Blue Light At Night? Save More Than Just Your Sleep!

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Beating The Insomnia Blues

You previously asked us about recipes for insomnia (or rather, recipes/foods to help with easing insomnia). We delivered!

But we also semi-promised we’d cover a bit more of the general management of insomnia, because while diet’s important, it’s not everything.

Sleep Hygiene

Alright, you probably know this first bit, but we’d be remiss if we didn’t cover it before moving on:

  • No caffeine or alcohol before bed
    • Ideally: none earlier either, but if you enjoy one or the other or both, we realize an article about sleep hygiene isn’t going to be what changes your mind
  • Fresh bedding
    • At the very least, fresh pillowcase(s). While washing and drying an entire bedding set constantly may be arduous and wasteful of resources, it never hurts to throw your latest pillowcase(s) in with each load of laundry you happen to do.
  • Warm bed, cool room = maximum coziness
  • Dark room. Speaking of which…

About That Darkness…

When we say the room should be dark, we really mean it:

  • Not dark like “evening mood lighting”, but actually dark.
  • Not dark like “in the pale moonlight”, but actually dark.
  • Not dark like “apart from the light peeking under the doorway”, but actually dark.
  • Not dark like “apart from a few LEDs on electronic devices that are on standby or are charging”, but actually dark.

There are many studies about the impact of blue light on sleep, but here’s one as an example.

If blue light with wavelength between 415 nm and 455 nm (in the visible spectrum) hits the retina, melatonin (the sleep hormone) will be suppressed.

The extent of the suppression is proportional to the amount of blue light. This means that there is a difference between starting at an “artificial daylight” lamp, and having the blue LED of your phone charger showing… but the effect is cumulative.

And it gets worse:

❝This high energy blue light passes through the cornea and lens to the retina causing diseases such as dry eye, cataract, age-related macular degeneration, even stimulating the brain, inhibiting melatonin secretion, and enhancing adrenocortical hormone production, which will destroy the hormonal balance and directly affect sleep quality.❞

Read it in full: Research progress about the effect and prevention of blue light on eyes

See also: Age-related maculopathy and the impact of blue light hazard

So, what this means, if we value our health, is:

  • Switch off, or if that’s impractical, cover the lights of electronic devices. This might be as simple as placing your phone face-down rather than face-up, for instance.
  • Invest in blackout blinds/curtains (per your preference). Serious ones, like these ← see how they don’t have to be black to be blackout! You don’t have to sacrifice style for function
  • If you can’t reasonably do the above, consider a sleep mask. Again, a good one. Not the kind you were given on a flight, or got free with some fluffy handcuffs. We mean a full-blackout sleep mask that’s designed to be comfortable enough to sleep in, like this one.
  • If you need to get up to pee or whatever, do like a pirate and keep one eye covered/closed. That way, it’ll remain unaffected by the light. Pirates did it to retain their night vision when switching between being on-deck or below, but you can do it to halve the loss of melatonin.

Lights-Out For Your Brain Too

You can have all the darkness in the world and still not sleep if your mind is racing thinking about:

  • your recent day
  • your next day
  • that conversation you wish had gone differently
  • what you really should have done when you were 18
  • how you would go about fixing your country’s socio-political and economic woes if you were in charge
  • Etc.

We wrote about how to hit pause on all that, in a previous edition of 10almonds.

Check it out: The Off-Button For Your Brain—How to “just say no” to your racing mind (this trick really works)

Sweet dreams!

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  • The Blue Zones, Second Edition – by Dan Buettner

    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.

    Eat beans & greens, take walks, have a purpose; you can probably list off the top of your head some of the “advices from Blue Zones”, so what makes this book stand out?

    This is perhaps one of the most thoughtful investigations; the author (a National Geographic researcher) toured and researched all the Blue Zones, took many many notes (we get details), and asked a lot of questions that others skipped.

    For example, a lot of books about the Blue Zones mention the importance of community—but they don’t go into much detail of what that looks like… And they certainly don’t tend to explain what we should do about it.

