The Simple Six – by Clinton Dobbins

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We at 10almonds don’t believe in keeping things a mystery, so…

“The Simple Six” are:

  1. the squat
  2. the goblet squat
  3. the hinge
  4. the kettlebell swing
  5. the push
  6. the push-up
  7. the kettle-bell press
  8. the pull
  9. the chin-up
  10. the gait, and
  11. walking.

Ok, we’re being a little glib here because to be fair, those are chunked into six groups, but the point is: don’t let the title fool you into thinking the book could have been an article; there’s plenty of valuable content here.

That said, it is a short book (64 pages), but with an average of 10 pages per exercise type, it’s a lot more than for example we could ever put into our newsletter.

Bottom line: we know that 10almonds readers like simple, clear, evidence-based, to-the-point health information, and that’s what this book is, so we do recommend it.

Click here to check out The Simple Six, and streamline your workouts!

Don’t Forget…

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

Recommended

  • Eat to Live – by Dr. Joel Fuhrman
  • The Biological Mind – by Dr. Alan Jasanoff
    Dr. Alan Jasanoff challenges the notion of the brain’s uniqueness, arguing that who we are is influenced by more than just our brain.

Learn to Age Gracefully

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  • Palliative care as a true art form

    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.

    How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?

    The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.

    Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.

    It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.

    Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.

    What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?

    To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.

    It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.

    This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.

    I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.

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

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  • Are You A Calorie-Burning Machine?

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    Burn, Calorie, Burn

    In Tuesday’s newsletter, we asked you whether you count calories, and got the above-depicted, below-described set of answers:

    • About 56% said “I am somewhat mindful of calories but keep only a rough tally”
    • About 32% said “I do not count calories / I don’t think it’s important for my health”
    • About 13% said “I rigorously check and record the calories of everything I consume”

    So what does the science say, about the merits of all these positions?

    A food’s calorie count is a good measure of how much energy we will, upon consuming the food, have to use or store: True or False?

    False, broadly. It can be, at best, a rough guideline. Do you know what a calorie actually is, by the way? Most people don’t.

    One thing to know before we get to that: there’s “cal” vs “kcal”. The latter is generally used when it comes to foodstuffs, and it’s what we’ll be meaning whenever we say “calorie” here. 1cal is 1/1000th of a kcal, that’s all.

    Now, for what a calorie actually is:

    A calorie is the amount of energy needed to raise the temperature of 1 liter of water by 1℃

    Question: so, how to we measure how much food is needed to do that?

    Answer: by using a bomb calorimeter! Which is the exciting name for the apparatus used to literally burn food and capture the heat produced to indeed raise the temperature of 1 liter of water by 1℃.

    If you’re having trouble imagining such equipment, here it is:

    Bomb Calorimeter: Definition, Construction, & Operation (with diagram and FAQs)

    The unfortunate implication of the above information

    A kilogram of sawdust contains about a 1000 kcal, give or take what wood was used and various other conditions.

    However, that does not mean you can usefully eat the sawdust. In other words:

    Calorie count tells us only how good something is at raising the temperature of water if physically burned.

    Now do you see why oils and sugars have such comparably high calorie counts?

    And while we may talk about “burning calories” as a metaphor, we do not, in fact, have a little wood stove inside us burning the food we eat.

    A calorie is a calorie: True or False?

    Definitely False! Building on from the above… We will get very little energy from sawdust; it’s not just that we can’t use it; we can’t store it either; it’ll mostly pass through as fiber.

    (however, please do not use sawdust to get your daily dose of fiber either, as it is not safe for human consumption and may give you diseases, depending on what is lurking in it)

    But let’s look at oil and sugar, two very high-calorie categories of food, because they’re really easy to physically burn and they give off a good flame.

    A bomb calorimeter may treat them quite equally, but to our body, they are metabolically very different indeed.

    For a start, most sugars will get absorbed and processed much more quickly than most oils, and that can overwhelm the liver (responsible for glycogen management), and lead to non-alcoholic fatty liver disease, diabetes, and more. Metabolic syndrome in general, and if you keep it up too much and you may find it’s now a lottery between dying of NAFLD, diabetes, or heart disease (it’ll usually be the heart disease that kills).

