cost of increased cancer risk; not worth it”
- Almost as many said “It’s a wondrous cure-all that makes you happier, healthier, and smell nice too”
- Four said “It is a dangerous scam and a sham; “au naturel” is the way to go”
So what does the science say?
Which HRT?
One subscriber who voted for “It’s a wondrous cure-all that makes you healthier, happier, and smell nice too” wrote to add:
❝My answer is based on biodentical hormone replacement therapy. Your survey did not specify.❞
And that’s an important distinction! We did indeed mean bioidentical HRT, because, being completely honest here, this European writer had no idea that Premarin etc were still in such wide circulation in the US.
So to quickly clear up any confusion:
- Bioidentical hormones: these are (as the name suggests) identical on a molecular level to the kind produced by humans.
- Conjugated Equine Estrogens: such as Premarin, come from animals. Indeed, the name “Premarin” comes from “pregnant mare urine”, the substance used to make it.
There are also hormone analogs, such as medroxyprogesterone acetate, which is a progestin and not the same thing as progesterone. Hormone analogs such as the aforementioned MPA are again, a predominantly-American thing—though they did test it first in third-world countries, after testing it on animals and finding it gave them various kinds of cancer (breast, cervical, ovarian, uterine).
A quick jumping-off point if you’re interested in that:
Depot medroxyprogesterone acetate and the risk of breast and gynecologic cancer
this is about its use as a contraceptive (so, much lower doses needed), but it is the same thing sometimes given in the US as part of menopausal HRT. You will note that the date on that research is 1996; DMPA is not exactly cutting-edge and was first widely used in the 1950s.
Similarly, CEEs (like Premarin) have been used since the 1930s, while estradiol (bioidentical estrogen) has been in use since the 1970s.
In short: we recommend being wary of those older kinds and mostly won’t be talking about them here.
Bioidentical hormones are safer: True or False?
True! This is an open-and-shut case:
❝Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts.
Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. ❞
Further research since that review has further backed up its findings.
Source: Are Bioidentical Hormones Safer or More Efficacious than Other Commonly Used Versions in HRT?
So simply, if you’re going on HRT (estrogen and/or progesterone), you might want to check it’s the bioidentical kind.
HRT can increase the risk of breast cancer: True or False?
Contingently True, but for most people, there is no significant increase in risk.
First: again, we’re talking bioidentical hormones, and in this case, estradiol. Older animal-derived attempts had much higher risks with much lesser efficaciousness.
There have been so many studies on this (alas, none that have been publicised enough to undo the bad PR in the wake of old-fashioned HRT from before the 70s), but here’s a systematic review that highlights some very important things:
❝Estradiol-only therapy carries no risk for breast cancer, while the breast cancer risk varies according to the type of progestogen.
Estradiol therapy combined with medroxyprogesterone, norethisterone and levonorgestrel related to an increased risk of breast cancer, estradiol therapy combined with dydrogesterone and progesterone carries no risk❞
In fewer words:
- Estradiol by itself: no increased risk of breast cancer
- Estradiol with MDPA or other progestogens that aren’t really progesterone: increased risk of breast cancer
- Estradiol with actual progesterone: back to no increased risk of breast cancer
So again, you might want to make sure you are getting actual bioidentical hormones, and not something else!
However! If you are aware that you already have an increased risk of breast cancer (e.g. family history, you’ve had it before, you know you have certain genes for it, etc), then you should certainly discuss that with your doctor, because your personal circumstances may be different:
❝Tailored HRT may be used without strong evidence of a deleterious effect after ovarian cancer, endometrial cancer, most other gynecological cancers, bowel cancer, melanoma, a family history of breast cancer, benign breast disease, in carriers of BRACA mutations, after breast cancer if adjuvant therapy is not being used, past thromboembolism, varicose veins, fibroids and past endometriosis.
Relative contraindications are existing cardiovascular and cerebrovascular disease and breast cancer being treated with adjuvant therapies❞
Source: HRT in difficult circumstances: are there any absolute contraindications?
HRT makes you happier, healthier, and smell nice too: True or False?
Contingently True, assuming you do want its effects, which generally means the restoration of much of the youthful vitality you enjoyed pre-menopause.
