What Mattress Is Best, By Science?
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The Foundations of Good Sleep
You probably know the importance of good sleep for good health. If not, here’s a quick refresher:
- Why You Probably Need More Sleep
- How Sleep-Deprived Are You, Really?
- The 6 Dimensions Of Sleep (And Why They Matter)
You should also definitely check out this quite famous book on the topic:
Why We Sleep – by Dr Matthew Walker
What helps, to get that good sleep
We’ve covered this a little before too, for example:
- Safe Effective Sleep Aids For Seniors
- Sleep Better With Better Air
- How To Nap Like A Pro (No More “Sleep Hangovers”!)
How to level-up from there
One of the biggest barriers to good sleep for many people is obstructive sleep apea:
Healthier, Natural Sleep Without Obstruction!
We covered (in the above article) a whole lot of ways of mitigating/managing obstructive sleep apnea. One of the things we mentioned as beneficial was avoiding sleeping on one’s back, and this is something Mayo Clinic’s Dr. Somers agreed with:
Back Sleeping, And Sleeping Differently After 50
“But side-sleeping is uncomfortable”
If this is you, then chances are you have the wrong mattress.
If your mattress is too firm, you can get around it by using this “five pillow” method:
Click Here If The Embedded Video Doesn’t Load Automatically
If your mattress is too soft, then sorry, you really just have to throw that thing out and start again.
The Goldilocks mattress
While different people will have different subjective preferences, the science is quite clear on what is actually best for people’s spines. As this review of 39 qualified scholarly articles concluded:
❝Results of this systematic review show that a medium-firm mattress promotes comfort, sleep quality and rachis alignment❞
~ Dr. Gianfilippo Caggiari et al.
Read in full: What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature
Note: to achieve “medium-firm” that remains “medium firm” has generally been assumed to require a memory-foam mattress.
How memory-foam works: memory-foam is a moderately thermosoftening material, designed to slightly soften at the touch of human body temperature, and be firmer at room temperature. This will result in it molding itself to the form of a human body, providing what amounts to personalized support for your personal shape and size, meaning your spine can stay exactly as it’s supposed to when you’re sleeping on your side, instead of (for example) your hips being wider meaning that your lumbar vertebrae are raised higher than your thoracic vertebrae, giving you the equivalent of a special nocturnal scoliosis.
It will, therefore, stop working if
- the ambient temperature is comparable to human body temperature (as happens in some places sometimes, and increasingly often these days)
- you die, and thus lose your body temperature (but in that case, your spinal alignment will be the least of your concerns)
Here’s a good explanation of the mechanics of memory foam from the Sleep Foundation:
Sleep Foundation | What is Memory Foam?
An alternative to memory foam?
If you don’t like memory foam (one criticism is that it doesn’t allow good ventilation underneath the body), there is an alterative, the grid mattress.
It’s very much “the new kid on the block” and the science is young for this, but for example this recent (April 2024) study that concluded:
❝The grid mattress is a simple, noninvasive, and nonpharmacological intervention that improved adults sleep quality and health. Controlled trials are encouraged to examine the effects of this mattress in a variety of populations and environments.❞
~ Dr. Heather Hausenblas et al.
Read in full: Effectiveness of a grid mattress on adults’ sleep quality and health: A quasi-experimental intervention study
However, that was a small (n=39) uncontrolled (i.e. there was no control group) study, and the conflict of interest statement is, well, interesting:
❝Heather A. Hausenblas, Stephanie L. Hooper, Martin Barragan, and Tarah Lynch declare no conflict of interest. Michael Breus served as a former consultant for Purple, LLC.❞
~ Ibid.
…which is a fabulous way of distracting from the mention in the “Acknowledgements” section to follow, that…
❝Purple, LLC, provided financial support for the study❞
~ Ibid.
Purple is the company that invented the mattress being tested. So while this doesn’t mean the study is necessarily dishonest and/or corrupt, it does at the very least raise a red flag for a potential instance of publication bias (because Purple may have funded multiple studies and then pulled funding of the ones that weren’t going their way).