    And that’s because community is often viewed as environmental in a way that we can’t control. If we want to take supplements, eat a certain way, exercise, etc, we can do all those things alone if we want. But if we want community? We’re reliant on other people—and that’s a taboo in the US, and US-influenced places.

    So, one way this book excels is in describing how exactly people foster community in the Blue Zones (hint: the big picture—the form of the community—is different in each place, but the individual actions taken are similar), with particular attention to the roles actively taken on by the community elders.

    In a similar vein, “reduce stress” is good, but what mindsets and mechanisms do they use that are still reproducible if we are not, for example, Okinawan farmers? Again, Buettner delivers in spades.

    Bottom line: this is the Blue Zones book that digs deeper than others, and makes the advices much more applicable no matter where we live.

    Click here to check out The Blue Zones, and build these 9 things into your life!

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  • Blood-Sugar Balancing Beetroot Cutlets

    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.

    These beetroot cutlets are meaty and proteinous and fibrous and even have a healthy collection of fats, making these much better for your heart and blood than an animal-based equivalent.

    You will need

    • 1 can kidney beans, drained and rinsed (or 1 cup same, cooked, drained, and rinsed)
    • ½ cup chopped roasted or steamed beetroot, blotted dry
    • ½ cup chopped walnuts (if allergic, substitute with ¼ cup pumpkin seeds)
    • ½ cup cooked (ideally: mixed) grains of your choice (if you need gluten-free, there are plenty of gluten-free grains and pseudocereals)
    • ¼ cup finely chopped onion
    • ¼ bulb garlic, minced or crushed
    • 2 tbsp nutritional yeast
    • 2 tbsp ground flaxseeds
    • 2 tbsp ground chia seeds
    • 2 tsp tomato purée
    • 1 tsp black pepper
    • ½ tsp white miso paste
    • ½ tsp smoked paprika
    • ½ tsp cayenne pepper
    • ¼ tsp MSG or ½ tsp low-sodium salt

    Method

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

    1) Combine the beetroot, beans, walnuts, grains, and onion in a food processor, and process until a coarse even mixture.

    2) Add the remaining ingredients and process to mix thoroughly.

    3) Transfer the mixture to a clean work surface and divide into six balls. If the structural integrity is not good (i.e. too soft), add a little more of any or all of these ingredients: chopped walnuts, ground flax, ground chia, nutritional yeast.

    4) Press the balls firmly into cutlets, and refrigerate for at least 1 hour, but longer is even better if you have the time. Alternatively, if you’d like to freeze them for later use, then this is the point at which to do that.

    5) Preheat the oven to 375℉ / 190℃.

    6) Roast the cutlets on a baking tray lined with baking paper, for about 30 minutes, turning over carefully with a spatula halfway through. They should be firm when done; if they’re not, give them a little longer.

    7) Serve hot, for example on a bed of greens and with a drizzle of aged balsamic vinegar.

    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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  • How do science journalists decide whether a psychology study is worth covering?

    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.

    Complex research papers and data flood academic journals daily, and science journalists play a pivotal role in disseminating that information to the public. This can be a daunting task, requiring a keen understanding of the subject matter and the ability to translate dense academic language into narratives that resonate with the general public.

    Several resources and tip sheets, including the Know Your Research section here at The Journalist’s Resource, aim to help journalists hone their skills in reporting on academic research.

    But what factors do science journalists look for to decide whether a social science research study is trustworthy and newsworthy? That’s the question researchers at the University of California, Davis, and the University of Melbourne in Australia examine in a recent study, “How Do Science Journalists Evaluate Psychology Research?” published in September in Advances in Methods and Practices in Psychological Science.

    Their online survey of 181 mostly U.S.-based science journalists looked at how and whether they were influenced by four factors in fictitious research summaries: the sample size (number of participants in the study), sample representativeness (whether the participants in the study were from a convenience sample or a more representative sample), the statistical significance level of the result (just barely statistically significant or well below the significance threshold), and the prestige of a researcher’s university.

    The researchers found that sample size was the only factor that had a robust influence on journalists’ ratings of how trustworthy and newsworthy a study finding was.

    University prestige had no effect, while the effects of sample representativeness and statistical significance were inconclusive.