The “and smell nice too” was partly rhetorical, but also partly literal: our scent is largely informed by our hormones, and higher estrogen results in a sweeter scent; lower estrogen results in a more bitter scent. Not generally considered an important health matter, but it’s a thing, so hey.
More often, people take menopausal HRT for more energy, stronger bones (reduced osteoporosis risk), healthier heart (reduced CVD risk), improved sexual health, better mood, healthier skin and hair, and general avoidance of menopause symptoms:
Read more: Skin, hair and beyond: the impact of menopause
We’d need another whole main feature to discuss all the benefits properly; today we’re just mythbusting.
HRT does have some drawbacks: True or False?
True, and/but how serious they are (beyond the aforementioned consideration in the case of an already-increased risk of breast cancer) is a matter of opinion.
For example, it is common to get a reprise of monthly cramps and/or mood swings, depending on how one is taking the HRT and other factors (e.g. your own personal physiology and genetic predispositions). For most people, these will even out over time.
It’s also even common to get a reprise of (much slighter than before) monthly bleeding, unless you have for example had a hysterectomy (no uterus = no bleeding). Again, this will usually settle down in a matter of months.
If you experience anything more alarming than that, then indeed check with your doctor.
HRT is a dangerous scam and sham: True or False?
False, simply. As described above, for most people they’re quite safe. Again, talking bioidentical hormones.
The other kind are in the most neutral sense a sham (i.e. they are literally sham hormones), though they’re not without their merits and for many people they may be better than nothing.
As for being a scam, biodentical hormones are widely prescribed in the many countries that have universal healthcare and/or a single-payer healthcare system, where there would be no profit motive (and considerable cost) in doing so.
They’re prescribed because they are effective and thus reduce healthcare spending in other areas (such as treating osteoporosis or CVD after the fact) and improve Health Related Quality of Life, and by extension, health-adjusted life-years, which is one of the top-used metrics for such systems.
See for example:
Our apologies, gentlemen
We wanted to also talk about testosterone therapy for the andropause, but we’ve run out of room today (because of covering the important distinction of bioidentical vs old-fashioned HRT)!
To make it up to you, we’ll do a full main feature on it (it’s an interesting topic) in the near future, so watch this space
Ladies, we’ll also at some point cover the pros and cons of different means of administration, e.g. pills, transdermal gel, injections, patches, pessaries, etc—which often have big differences.
That’ll be in a while though, because we try to vary our topics, so we can’t talk about menopausal HRT all the time, fascinating and important a topic it is.
Meanwhile… take care, all!
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What pathogen might spark the next pandemic? How scientists are preparing for ‘disease X’
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Before the COVID pandemic, the World Health Organization (WHO) had made a list of priority infectious diseases. These were felt to pose a threat to international public health, but where research was still needed to improve their surveillance and diagnosis. In 2018, “disease X” was included, which signified that a pathogen previously not on our radar could cause a pandemic.
While it’s one thing to acknowledge the limits to our knowledge of the microbial soup we live in, more recent attention has focused on how we might systematically approach future pandemic risks.
Former US Secretary of Defense Donald Rumsfeld famously talked about “known knowns” (things we know we know), “known unknowns” (things we know we don’t know), and “unknown unknowns” (the things we don’t know we don’t know).
Although this may have been controversial in its original context of weapons of mass destruction, it provides a way to think about how we might approach future pandemic threats.
Anna Shvets/Pexels Influenza: a ‘known known’
Influenza is largely a known entity; we essentially have a minor pandemic every winter with small changes in the virus each year. But more major changes can also occur, resulting in spread through populations with little pre-existing immunity. We saw this most recently in 2009 with the swine flu pandemic.
However, there’s a lot we don’t understand about what drives influenza mutations, how these interact with population-level immunity, and how best to make predictions about transmission, severity and impact each year.
The current H5N1 subtype of avian influenza (“bird flu”) has spread widely around the world. It has led to the deaths of many millions of birds and spread to several mammalian species including cows in the United States and marine mammals in South America.
Human cases have been reported in people who have had close contact with infected animals, but fortunately there’s currently no sustained spread between people.