If you are interested in Purple’s mattress and how it works, you can check it out here ← this is a link for your interest and information; not an advertisement or an endorsement. We look forward to seeing more science for this though, and echo their own call for randomized controlled trials!
Summary
Sleep is important, and while it’s a popular myth that we need less as we get older, the truth is that we merely get less on average, while still needing the same amount.
A medium-firm memory-foam mattress is a very good, well-evidenced way to support that (both figuratively and literally!).
A grid mattress is an interesting innovation, and/but we’d like to see more science for it.
Take care!
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7 Kinds Of Rest When Sleep Is Not Enough
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Taking Rest Seriously (More Than Just Sleep)
This is Dr. Matthew Edlund. He has 44 years experience as a psychiatrist, and is also a sleep specialist. He has a holistic view of health, which is reflected in his practice; he advocates for “a more complete health: physical, mental, social, and spiritual well-being”.
What does he want us to know?
Sleep, yes
Sleep cannot do all things for us in terms of rest, but it can do a lot, and it is critical. It is, in short, a necessary-but-not-sufficient condition for being well-rested.
See also: Why You Probably Need More Sleep
Rest actively
Rest is generally thought of as a passive activity, if you’ll pardon the oxymoron. Popular thinking is that it’s not something defined by what we do, so much what we stop doing.
In contrast, Dr. Edlund argues that to take rest seriously, we need do restful things.
Rest is as important as eating, and we wouldn’t want for that to “just happen”, would we?
Dr. Edlund advocates for restful activities such as going to the garden (or a nearby park) to relax. He also suggests we not underestimate the power of sex as an actively restful activity—this one is generally safer in the privacy of one’s home, though!
Rest physically
This is about actively relaxing our body—yoga is a great option here, practised in a way that is not physically taxing, but is physically rejuvenating; gentle stretches are key. Without such things, our body will keep tension, and that is not restful.
For the absolute most restful yogic practice? Check out:
Non-Sleep Deep Rest: A Neurobiologist’s Take
this is about yoga nidra!
Rest mentally
The flipside of the above is that we do need to rest our mind also. When we try to rest from a mental activity by taking on a different mental activity that uses the same faculties of the brain, it is not restful.
Writer’s example: as a writer, I could not rest from my writing by writing recreationally, or even by reading. An accountant, however, could absolutely rest from accounting by picking up a good book, should they feel so inclined.
Rest socially
While we all have our preferences when it comes to how much or how little social interaction we like in our lives, humans are fundamentally social creatures, and it is hardwired into us by evolution to function at our best in a community.
This doesn’t mean you have to go out partying every night, but it does mean you should take care to spend at least a little time with friends, even if just once or twice per week, and yes, even if it’s just a videocall (in person is best, but not everyone lives close by!)
If your social life is feeling a little thin on the ground these days, that’s a very common thing—not only as we get older, but also as many social institutions took a dive in functionality on account of the pandemic, and many are still floundering. Nevertheless, there are more options than you probably realize; yes, even for the naturally reclusive:
How To Beat Loneliness & Isolation
Rest spiritually
Be we religious or not, there are scientifically well-evidenced benefits to religious practices—some are because of the social aspect, and follow on from what we talked about just above. Other benefits come from activities such as prayer or meditation (which means that having some kind of faith, while beneficial, is not actually a requirement for spiritual rest—comparable practices without faith are fine too).
We discussed the overlapping practices of prayer and meditation, here:
The Science Of Mantra Meditation
Rest at home
Obviously, most people sleep at home. But…
Busy family homes can sometimes need a bit of conscious effort to create a restful environment, even if just for a while. A family dinner together is one great way to achieve this, and also ties in with the social element we mentioned before!
A different challenge faced by a lot of older people without live-in families, on the other hand, is the feeling of too much opportunity for rest—and then a feeling of shame for taking it. The view is commonly held that, for example, taking an afternoon nap is a sign of weakness.
On the contrary: taking an afternoon nap can be a good source of strength! Check out:
How To Nap Like A Pro (No More “Sleep Hangovers”!)