    But there’s nuance to the findings, the authors note.

    “I don’t want people to think that science journalists aren’t paying attention to other things, and are only paying attention to sample size,” says Julia Bottesini, an independent researcher, a recent Ph.D. graduate from the Psychology Department at UC Davis, and the first author of the study.

    Overall, the results show that “these journalists are doing a very decent job” vetting research findings, Bottesini says.

    Also, the findings from the study are not generalizable to all science journalists or other fields of research, the authors note.

    “Instead, our conclusions should be circumscribed to U.S.-based science journalists who are at least somewhat familiar with the statistical and replication challenges facing science,” they write. (Over the past decade a series of projects have found that the results of many studies in psychology and other fields can’t be reproduced, leading to what has been called a ‘replication crisis.’)

    “This [study] is just one tiny brick in the wall and I hope other people get excited about this topic and do more research on it,” Bottesini says.

    More on the study’s findings

    The study’s findings can be useful for researchers who want to better understand how science journalists read their research and what kind of intervention — such as teaching journalists about statistics — can help journalists better understand research papers.

    “As an academic, I take away the idea that journalists are a great population to try to study because they’re doing something really important and it’s important to know more about what they’re doing,” says Ellen Peters, director of Center for Science Communication Research at the School of Journalism and Communication at the University of Oregon. Peters, who was not involved in the study, is also a psychologist who studies human judgment and decision-making.

    Peters says the study was “overall terrific.” She adds that understanding how journalists do their work “is an incredibly important thing to do because journalists are who reach the majority of the U.S. with science news, so understanding how they’re reading some of our scientific studies and then choosing whether to write about them or not is important.”

    The study, conducted between December 2020 and March 2021, is based on an online survey of journalists who said they at least sometimes covered science or other topics related to health, medicine, psychology, social sciences, or well-being. They were offered a $25 Amazon gift card as compensation.

    Among the participants, 77% were women, 19% were men, 3% were nonbinary and 1% preferred not to say. About 62% said they had studied physical or natural sciences at the undergraduate level, and 24% at the graduate level. Also, 48% reported having a journalism degree. The study did not include the journalists’ news reporting experience level.

    Participants were recruited through the professional network of Christie Aschwanden, an independent journalist and consultant on the study, which could be a source of bias, the authors note.

    “Although the size of the sample we obtained (N = 181) suggests we were able to collect a range of perspectives, we suspect this sample is biased by an ‘Aschwanden effect’: that science journalists in the same professional network as C. Aschwanden will be more familiar with issues related to the replication crisis in psychology and subsequent methodological reform, a topic C. Aschwanden has covered extensively in her work,” they write.

    Participants were randomly presented with eight of 22 one-paragraph fictitious social and personality psychology research summaries with fictitious authors. The summaries are posted on Open Science Framework, a free and open-source project management tool for researchers by the Center for Open Science, with a mission to increase openness, integrity and reproducibility of research.

    For instance, one of the vignettes reads:

    “Scientists at Harvard University announced today the results of a study exploring whether introspection can improve cooperation. 550 undergraduates at the university were randomly assigned to either do a breathing exercise or reflect on a series of questions designed to promote introspective thoughts for 5 minutes. Participants then engaged in a cooperative decision-making game, where cooperation resulted in better outcomes. People who spent time on introspection performed significantly better at these cooperative games (t (548) = 3.21, p = 0.001). ‘Introspection seems to promote better cooperation between people,’ says Dr. Quinn, the lead author on the paper.”

    In addition to answering multiple-choice survey questions, participants were given the opportunity to answer open-ended questions, such as “What characteristics do you [typically] consider when evaluating the trustworthiness of a scientific finding?”

    Bottesini says those responses illuminated how science journalists analyze a research study. Participants often mentioned the prestige of the journal in which it was published or whether the study had been peer-reviewed. Many also seemed to value experimental research designs over observational studies.

    Considering statistical significance

    When it came to considering p-values, “some answers suggested that journalists do take statistical significance into account, but only very few included explanations that suggested they made any distinction between higher or lower p values; instead, most mentions of p values suggest journalists focused on whether the key result was statistically significant,” the authors write.