    See also:

    Meanwhile, we know all about the different kinds of nutritional profiles that oils can have, and some can promote having high energy without putting on fat, while others can strain the heart. Not even “a fat is a fat”, so “a calorie is a calorie” doesn’t get much mileage outside of a bomb calorimeter!

    See also:

    A calorie-controlled / calorie-restricted diet is an effective weight loss strategy: True or False?

    True, usually! Surprise!

    • On the one hand: calories are a wildly imprecise way to reckon the value of food, and using them as a guide to health can be dangerously misleading
    • On the other hand: the very activity of calorie-counting itself promotes mindful eating, which is very good for the health

    There is a strong difference between the mind of somebody who is carefully logging their pre-bedtime piece of chocolate and reflecting on its nutritional value, vs someone who isn’t sure whether this is their second or third glass of wine, nor how much the glass contained.

    So if you want to get most of the benefits of a calorie-controlled diet without counting calories, you may try taking a “mindful eating” approach to diet.

    However! If you want to do this for weight loss, be aware, that you will have to practice it all the time, not just for one meal here and there.

    You can read more on how to do “mindful eating” here:

    Dr. Rupy Aujla: The Kitchen Doctor | Mindful Eating & Interoception

    Take care!

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  • Tasty Versatile Rice

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

    In the nearish future, we’re going to do some incredible rice dishes, but first we need to make sure we’re all on the same page about cooking rice, so here’s a simple recipe first, to get technique down and work in some essentials. We’ll be using wholegrain basmati rice, because it has a low glycemic index, lowest likelihood of heavy metal contamination (a problem for some kinds of rice), and it’s one of the easiest rices to cook well.

    You will need

    • 1 cup wholegrain basmati rice (it may also be called “brown basmati rice“; this is the same)
    • 1 1/2 cups vegetable stock (ideally you have made this yourself from vegetable offcuts that you saved in the freezer, then it will be healthiest and lowest in sodium; failing that, low-sodium vegetable stock cubes can be purchased at most large supermarkets. and then made up at home with hot water)
    • 1 tbsp extra virgin olive oil
    • 1 tbsp chia seeds
    • 1 tbsp black pepper, coarse ground
    • 1 tsp turmeric powder (this small quantity will not change the flavor, but it has important health benefits, and also makes the rice a pleasant golden color)
    • 1 tsp garlic powder
    • 1 tsp yeast extract (this gently improves the savory flavor and also adds vitamin B12)
    • Optional small quantity of green herbs for garnish. Cilantro is good (unless you have the soap gene); parsley never fails.

    This is the ingredients list for a super-basic rice that will go with anything rice will go with; another day we can talk more extensive mixes of herbs and spice blends for different kinds of dishes (and different health benefits!), but for now, let’s get going!

    Method

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

    1) Wash the rice thoroughly. We recommend using a made-for-purpose rice-washing bowl (like this one, for example), but failing that, simply rinse it thoroughly with cold water using a bowl and a sieve. You will probably need to rinse it 4–5 times, but with practice, it will only take a few seconds per rinse, and the water will be coming up clear.

    2) Warm the pan. It doesn’t matter for the moment whether you’re using an electronic rice cooker, a stovetop pressure cooker, electronic pressure cooker, or just a sturdy pan with a heavy lid available, aside from that if it’s something non-stovetop, you now want it to be on low to warm up already.

    3) Separately in a saucepan, bring your stock to a simmer

    4) Put the tbsp of olive oil into the pan (even if you’re confident the rice won’t stick; this isn’t entirely about that) and turn up the heat (if it’s a very simple rice cooker, most at least have a warm/cook differentiation; if so, turn it to “cook”). You don’t want the oil to get to the point of smoking, so, to test the temperature as it heats, flick a single drop of water from your fingertip (you did wash your hands first, right? We haven’t been including that step, but please do wash your hands before doing kitchen things) into the pan. If it sizzles, the pan is hot enough now for the next step.

    5) Put the rice into the pan. That’s right, with no extra liquid yet; we’re going to toast it for a moment. Stir it a little, for no more than a minute; keep it moving; don’t let it burn! If you try this several times and fail, it could be that you need a better pan. Treat yourself to one when you get the opportunity; until then, skip the toasting part if necessary.