Rest at work
Our readership has a lot of retirees, but we know that’s not the case for everyone. How then, to rest while at work? Ideally we have breaks, of course, but most workplaces do not exactly have an amusement arcade in the break room. Nevertheless, there are some quick resets that can be done easily, anywhere, and (almost) any time:
Meditation Games: Meditation That You’ll Actually Enjoy
Want to know more?
You might also like:
How To Rest More Efficiently (Yes, Really)
Take care!
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How do science journalists decide whether a psychology study is worth covering?
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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
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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Artichoke vs Brussels Sprouts – Which is Healthier?
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Our Verdict
When comparing artichoke to Brussels sprouts, we picked the sprouts.
Why?
Finally, a vegetable that beats artichoke—after it previously beat heart-of-palm, asparagus, and even cabbage! It was still close though, which is impressive for artichoke, considering what a nutritional powerhouse Brussels sprouts are:
In terms of macros, the only meaningful difference is that artichoke has slightly more carbs and fiber, so artichoke gets the most marginal of nominal wins in this category.
In the category of vitamins, however, artichoke has more of vitamins B3, B9, and choline, while Brussels sprouts have more of vitamins A, B1, B2, B6, C, E, and K, giving sprouts the clear victory here, especially with much higher margins of difference (e.g. 58x more vitamin A, as well as 7x more vitamin C, and 10x more vitamin K).
When it comes to minerals, artichoke has more copper, magnesium, phosphorus, and zinc, while Brussels sprouts have more iron, manganese, potassium, and selenium, resulting in a 4:4 tie, and the small margins of difference are mostly comparable, with the exception that sprouts have 8x more selenium. So, Brussels sprouts win this category very marginally on that tie-breaker.
Adding up the sections we see that macros and minerals gave a small win each to artichoke and sprouts respectively, while the vitamins category was an overwhelming win for sprouts, so—with this deciding factor in mind—sprouts win the day today.
Want to learn more?
You might like to read:
Sprout Your Seeds, Grains, Beans, Etc
Enjoy!
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Overdosing on Chemo: A Common Gene Test Could Save Hundreds of Lives Each Year
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One January morning in 2021, Carol Rosen took a standard treatment for metastatic breast cancer. Three gruesome weeks later, she died in excruciating pain from the very drug meant to prolong her life.
Rosen, a 70-year-old retired schoolteacher, passed her final days in anguish, enduring severe diarrhea and nausea and terrible sores in her mouth that kept her from eating, drinking, and, eventually, speaking. Skin peeled off her body. Her kidneys and liver failed. “Your body burns from the inside out,” said Rosen’s daughter, Lindsay Murray, of Andover, Massachusetts.
Rosen was one of more than 275,000 cancer patients in the United States who are infused each year with fluorouracil, known as 5-FU, or, as in Rosen’s case, take a nearly identical drug in pill form called capecitabine. These common types of chemotherapy are no picnic for anyone, but for patients who are deficient in an enzyme that metabolizes the drugs, they can be torturous or deadly.
Those patients essentially overdose because the drugs stay in the body for hours rather than being quickly metabolized and excreted. The drugs kill an estimated 1 in 1,000 patients who take them — hundreds each year — and severely sicken or hospitalize 1 in 50. Doctors can test for the deficiency and get results within a week — and then either switch drugs or lower the dosage if patients have a genetic variant that carries risk.
Yet a recent survey found that only 3% of U.S. oncologists routinely order the tests before dosing patients with 5-FU or capecitabine. That’s because the most widely followed U.S. cancer treatment guidelines — issued by the National Comprehensive Cancer Network — don’t recommend preemptive testing.
The FDA added new warnings about the lethal risks of 5-FU to the drug’s label on March 21 following queries from KFF Health News about its policy. However, it did not require doctors to administer the test before prescribing the chemotherapy.
The agency, whose plan to expand its oversight of laboratory testing was the subject of a House hearing, also March 21, has said it could not endorse the 5-FU toxicity tests because it’s never reviewed them.
But the FDA at present does not review most diagnostic tests, said Daniel Hertz, an associate professor at the University of Michigan College of Pharmacy. For years, with other doctors and pharmacists, he has petitioned the FDA to put a black box warning on the drug’s label urging prescribers to test for the deficiency.