    Also, many participants mentioned that it was very important to talk to outside experts or researchers in the same field to get a better understanding of the finding and whether it could be trusted, the authors write.

    “Journalists also expressed that it was important to understand who funded the study and whether the researchers or funders had any conflicts of interest,” they write.

    Participants also “indicated that making claims that were calibrated to the evidence was also important and expressed misgivings about studies for which the conclusions do not follow from the evidence,” the authors write.

    In response to the open-ended question, “What characteristics do you [typically] consider when evaluating the trustworthiness of a scientific finding?” some journalists wrote they checked whether the study was overstating conclusions or claims. Below are some of their written responses:

    • “Is the researcher adamant that this study of 40 college kids is representative? If so, that’s a red flag.”
    • “Whether authors make sweeping generalizations based on the study or take a more measured approach to sharing and promoting it.”
    • “Another major point for me is how ‘certain’ the scientists appear to be when commenting on their findings. If a researcher makes claims which I consider to be over-the-top about the validity or impact of their findings, I often won’t cover.”
    • “I also look at the difference between what an experiment actually shows versus the conclusion researchers draw from it — if there’s a big gap, that’s a huge red flag.”

    Peters says the study’s findings show that “not only are journalists smart, but they have also gone out of their way to get educated about things that should matter.”

    What other research shows about science journalists

    A 2023 study, published in the International Journal of Communication, based on an online survey of 82 U.S. science journalists, aims to understand what they know and think about open-access research, including peer-reviewed journals and articles that don’t have a paywall, and preprints. Data was collected between October 2021 and February 2022. Preprints are scientific studies that have yet to be peer-reviewed and are shared on open repositories such as medRxiv and bioRxiv. The study finds that its respondents “are aware of OA and related issues and make conscious decisions around which OA scholarly articles they use as sources.”

    A 2021 study, published in the Journal of Science Communication, looks at the impact of the COVID-19 pandemic on the work of science journalists. Based on an online survey of 633 science journalists from 77 countries, it finds that the pandemic somewhat brought scientists and science journalists closer together. “For most respondents, scientists were more available and more talkative,” the authors write. The pandemic has also provided an opportunity to explain the scientific process to the public, and remind them that “science is not a finished enterprise,” the authors write.

    More than a decade ago, a 2008 study, published in PLOS Medicine, and based on an analysis of 500 health news stories, found that “journalists usually fail to discuss costs, the quality of the evidence, the existence of alternative options, and the absolute magnitude of potential benefits and harms,” when reporting on research studies. Giving time to journalists to research and understand the studies, giving them space for publication and broadcasting of the stories, and training them in understanding academic research are some of the solutions to fill the gaps, writes Gary Schwitzer, the study author.

    Advice for journalists

    We asked Bottesini, Peters, Aschwanden and Tamar Wilner, a postdoctoral fellow at the University of Texas, who was not involved in the study, to share advice for journalists who cover research studies. Wilner is conducting a study on how journalism research informs the practice of journalism. Here are their tips:

    1. Examine the study before reporting it.

    Does the study claim match the evidence? “One thing that makes me trust the paper more is if their interpretation of the findings is very calibrated to the kind of evidence that they have,” says Bottesini. In other words, if the study makes a claim in its results that’s far-fetched, the authors should present a lot of evidence to back that claim.

    Not all surprising results are newsworthy. If you come across a surprising finding from a single study, Peters advises you to step back and remember Carl Sagan’s quote: “Extraordinary claims require extraordinary evidence.”

    How transparent are the authors about their data? For instance, are the authors posting information such as their data and the computer codes they use to analyze the data on platforms such as Open Science Framework, AsPredicted, or The Dataverse Project? Some researchers ‘preregister’ their studies, which means they share how they’re planning to analyze the data before they see them. “Transparency doesn’t automatically mean that a study is trustworthy,” but it gives others the chance to double-check the findings, Bottesini says.

    Look at the study design. Is it an experimental study or an observational study? Observational studies can show correlations but not causation.