While detecting influenza in animals is a huge task in a large country such as Australia, there are systems in place to detect and respond to bird flu in wildlife and production animals.
Scientists are continually monitoring a range of pathogens with pandemic potential. Edward Jenner/Pexels It’s inevitable there will be more influenza pandemics in the future. But it isn’t always the one we are worried about.
Attention had been focused on avian influenza since 1997, when an outbreak in birds in Hong Kong caused severe disease in humans. But the subsequent pandemic in 2009 originated in pigs in central Mexico.
Coronaviruses: an ‘unknown known’
Although Rumsfeld didn’t talk about “unknown knowns”, coronaviruses would be appropriate for this category. We knew more about coronaviruses than most people might have thought before the COVID pandemic.
We’d had experience with severe acute respiratory syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) causing large outbreaks. Both are caused by viruses closely related to SARS-CoV-2, the coronavirus that causes COVID. While these might have faded from public consciousness before COVID, coronaviruses were listed in the 2015 WHO list of diseases with pandemic potential.
Previous research into the earlier coronaviruses proved vital in allowing COVID vaccines to be developed rapidly. For example, the Oxford group’s initial work on a MERS vaccine was key to the development of AstraZeneca’s COVID vaccine.
Similarly, previous research into the structure of the spike protein – a protein on the surface of coronaviruses that allows it to attach to our cells – was helpful in developing mRNA vaccines for COVID.
It would seem likely there will be further coronavirus pandemics in the future. And even if they don’t occur at the scale of COVID, the impacts can be significant. For example, when MERS spread to South Korea in 2015, it only caused 186 cases over two months, but the cost of controlling it was estimated at US$8 billion (A$11.6 billion).
COVID could be regarded as an ‘unknown known’. Markus Spiske/Pexels The 25 viral families: an approach to ‘known unknowns’
Attention has now turned to the known unknowns. There are about 120 viruses from 25 families that are known to cause human disease. Members of each viral family share common properties and our immune systems respond to them in similar ways.
An example is the flavivirus family, of which the best-known members are yellow fever virus and dengue fever virus. This family also includes several other important viruses, such as Zika virus (which can cause birth defects when pregnant women are infected) and West Nile virus (which causes encephalitis, or inflammation of the brain).
The WHO’s blueprint for epidemics aims to consider threats from different classes of viruses and bacteria. It looks at individual pathogens as examples from each category to expand our understanding systematically.
The US National Institute of Allergy and Infectious Diseases has taken this a step further, preparing vaccines and therapies for a list of prototype pathogens from key virus families. The goal is to be able to adapt this knowledge to new vaccines and treatments if a pandemic were to arise from a closely related virus.
Pathogen X, the ‘unknown unknown’
There are also the unknown unknowns, or “disease X” – an unknown pathogen with the potential to trigger a severe global epidemic. To prepare for this, we need to adopt new forms of surveillance specifically looking at where new pathogens could emerge.
In recent years, there’s been an increasing recognition that we need to take a broader view of health beyond only thinking about human health, but also animals and the environment. This concept is known as “One Health” and considers issues such as climate change, intensive agricultural practices, trade in exotic animals, increased human encroachment into wildlife habitats, changing international travel, and urbanisation.
This has implications not only for where to look for new infectious diseases, but also how we can reduce the risk of “spillover” from animals to humans. This might include targeted testing of animals and people who work closely with animals. Currently, testing is mainly directed towards known viruses, but new technologies can look for as yet unknown viruses in patients with symptoms consistent with new infections.
We live in a vast world of potential microbiological threats. While influenza and coronaviruses have a track record of causing past pandemics, a longer list of new pathogens could still cause outbreaks with significant consequences.
Continued surveillance for new pathogens, improving our understanding of important virus families, and developing policies to reduce the risk of spillover will all be important for reducing the risk of future pandemics.
This article is part of a series on the next pandemic.
Allen Cheng, Professor of Infectious Diseases, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Eat to Beat Your Diet – by Dr. William Li
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We previously reviewed Dr. Li’s excellent “Eat To Beat Disease”, so you may be wondering how much overlap there is. While he does still cover such topics as angiogenesis, organ regeneration, microbiome health, DNA protection, and immunological considerations, and much of the dietary advice is similar, most of the explanation is different.