“FDA has responsibility to assure that drugs are used safely and effectively,” he said. The failure to warn, he said, “is an abdication of their responsibility.”
The update is “a small step in the right direction, but not the sea change we need,” he said.
Europe Ahead on Safety
British and European Union drug authorities have recommended the testing since 2020. A small but growing number of U.S. hospital systems, professional groups, and health advocates, including the American Cancer Society, also endorse routine testing. Most U.S. insurers, private and public, will cover the tests, which Medicare reimburses for $175, although tests may cost more depending on how many variants they screen for.
In its latest guidelines on colon cancer, the Cancer Network panel noted that not everyone with a risky gene variant gets sick from the drug, and that lower dosing for patients carrying such a variant could rob them of a cure or remission. Many doctors on the panel, including the University of Colorado oncologist Wells Messersmith, have said they have never witnessed a 5-FU death.
In European hospitals, the practice is to start patients with a half- or quarter-dose of 5-FU if tests show a patient is a poor metabolizer, then raise the dose if the patient responds well to the drug. Advocates for the approach say American oncology leaders are dragging their feet unnecessarily, and harming people in the process.
“I think it’s the intransigence of people sitting on these panels, the mindset of ‘We are oncologists, drugs are our tools, we don’t want to go looking for reasons not to use our tools,’” said Gabriel Brooks, an oncologist and researcher at the Dartmouth Cancer Center.
Oncologists are accustomed to chemotherapy’s toxicity and tend to have a “no pain, no gain” attitude, he said. 5-FU has been in use since the 1950s.
Yet “anybody who’s had a patient die like this will want to test everyone,” said Robert Diasio of the Mayo Clinic, who helped carry out major studies of the genetic deficiency in 1988.
Oncologists often deploy genetic tests to match tumors in cancer patients with the expensive drugs used to shrink them. But the same can’t always be said for gene tests aimed at improving safety, said Mark Fleury, policy director at the American Cancer Society’s Cancer Action Network.
When a test can show whether a new drug is appropriate, “there are a lot more forces aligned to ensure that testing is done,” he said. “The same stakeholders and forces are not involved” with a generic like 5-FU, first approved in 1962, and costing roughly $17 for a month’s treatment.
Oncology is not the only area in medicine in which scientific advances, many of them taxpayer-funded, lag in implementation. For instance, few cardiologists test patients before they go on Plavix, a brand name for the anti-blood-clotting agent clopidogrel, although it doesn’t prevent blood clots as it’s supposed to in a quarter of the 4 million Americans prescribed it each year. In 2021, the state of Hawaii won an $834 million judgment from drugmakers it accused of falsely advertising the drug as safe and effective for Native Hawaiians, more than half of whom lack the main enzyme to process clopidogrel.
The fluoropyrimidine enzyme deficiency numbers are smaller — and people with the deficiency aren’t at severe risk if they use topical cream forms of the drug for skin cancers. Yet even a single miserable, medically caused death was meaningful to the Dana-Farber Cancer Institute, where Carol Rosen was among more than 1,000 patients treated with fluoropyrimidine in 2021.
Her daughter was grief-stricken and furious after Rosen’s death. “I wanted to sue the hospital. I wanted to sue the oncologist,” Murray said. “But I realized that wasn’t what my mom would want.”
Instead, she wrote Dana-Farber’s chief quality officer, Joe Jacobson, urging routine testing. He responded the same day, and the hospital quickly adopted a testing system that now covers more than 90% of prospective fluoropyrimidine patients. About 50 patients with risky variants were detected in the first 10 months, Jacobson said.
Dana-Farber uses a Mayo Clinic test that searches for eight potentially dangerous variants of the relevant gene. Veterans Affairs hospitals use a 11-variant test, while most others check for only four variants.
Different Tests May Be Needed for Different Ancestries
The more variants a test screens for, the better the chance of finding rarer gene forms in ethnically diverse populations. For example, different variants are responsible for the worst deficiencies in people of African and European ancestry, respectively. There are tests that scan for hundreds of variants that might slow metabolism of the drug, but they take longer and cost more.