    “Observational studies can be very important for suggesting hypotheses and pointing us towards relationships and associations,” Aschwanden says.

    Experimental studies can provide stronger evidence toward a cause, but journalists must still be cautious when reporting the results, she advises. “If we end up implying causality, then once it’s published and people see it, it can really take hold,” she says.

    Know the difference between preprints and peer-reviewed, published studies. Peer-reviewed papers tend to be of higher quality than those that are not peer-reviewed. Read our tip sheet on the difference between preprints and journal articles.

    Beware of predatory journals. Predatory journals are journals that “claim to be legitimate scholarly journals, but misrepresent their publishing practices,” according to a 2020 journal article, published in the journal Toxicologic Pathology,Predatory Journals: What They Are and How to Avoid Them.”

    2. Zoom in on data.

    Read the methods section of the study. The methods section of the study usually appears after the introduction and background section. “To me, the methods section is almost the most important part of any scientific paper,” says Aschwanden. “It’s amazing to me how often you read the design and the methods section, and anyone can see that it’s a flawed design. So just giving things a gut-level check can be really important.”

    What’s the sample size? Not all good studies have large numbers of participants but pay attention to the claims a study makes with a small sample size. “If you have a small sample, you calibrate your claims to the things you can tell about those people and don’t make big claims based on a little bit of evidence,” says Bottesini.

    But also remember that factors such as sample size and p-value are not “as clear cut as some journalists might assume,” says Wilner.

    How representative of a population is the study sample? “If the study has a non-representative sample of, say, undergraduate students, and they’re making claims about the general population, that’s kind of a red flag,” says Bottesini. Aschwanden points to the acronym WEIRD, which stands for “Western, Educated, Industrialized, Rich, and Democratic,” and is used to highlight a lack of diversity in a sample. Studies based on such samples may not be generalizable to the entire population, she says.

    Look at the p-value. Statistical significance is both confusing and controversial, but it’s important to consider. Read our tip sheet, “5 Things Journalists Need to Know About Statistical Significance,” to better understand it.

    3. Talk to scientists not involved in the study.

    If you’re not sure about the quality of a study, ask for help. “Talk to someone who is an expert in study design or statistics to make sure that [the study authors] use the appropriate statistics and that methods they use are appropriate because it’s amazing to me how often they’re not,” says Aschwanden.

    Get an opinion from an outside expert. It’s always a good idea to present the study to other researchers in the field, who have no conflicts of interest and are not involved in the research you’re covering and get their opinion. “Don’t take scientists at their word. Look into it. Ask other scientists, preferably the ones who don’t have a conflict of interest with the research,” says Bottesini.

    4. Remember that a single study is simply one piece of a growing body of evidence.

    “I have a general rule that a single study doesn’t tell us very much; it just gives us proof of concept,” says Peters. “It gives us interesting ideas. It should be retested. We need an accumulation of evidence.”

    Aschwanden says as a practice, she tries to avoid reporting stories about individual studies, with some exceptions such as very large, randomized controlled studies that have been underway for a long time and have a large number of participants. “I don’t want to say you never want to write a single-study story, but it always needs to be placed in the context of the rest of the evidence that we have available,” she says.

    Wilner advises journalists to spend some time looking at the scope of research on the study’s specific topic and learn how it has been written about and studied up to that point.

    “We would want science journalists to be reporting balance of evidence, and not focusing unduly on the findings that are just in front of them in a most recent study,” Wilner says. “And that’s a very difficult thing to as journalists to do because they’re being asked to make their article very newsy, so it’s a difficult balancing act, but we can try and push journalists to do more of that.”

    5. Remind readers that science is always changing.

    “Science is always two steps forward, one step back,” says Peters. Give the public a notion of uncertainty, she advises. “This is what we know today. It may change tomorrow, but this is the best science that we know of today.”

    Aschwanden echoes the sentiment. “All scientific results are provisional, and we need to keep that in mind,” she says. “It doesn’t mean that we can’t know anything, but it’s very important that we don’t overstate things.”

    Authors of a study published in PNAS in January analyzed more than 14,000 psychology papers and found that replication success rates differ widely by psychology subfields. That study also found that papers that could not be replicated received more initial press coverage than those that could. 