Because, this time, rather than looking at beating disease in general, there’s a much stronger focus on metabolic disease in particular, and yes, for those who want to do so, losing fat.
The scientific explanations are in-depth, such that you come way with not merely “I should eat an avocado once in a while”, but a comprehensive understanding of the body’s metabolic processes, from the chemistry to the organs involved, from the cellular to the systemic.
The style is on the hard end of pop-science. It’s approachably readable, while having a lot of densely-packed information with minimal fluff. You will be more than getting your money’s worth out of its 496 pages.
Bottom line: if you’d like to perk up your metabolism with a dietary approach that’s enjoyable and very restrictive, then this book will arm you with the knowledge to do that.
Click here to check out Eat To Beat Your Diet, and eat to beat your diet!
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Apple vs Apricot – Which is Healthier?
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Our Verdict
When comparing apple to apricot, we picked the apricot.
Why?
In terms of macros, there’s not too much between them; apples are higher in carbs and only a little higher in fiber, which disparity makes for a slightly higher glycemic index, but it’s not a big difference and they are both low GI foods.
Micronutrients, however, set these two fruits apart:
In the category of vitamins, apple is a tiny bit higher in choline, while apricots are higher in vitamins A, B1, B2, B3, B5, B6, B9, C, E, and K—in most cases, by quite large margins, too. All in all, a clear and easy win for apricots.
When it comes to minerals, apples are not higher in any minerals, while apricots are higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. There’s simply no contest here.
In short, if an apple a day keeps the doctor away, then an apricot will give the doctor a nice weekend break somewhere.
Want to learn more?
You might like to read:
Top 8 Fruits That Prevent & Kill Cancer
Take care!
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Hearty Healthy Ragù
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Ragù is a traditional Italian meaty sauce with tomato, and is the base for a number of other Italian dishes. It can be enjoyed as-is, or with very minor modifications can be turned into a Bolognese sauce or a lasagna filling or various other things. Our variations from tradition are mainly twofold here: we’re using nutrition-packed lentils instead of meat (but with a couple of twists that make them meatier), and we’re not using wine.
Traditionally, red wine is used in a ragù (white wine if you want to make it into a Bolognese sauce, by the way), but with all we’re doing it’s not necessary. If you want to add a splash of wine, we’re not going to call that a healthy ingredient, but we’re also not the boss of you
You will need
- 1 large onion (or equivalent small ones), chopped roughly
- 1 bulb garlic (or to your heart’s content), chopped finely or crushed
- 4 large tomatoes, chopped (or 2 cans chopped tomatoes)
- 1 tube (usually about 7 oz) tomato purée
- 1 cup brown lentils (green lentils will do if you can’t get brown)
- 1 tbsp chia seeds
- 1 tbsp black pepper, cracked or coarse ground
- 1 bunch fresh basil, finely chopped (or 1 tbsp, freeze-dried)
- 1 bunch fresh oregano, finely chopped (or 1 tbsp, freeze-dried)
- 1 tbsp nutritional yeast (failing that, 1 tbsp yeast extract, yes, even if you don’t like it, we promise it won’t taste like it once it’s done; it just makes the dish meatier in taste and also adds vitamin B12)
- 1 tsp cumin, ground (note that this one was tsp, not tbsp like the others)
- 1 tsp MSG, or 2 tsp low-sodium salt
- 4 cups water
- Olive oil for frying (ideally Extra Virgin, but so long as it’s at least marked virgin olive oil and not cut with other oils, that’s fine)
- Parsley, chopped, to garnish
Method
(we suggest you read everything at least once before doing anything)
1) Put the lentils in a small saucepan, or if you have one, a rice cooker (the rice cooker is better; works better and requires less attention), adding the chia seeds, MSG or low sodium salt, and nutritional yeast (or yeast extract). as well as the cumin. Add 4 cups boiling water and turn on the heat to cook them. This will probably take about 15–20 minutes; you want the lentils to be soft; a tiny bit past al dente, but not so far as mushy.