    6) Add the chia seeds and spices, followed by the stock, followed by the yeast extract. Why did we do the stock before the yeast extract? It’s because hot liquid will get all the yeast extract off the teaspoon 🙂

    7) Put the lid on/down (per what kind of pan or rice cooker you are using), and turn up the heat (if it is a variable heat source) until a tiny bit of steam starts making its way out. When it does, turn it down to a simmer, and let the rice cook. Don’t stir it, don’t jiggle it; trust the process. If you stir or jiggle it, the rice will cook unevenly and, paradoxically, probably stick.

    8) Do keep an eye on it, because when steam stops coming out, it is done, and needs taking off the heat immediately. If using an automatic rice cooker, you can be less attentive if you like, because it will monitor this for you.

    Note: if you are using a simple pan with a non-fastening lid (any other kind of rice cooking setup is better), more steam will escape than the other methods, and it’s possible that it might run out of steam (literally) before the rice is finished. If the steam stops and you find the rice isn’t done, add a splash of water as necessary (the rice doesn’t need to be submerged, it just needs to have liquid; the steam is part of the cooking process), and make a note of how much you had to add (so that next time you can just add it at the start), and put it back on the heat until it is done.

    9) Having taken it off the heat, let it sit for 5 minutes (with the lid still on) before doing any fluffing-up. Then you can fluff-up and serve, adding the garnish if you want one.

    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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Related Posts

  • Eat to Live – by Dr. Joel Fuhrman
  • The Powerful Constraints on Medical Care in Catholic Hospitals Across America

    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.

    Nurse midwife Beverly Maldonado recalls a pregnant woman arriving at Ascension Saint Agnes Hospital in Maryland after her water broke. It was weeks before the baby would have any chance of survival, and the patient’s wishes were clear, she recalled: “Why am I staying pregnant then? What’s the point?” the patient pleaded.

    But the doctors couldn’t intervene, she said. The fetus still had a heartbeat and it was a Catholic hospital, subject to the “Ethical and Religious Directives for Catholic Health Care Services” that prohibit or limit procedures like abortion that the church deems “immoral” or “intrinsically evil,” according to its interpretation of the Bible.

    “I remember asking the doctors. And they were like, ‘Well, the baby still has a heartbeat. We can’t do anything,’” said Maldonado, now working as a nurse midwife in California, who asked them: “What do you mean we can’t do anything? This baby’s not going to survive.”

    The woman was hospitalized for days before going into labor, Maldonado said, and the baby died.

    Ascension declined to comment for this article.

    The Catholic Church’s directives are often at odds with accepted medical standards, especially in areas of reproductive health, according to physicians and other medical practitioners.

    The American College of Obstetricians and Gynecologists’ clinical guidelines for managing pre-labor rupture of membranes, in which a patient’s water breaks before labor begins, state that women should be offered options, including ending the pregnancy.

    Maldonado felt her patient made her wishes clear.

    “Under the ideal medical practice, that patient should be helped to obtain an appropriate method of terminating the pregnancy,” said Christian Pettker, a professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, who helped author the guidelines.

    He said, “It would be perfectly medically appropriate to do a termination of pregnancy before the cessation of cardiac activity, to avoid the health risks to the pregnant person.”

    “Patients are being turned away from necessary care,” said Jennifer Chin, an OB-GYN at UW Medicine in Seattle, because of the “emphasis on these ethical and religious directives.”

    They can be a powerful constraint on the care that patients receive at Catholic hospitals, whether emergency treatment when a woman’s health is at risk, or access to birth control and abortions.

    More and more women are running into barriers to obtaining care as Catholic health systems have aggressively acquired secular hospitals in much of the country. Four of the 10 largest U.S. hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality. There are just over 600 Catholic general hospitals nationally and roughly 100 more managed by Catholic chains that place some religious limits on care, a KFF Health News investigation reveals.

    Maldonado’s experience in Maryland came just months before the Supreme Court’s ruling in 2022 to overturn Roe v. Wade, a decision that compounded the impact of Catholic health care restrictions. In its wake, roughly a third of states have banned or severely limited access to abortion, creating a one-two punch for women seeking to prevent pregnancy or to end one. Ironically, some states where Catholic hospitals dominate — such as Washington, Oregon, and Colorado — are now considered medical havens for women in nearby states that have banned abortion.