These are bitter facts for Scott Kapoor, a Toronto-area emergency room physician whose brother, Anil Kapoor, died in February 2023 of 5-FU poisoning.
Anil Kapoor was a well-known urologist and surgeon, an outgoing speaker, researcher, clinician, and irreverent friend whose funeral drew hundreds. His death at age 58, only weeks after he was diagnosed with stage 4 colon cancer, stunned and infuriated his family.
In Ontario, where Kapoor was treated, the health system had just begun testing for four gene variants discovered in studies of mostly European populations. Anil Kapoor and his siblings, the Canadian-born children of Indian immigrants, carry a gene form that’s apparently associated with South Asian ancestry.
Scott Kapoor supports broader testing for the defect — only about half of Toronto’s inhabitants are of European descent — and argues that an antidote to fluoropyrimidine poisoning, approved by the FDA in 2015, should be on hand. However, it works only for a few days after ingestion of the drug and definitive symptoms often take longer to emerge.
Most importantly, he said, patients must be aware of the risk. “You tell them, ‘I am going to give you a drug with a 1 in 1,000 chance of killing you. You can take this test. Most patients would be, ‘I want to get that test and I’ll pay for it,’ or they’d just say, ‘Cut the dose in half.’”
Alan Venook, the University of California-San Francisco oncologist who co-chairs the panel that sets guidelines for colorectal cancers at the National Comprehensive Cancer Network, has led resistance to mandatory testing because the answers provided by the test, in his view, are often murky and could lead to undertreatment.
“If one patient is not cured, then you giveth and you taketh away,” he said. “Maybe you took it away by not giving adequate treatment.”
Instead of testing and potentially cutting a first dose of curative therapy, “I err on the latter, acknowledging they will get sick,” he said. About 25 years ago, one of his patients died of 5-FU toxicity and “I regret that dearly,” he said. “But unhelpful information may lead us in the wrong direction.”
In September, seven months after his brother’s death, Kapoor was boarding a cruise ship on the Tyrrhenian Sea near Rome when he happened to meet a woman whose husband, Atlanta municipal judge Gary Markwell, had died the year before after taking a single 5-FU dose at age 77.
“I was like … that’s exactly what happened to my brother.”
Murray senses momentum toward mandatory testing. In 2022, the Oregon Health & Science University paid $1 million to settle a suit after an overdose death.
“What’s going to break that barrier is the lawsuits, and the big institutions like Dana-Farber who are implementing programs and seeing them succeed,” she said. “I think providers are going to feel kind of bullied into a corner. They’re going to continue to hear from families and they are going to have to do something about it.”
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.
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Study links microplastics with human health problems – but there’s still a lot we don’t know
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Mark Patrick Taylor, Macquarie University and Scott P. Wilson, Macquarie University
A recent study published in the prestigious New England Journal of Medicine has linked microplastics with risk to human health.
The study involved patients in Italy who had a condition called carotid artery plaque, where plaque builds up in arteries, potentially blocking blood flow. The researchers analysed plaque specimens from these patients.
They found those with carotid artery plaque who had microplastics and nanoplastics in their plaque had a higher risk of heart attack, stroke, or death (compared with carotid artery plaque patients who didn’t have any micro- or nanoplastics detected in their plaque specimens).
Importantly, the researchers didn’t find the micro- and nanoplastics caused the higher risk, only that it was correlated with it.
So, what are we to make of the new findings? And how does it fit with the broader evidence about microplastics in our environment and our bodies?
What are microplastics?
Microplastics are plastic particles less than five millimetres across. Nanoplastics are less than one micron in size (1,000 microns is equal to one millimetre). The precise size classifications are still a matter of debate.
Microplastics and nanoplastics are created when everyday products – including clothes, food and beverage packaging, home furnishings, plastic bags, toys and toiletries – degrade. Many personal care products contain microsplastics in the form of microbeads.
Plastic is also used widely in agriculture, and can degrade over time into microplastics and nanoplastics.
These particles are made up of common polymers such as polyethylene, polypropylene, polystyrene and polyvinyl chloride. The constituent chemical of polyvinyl chloride, vinyl chloride, is considered carcinogenic by the US Environmental Protection Agency.