2) Fry the onion in some olive oil in a big pan (everything is going in here eventually if the pan is big enough; if it isn’t, you’ll need to transfer to a bigger pan in a bit). Once they’re nearly done, throw in the garlic too. If the lentils aren’t done yet, take the onions and garlic off the heat while you wait. After a few times of doing this recipe, you’ll be doing everything like clockwork and it’ll all align perfectly.
3) Drain the lentils (if all the water wasn’t absorbed; again, after doing it a few times, you’ll just use the right amount of water for your apparatus) but don’t rinse them (remember you put seasonings in here!), and add them to the pan with the onions and garlic; add a splash more olive oil if necessary, and stir until all the would-be-excess fat is absorbed into the lentils.
Note: the excess fat to be absorbed by the lentils was a feature not a bug; we wanted a little fat in the lentils! Makes the dish meatier and tastier, as well as more nutrient-dense.
4) add the tomatoes and tomato purée, stirring them in thoroughly; add the basil and oregano too and stir those in as well. Set it on a low heat for at least 10–15 minutes, stirring occasionally to let the flavors blend.
(if you happen to be serving pasta with it, then the time it takes to boil water and cook the pasta is a good time for the flavors to do their thing)
5) take it off the heat, and add the parsley garnish. It’s done!
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- What Is The Mediterranean Diet, Anyway?
- Four Ways To Upgrade The Mediterranean
- Eat More (Of This) For Lower Blood Pressure ← one more reason for the brown lentils today
- Chia: The Tiniest Seeds With The Most Value
- Black Pepper’s Impressive Anti-Cancer Arsenal
- The Many Health Benefits of Garlic
- Olive Oil: Is “Extra Virgin” Worth It?
Take care!
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Yoga Therapy for Arthritis – by Dr. Steffany Moonaz & Erin Byron
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Two quick notes to start with:
- One of the problems with arthritis and exercise is that arthritis can often impede exercise.
- Another of the problems with arthritis and exercise is that some kinds of exercise can exacerbate arthritis.
This book deals with both of those issues, by providing yoga specifically tailored to living with arthritis. Indeed, the first-listed author’s PhD in public health was the result of 8 years of study developing an evidence-based yoga program for people with arthritis, including osteoarthritis and rheumatoid arthritis.
The authors take the view that arthritis is a whole-person disease (i.e. it affects all parts of you), and so addressing it requires a whole-person approach, which is what this book delivers.
As such, this is not just a book of asana (yoga postures). It does provide that, of course (as well as breathing exercises), but also its 328 pages additionally cover a lot of conscious work from the inside out, including attention to the brain, energy levels, pain, and so forth, and that the practice of yoga should not merely directly improve the joints via gentle physical exercise, but also should help to heal the whole person, including reducing stress levels, reducing physical tension, and with those two things, reducing inflammation also—and also, due to both that and the asana side of practice, better-functioning organs, which is always a bonus.
The style is interesting, as it refers to both science (8 pages of hard-science bibliography) and yogic principles (enough esoterica to put off, say, James Randi or Penn & Teller). This reviewer is very comfortable with both, and so if you, dear reader, are comfortable with both too, then you will surely enjoy this book.
Bottom line: if you or a loved one has arthritis, you’ll wish you got this book sooner.
Click here to check out Yoga Therapy For Arthritis, and live better!
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From banning junk food ads to a sugar tax: with diabetes on the rise, we can’t afford to ignore the evidence any longer
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There are renewed calls this week for the Australian government to implement a range of measures aimed at improving our diets. These include restrictions on junk food advertising, improvements to food labelling, and a levy on sugary drinks.
This time the recommendations come from a parliamentary inquiry into diabetes in Australia. Its final report, tabled in parliament on Wednesday, was prepared by a parliamentary committee comprising members from across the political spectrum.
The release of this report could be an indication that Australia is finally going to implement the evidence-based healthy eating policies public health experts have been recommending for years.
But we know Australian governments have historically been unwilling to introduce policies the powerful food industry opposes. The question is whether the current government will put the health of Australians above the profits of companies selling unhealthy food.
benjamas11/Shutterstock Diabetes in Australia
Diabetes is one of the fastest growing chronic health conditions in the nation, with more than 1.3 million people affected. Projections show the number of Australians diagnosed with the condition is set to rise rapidly in coming decades.