    KFF Health News analyzed state-level birth data to discover that more than half a million babies are born each year in the U.S. in Catholic-run hospitals, including those owned by CommonSpirit Health, Ascension, Trinity Health, and Providence St. Joseph Health. That’s 16% of all hospital births each year, with rates in 10 states exceeding 30%. In Washington, half of all babies are born at such hospitals, the highest share in the country.

    “We had many instances where people would have to get in their car to drive to us while they were bleeding, or patients who had had their water bags broken for up to five days or even up to a week,” said Chin, who has treated patients turned away by Catholic hospitals.

    Physicians who turned away patients like that “were going against evidence-based care and going against what they had been taught in medical school and residency,” she said, “but felt that they had to provide a certain type of care — or lack of care — just because of the strength of the ethical and religious directives.”

    Following religious mandates can be dangerous, Chin and other clinicians said.

    When a patient has chosen to end a pregnancy after the amniotic sac — or water — has broken, Pettker said, “any delay that might be added to a procedure that is inevitably going to happen places that person at risk of serious, life-threatening complications,” including sepsis and organ infection.

    Reporters analyzed American Hospital Association data as of August and used Catholic Health Association directories, news reports, government documents, and hospital websites and other materials to determine which hospitals are Catholic or part of Catholic systems, and gathered birth data from state health departments and hospital associations. They interviewed patients, medical providers, academic experts, advocacy organizations, and attorneys, and reviewed hundreds of pages of court and government records and guidance from Catholic health institutions and authorities to understand how the directives affect patient care.

    Nationally, nearly 800,000 people have only Catholic or Catholic-affiliated birth hospitals within an hour’s drive, according to KFF Health News’ analysis. For example, that’s true of 1 in 10 North Dakotans. In South Dakota, it’s 1 in 20. When care is more than an hour away, academic researchers often define the area as a hospital desert. Pregnant women who must drive farther to a delivery facility are at higher risk of harm to themselves or their fetus, research shows.

    Many Americans don’t have a choice — non-Catholic hospitals are too far to reach in an emergency or aren’t in their insurance networks. Ambulances may take patients to a Catholic facility without giving them a say. Women often don’t know that hospitals are affiliated with the Catholic Church or that they restrict reproductive care, academic research suggests.

    And, in most of the country, state laws shield at least some hospitals from lawsuits for not performing procedures they object to on religious grounds, leaving little recourse for patients who were harmed because care was withheld. Thirty-five states prevent patients from suing hospitals for not providing abortions, including 25 states where abortion remains broadly legal. About half of those laws don’t include exceptions for emergencies, ectopic pregnancies, or miscarriages. Sixteen states prohibit lawsuits against hospitals for refusing to perform sterilization procedures.

    “It’s hard for the ordinary citizen to understand, ‘Well, what difference does it make if my hospital is bought by this other big health system, as long as it stays open? That’s all I care about,’” said Erin Fuse Brown, who is the director of the Center for Law, Health & Society at Georgia State University and an expert in health care consolidation. Catholic directives also ban medical aid in dying for terminally ill patients.

    People “may not realize that they’re losing access to important services, like reproductive health [and] end-of-life care,” she said.

    ‘Our Faith-Based Health Care Ministry’

    After the Supreme Court ended the constitutional right to abortion in June 2022, Michigan resident Kalaina Sullivan wanted surgery to permanently prevent pregnancy.

    Michigan voters in November that year enshrined the right to abortion under the state constitution, but the state’s concentration of Catholic hospitals means people like Sullivan sometimes still struggle to obtain reproductive health care.

    Because her doctor worked for the Catholic chain Trinity Health, the nation’s fourth-largest hospital system, she had the surgery with a different doctor at North Ottawa Community Health System, an independent hospital near the shores of Lake Michigan.

    Less than two months later, that, too, became a Catholic hospital, newly acquired by Trinity.

    To mark the transition, Cory Mitchell, who at the time was the mission leader of Trinity Health Muskegon, stood before his new colleagues and offered a blessing.

    “The work of your hands is what makes our faith-based health care ministry possible,” he said, according to a video of the ceremony Trinity Health provided to KFF Health News. “May these hands continue to bring compassion, compassion and healing, to all those they touch.”

    Trinity Health declined to answer detailed questions about its merger with North Ottawa Community Health System and the ethical and religious directives. “Our commitment to high-quality, compassionate care means informing our patients of all appropriate care options, and trusting and supporting our physicians to make difficult and medically necessary decisions in the best interest of their patients’ health and safety,” spokesperson Jennifer Amundson said in an emailed statement. “High-quality, safe care is critical for the women in our communities and in cases where a non-critical service is not available at our facility, the physician will transfer care as appropriate.”