    The authors note that the media “plays a significant role in creating the public’s image of science and democratizing knowledge, but it is often incentivized to report on counterintuitive and eye-catching results.”

    Ideally, the news media would have a positive relationship with replication success rates in psychology, the authors of the PNAS study write. “Contrary to this ideal, however, we found a negative association between media coverage of a paper and the paper’s likelihood of replication success,” they write. “Therefore, deciding a paper’s merit based on its media coverage is unwise. It would be valuable for the media to remind the audience that new and novel scientific results are only food for thought before future replication confirms their robustness.”

    Additional reading

    Uncovering the Research Behaviors of Reporters: A Conceptual Framework for Information Literacy in Journalism
    Katerine E. Boss, et al. Journalism & Mass Communication Educator, October 2022.

    The Problem with Psychological Research in the Media
    Steven Stosny. Psychology Today, September 2022.

    Critically Evaluating Claims
    Megha Satyanarayana, The Open Notebook, January 2022.

    How Should Journalists Report a Scientific Study?
    Charles Binkley and Subramaniam Vincent. Markkula Center for Applied Ethics at Santa Clara University, September 2020.

    What Journalists Get Wrong About Social Science: Full Responses
    Brian Resnick. Vox, January 2016.

    From The Journalist’s Resource

    8 Ways Journalists Can Access Academic Research for Free

    5 Things Journalists Need to Know About Statistical Significance

    5 Common Research Designs: A Quick Primer for Journalists

    5 Tips for Using PubPeer to Investigate Scientific Research Errors and Misconduct

    Percent Change versus Percentage-Point Change: What’s the Difference? 4 Tips for Avoiding Math Errors

    What’s Standard Deviation? 4 Things Journalists Need to Know

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response

    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.

    BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.

    Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.

    Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”

    As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.

    Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.

    The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.

    Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.

    But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.

    Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.

    Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.

    “If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”

    From Pioneer to Lagger

    California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.

    The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.

    Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.

    In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.

    When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.

    Fall From Grace

    Morrow’s troubles started long after the original California program had been shut down.

    The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.

    But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.

    The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.

    Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”

    By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”

    Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.

    “I didn’t have to feel naked and judged,” she said.

    Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.

    Physician Privacy vs. Patient Protection

    The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.

    Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.

    Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.

    Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.

    “To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.

    Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.

    The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.

    People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.

    “The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.

    The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.

    Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.

    “I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    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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  • Powered by Plants – by Ocean Robbins & Nichole Dandrea-Russert

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    Of the two authors, the former is a professional public speaker, and the latter is a professional dietician. As a result, we get a book that is polished and well-presented, while actually having a core of good solid science (backed up with plenty of references).

    There’s an introductory section that’s all about the “notable nutrients”, that will be focused on in the ingredients choices for the recipes in the rest of the book.

    The recipes themselves are simple enough to do quickly, yet interesting enough that you’ll want to do them, and certainly they contain all the plant-based nutrient-density you might expect.

    Bottom line: if you’d like to expand your plant-based cooking with a focus on nutrition and ease without sacrificing fun, then this is a great cookbook for that.

    Click here to check out Powered by Plants, and get powered by plants!

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  • Yes, we still need chickenpox vaccines

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    For people who grew up before a vaccine was available, chickenpox is largely remembered as an unpleasant experience that almost every child suffered through. The highly contagious disease tore through communities, leaving behind more than a few lasting scars. 

    For many children, chickenpox was much more than a week or two of itchy discomfort. It was a serious and sometimes life-threatening infection.

    Prior to the chickenpox vaccine’s introduction in 1995, 90 percent of children got chickenpox. Those children grew into adults with an increased risk of developing shingles, a disease caused by the same virus—varicella-zoster—as chickenpox, which lies dormant in the body for decades. 

    The vaccine changed all that, nearly wiping out chickenpox in the U.S. in under three decades. The vaccine has been so successful that some people falsely believe the disease no longer exists and that vaccination is unnecessary. This couldn’t be further from the truth. 