Type 2 diabetes accounts for the vast majority of cases of diabetes. It’s largely preventable, with obesity among the strongest risk factors.
This latest report makes it clear we need an urgent focus on obesity prevention to reduce the burden of diabetes. Type 2 diabetes and obesity cost the Australian economy billions of dollars each year and preventive solutions are highly cost-effective.
This means the money spent on preventing obesity and diabetes would save the government huge amounts in health care costs. Prevention is also essential to avoid our health systems being overwhelmed in the future.
What does the report recommend?
The report puts forward 23 recommendations for addressing diabetes and obesity. These include:
- restrictions on the marketing of unhealthy foods to children, including on TV and online
- improvements to food labelling that would make it easier for people to understand products’ added sugar content
- a levy on sugary drinks, where products with higher sugar content would be taxed at a higher rate (commonly called a sugar tax).
These key recommendations echo those prioritised in a range of reports on obesity prevention over the past decade. There’s compelling evidence they’re likely to work.
Restrictions on unhealthy food marketing
There was universal support from the committee for the government to consider regulating marketing of unhealthy food to children.
Public health groups have consistently called for comprehensive mandatory legislation to protect children from exposure to marketing of unhealthy foods and related brands.
An increasing number of countries, including Chile and the United Kingdom, have legislated unhealthy food marketing restrictions across a range of settings including on TV, online and in supermarkets. There’s evidence comprehensive policies like these are having positive results.
In Australia, the food industry has made voluntary commitments to reduce some unhealthy food ads directly targeting children. But these promises are widely viewed as ineffective.
The government is currently conducting a feasibility study on additional options to limit unhealthy food marketing to children.
But the effectiveness of any new policies will depend on how comprehensive they are. Food companies are likely to rapidly shift their marketing techniques to maximise their impact. If any new government restrictions do not include all marketing channels (such as TV, online and on packaging) and techniques (including both product and brand marketing), they’re likely to fail to adequately protect children.
Food labelling
Food regulatory authorities are currently considering a range of improvements to food labelling in Australia.
For example, food ministers in Australia and New Zealand are soon set to consider mandating the health star rating front-of-pack labelling scheme.
Public health groups have consistently recommended mandatory implementation of health star ratings as a priority for improving Australian diets. Such changes are likely to result in meaningful improvements to the healthiness of what we eat.
Regulators are also reviewing potential changes to how added sugar is labelled on product packages. The recommendation from the committee to include added sugar labelling on the front of product packaging is likely to support this ongoing work.
But changes to food labelling laws are notoriously slow in Australia. And food companies are known to oppose and delay any policy changes that might hurt their profits.
Health star ratings are not compulsory in Australia. BLACKDAY/Shutterstock A sugary drinks tax
Of the report’s 23 recommendations, the sugary drinks levy was the only one that wasn’t universally supported by the committee. The four Liberal and National party members of the committee opposed implementation of this policy.
As part of their rationale, the dissenting members cited submissions from food industry groups that argued against the measure. This follows a long history of the Liberal party siding with the sugary drinks industry to oppose a levy on their products.
The dissenting members didn’t acknowledge the strong evidence that a sugary drinks levy has worked as intended in a wide range of countries.
In the UK, for example, a levy on sugary drinks implemented in 2018 has successfully lowered the sugar content in UK soft drinks and reduced sugar consumption.
The dissenting committee members argued a sugary drinks levy would hurt families on lower incomes. But previous Australian modelling has shown the two most disadvantaged quintiles would reap the greatest health benefits from such a levy, and accrue the highest savings in health-care costs.
What happens now?
Improvements to population diets and prevention of obesity will require a comprehensive and coordinated package of policy reforms.
Globally, a range of countries facing rising epidemics of obesity and diabetes are starting to take such strong preventive action.
In Australia, after years of inaction, this week’s report is the latest sign that long-awaited policy change may be near.
But meaningful and effective policy change will require politicians to listen to the public health evidence rather than the protestations of food companies concerned about their bottom line.
Gary Sacks, Professor of Public Health Policy, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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