Of course, the actual risk of harm depends on your level of exposure. As toxicologists are fond of saying, it’s the dose that makes the poison, so we need to be careful to not over-interpret emerging research.
A closer look at the study
This new study in the New England Journal of Medicine was a small cohort, initially comprising 304 patients. But only 257 completed the follow-up part of the study 34 months later.
The study had a number of limitations. The first is the findings related only to asymptomatic patients undergoing carotid endarterectomy (a procedure to remove carotid artery plaque). This means the findings might not be applicable to the wider population.
The authors also point out that while exposure to microplastics and nanoplastics has been likely increasing in recent decades, heart disease rates have been falling.
That said, the fact so many people in the study had detectable levels of microplastics in their body is notable. The researchers found detectable levels of polyethylene and polyvinyl chloride (two types of plastic) in excised carotid plaque from 58% and 12% of patients, respectively.
These patients were more likely to be younger men with diabetes or heart disease and a history of smoking. There was no substantive difference in where the patients lived.
Inflammation markers in plaque samples were more elevated in patients with detectable levels of microplastics and nanoplastics versus those without.
Microplastics are created when everyday products degrade. JS14/Shutterstock And, then there’s the headline finding: patients with microplastics and nanoplastics in their plaque had a higher risk of having what doctors call “a primary end point event” (non-fatal heart attack, non-fatal stroke, or death from any cause) than those who did not present with microplastics and nanoplastics in their plaque.
The authors of the study note their results “do not prove causality”.
However, it would be remiss not to be cautious. The history of environmental health is replete with examples of what were initially considered suspect chemicals that avoided proper regulation because of what the US National Research Council refers to as the “untested-chemical assumption”. This assumption arises where there is an absence of research demonstrating adverse effects, which obviates the requirement for regulatory action.
In general, more research is required to find out whether or not microplastics cause harm to human health. Until this evidence exists, we should adopt the precautionary principle; absence of evidence should not be taken as evidence of absence.
Global and local action
Exposure to microplastics in our home, work and outdoor environments is inevitable. Governments across the globe have started to acknowledge we must intervene.
The Global Plastics Treaty will be enacted by 175 nations from 2025. The treaty is designed, among other things, to limit microplastic exposure globally. Burdens are greatest especially in children and especially those in low-middle income nations.
In Australia, legislation ending single use plastics will help. So too will the increased rollout of container deposit schemes that include plastic bottles.
Microplastics pollution is an area that requires a collaborative approach between researchers, civil societies, industry and government. We believe the formation of a “microplastics national council” would help formulate and co-ordinate strategies to tackle this issue.
Little things matter. Small actions by individuals can also translate to significant overall environmental and human health benefits.
Choosing natural materials, fabrics, and utensils not made of plastic and disposing of waste thoughtfully and appropriately – including recycling wherever possible – is helpful.
Mark Patrick Taylor, Chief Environmental Scientist, EPA Victoria; Honorary Professor, School of Natural Sciences, Macquarie University and Scott P. Wilson, Research Director, Australian Microplastic Assessment Project (AUSMAP); Honorary Senior Research Fellow, School of Natural Sciences, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Put Your Feet Up! (Against A Wall, For 20 Minutes)
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Feel free to browse our articles while you do
Here are 10 good reasons to give it a try; there are another 10 in the short (3:18) video:
- Improves blood circulation
- Improves blood pressure
- Relaxes the body as a whole
- Alleviates lower back tension
- Eases headaches and migraines
- Reduces knee pain
- Relieves swelling in feet and ankles
- Improves lymphatic flow
- Stretches the hamstrings (and hip flexors, if you do it wide)
- Helps quiet the mind
As for the rest…
Click Here If The Embedded Video Doesn’t Load Automatically
PS: about that circulation… As a general rule of thumb, anything that slightly confuses the heart (anatomically, not romantically) will tend to have a beneficial effect, in moderation. This goes for being upside-down (as is partly the case here), and also for high-intensity interval training (HIIT):
How To Do HIIT (Without Wrecking Your Body)
Take care!
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