    Vaccination spares children and adults from the misery of chickenpox and the serious short- and long-term risks associated with the disease. The CDC estimates that 93 percent of children in the U.S. are fully vaccinated against chickenpox. However, outbreaks can still occur among unvaccinated and under-vaccinated populations. 

    Here are some of the many reasons why we still need chickenpox vaccines.

    Chickenpox is more serious than you may remember

    For most children, chickenpox lasts around a week. Symptoms vary in severity but typically include a rash of small, itchy blisters that scab over, fever, fatigue, and headache. 

    However, in one out of every 4,000 chickenpox cases, the virus infects the brain, causing swelling. If the varicella-zoster virus makes it to the part of the brain that controls balance and muscle movements, it can cause a temporary loss of muscle control in the limbs that can last for months. Chickenpox can also cause other serious complications, including skin, lung, and blood infections. 

    Prior to the U.S.’ approval of the vaccine in 1995, children accounted for most of the country’s chickenpox cases, with over 10,000 U.S. children hospitalized with chickenpox each year. 

    The chickenpox vaccine is very effective and safe

    Chickenpox is an extremely contagious disease. People without immunity have a 90 percent chance of contracting the virus if exposed. 

    Fortunately, the chickenpox vaccine provides lifetime protection and is around 90 percent effective against infection and nearly 100 percent effective against severe illness. It also reduces the risk of developing shingles later in life. 

    In addition to being incredibly effective, the chickenpox vaccine is very safe, and serious side effects are extremely rare. Some people may experience mild side effects after vaccination, such as pain at the injection site and a low fever.

    Although infection provides immunity against future chickenpox infections, letting children catch chickenpox to build up immunity is never worth the risk, especially when a safe vaccine is available. The purpose of vaccination is to gain immunity without serious risk. 

    The chickenpox vaccine is one of the greatest vaccine success stories in history

    It’s difficult to overstate the impact of the chickenpox vaccine. Within five years of the U.S. beginning universal vaccination against chickenpox, the disease had declined by over 80 percent in some regions. 

    Nearly 30 years after the introduction of the chickenpox vaccine, the disease is almost completely wiped out. Cases and hospitalizations have plummeted by 97 percent, and chickenpox deaths among people under 20 are essentially nonexistent

    Thanks to the vaccine, in less than a generation, a disease that once swept through schools and affected nearly every child has been nearly eliminated. And, unlike vaccines introduced in the early 20th century, no one can argue that improved hygiene, sanitation, and health helped reduce chickenpox cases beginning in the 1990s.

    Having chickenpox as a child puts you at risk of shingles later

    Although most people recover from chickenpox within a week or two, the virus that causes the disease, varicella-zoster, remains dormant in the body. This latent virus can reactivate years after the original infection as shingles, a tingling or burning rash that can cause severe pain and nerve damage.  

    One in 10 people who have chickenpox will develop shingles later in life. The risk increases as people get older as well as for those with weakened immune systems. 

    Getting chickenpox as an adult can be deadly

    Although chickenpox is generally considered a childhood disease, it can affect unvaccinated people of any age. In fact, adult chickenpox is far deadlier than pediatric cases. 

    Serious complications like pneumonia and brain swelling are more common in adults than in children with chickenpox. One in 400 adults who get chickenpox develops pneumonia, and one to two out of 1,000 develop brain swelling.

    Vaccines have virtually eliminated chickenpox, but outbreaks still happen

    Although the chickenpox vaccine has dramatically reduced the impact of a once widespread disease, declining immunity could lead to future outbreaks. A Centers for Disease Control and Prevention analysis found that chickenpox vaccination rates dropped in half of U.S. states in the 2022-2023 school year compared to the previous year. And more than a dozen states have immunization rates below 90 percent.

    In 2024, New York City and Florida had chickenpox outbreaks that primarily affected unvaccinated and under-vaccinated children. With declining public confidence in routine vaccines and rising school vaccine exemption rates, these types of outbreaks will likely become more common.

    The CDC recommends that children receive two chickenpox vaccine doses before age 6. Older children and adults who are unvaccinated and have never had chickenpox should also receive two doses of the vaccine.

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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