    Leaders in Catholic-based health systems have hammered home the importance of the church’s directives, which are issued by the U.S. Conference of Catholic Bishops, all men, and were first drafted in 1948. The essential view on abortion is as it was in 1948. The last revision, in 2018, added several directives addressing Catholic health institution acquisitions or mergers with non-Catholic ones, including that “whatever comes under control of the Catholic institution — whether by acquisition, governance, or management — must be operated in full accord with the moral teaching of the Catholic Church.”

    “While many of the faithful in the local church may not be aware of these requirements for Catholic health care, the local bishop certainly is,” wrote Sister Doris Gottemoeller, a former board member of the Bon Secours Mercy Health system, in a 2023 Catholic Health Association journal article. “In fact, the bishop should be briefed on a regular basis about the hospital’s activities and strategies.”

    Now, for care at a non-Catholic hospital, Sullivan would need to travel nearly 30 miles.

    “I don’t see why there’s any reason for me to have to follow the rules of their religion and have that be a part of what’s going on with my body,” she said.

    Risks Come With Religion

    Nathaniel Hibner, senior director of ethics at the Catholic Health Association, said the ethical and religious directives allow clinicians to provide medically necessary treatments in emergencies. In a pregnancy crisis when a person’s life is at risk, “I do not believe that the ERDs should restrict the physician in acting in the way that they see medically indicated.”

    “Catholic health care is committed to the health of all women and mothers who enter into our facilities,” Hibner said.

    The directives permit care to cure “a proportionately serious pathological condition of a pregnant woman” even if it would “result in the death of the unborn child.” Hibner demurred when asked who defines what that means and when such care is provided, saying, “for the most part, the physician and the patients are the ones that are having a conversation and dialogue with what is supposed to be medically appropriate.”

    It is common for practitioners at any hospital to consult an ethics board about difficult cases — such as whether a teenager with cancer can decline treatment. At Catholic hospitals, providers must ask a board for permission to perform procedures restricted by the religious directives, clinicians and researchers say. For example, could an abortion be performed if a pregnancy threatened the mother’s life?

    How and when an ethics consultation occurs depends on the hospital, Hibner said. “That ethics consultation can be initiated by anyone involved in the direct care of that situation — the patient, the surrogate of that patient, the physician, the nurse, the social worker all have the ability to request a consultation,” he said. When asked whether a consultation with an ethics board can occur without a request, he said “sometimes it could.”

    How strictly directives are followed can depend on the hospital and the views of the local bishop.

    “If the hospital has made a difficult decision about a critical pregnancy or an end-of-life care situation, the bishop should be the first to know about it,” Gottemoeller wrote.

    In an interview, Gottemoeller said that even when pregnancy termination decisions are made on sound ethical grounds, not informing the bishop puts him in a bad position and hurts the church. “If there’s a possibility of it being misunderstood, or misinterpreted, or criticized,” Gottemoeller said, the bishop should understand what happened and why “before the newspapers call him and ask him for an opinion.”

    “And if he has to say, ‘Well, I think you made a mistake,’ well, all right,” she said. “But don’t let him be blindsided. I mean, we’re one church and the bishop has pastoral concern over everything in his diocese.”

    Katherine Parker Bryden, a nurse midwife in Iowa who works for MercyOne, said she regularly tells pregnant patients that the hospital cannot perform tubal sterilization surgery, to prevent future pregnancies, or refer patients to other hospitals that do. MercyOne is one of the largest health systems in Iowa. Nearly half of general hospitals in the state are Catholic or Catholic-affiliated — the highest share among all states.

    The National Catholic Bioethics Center, an ethics authority for Catholic health institutions, has said that referrals for care that go against church teaching would be “immoral.”

    “As providers, you’re put in this kind of moral dilemma,” Parker Bryden said. “Am I serving my patients or am I serving the archbishop and the pope?”

    In response to questions, MercyOne spokesperson Eve Lederhouse said in an email that its providers “offer care and services that are consistent with the guidelines of a Catholic health system.”

    Maria Rodriguez, an OB-GYN professor at Oregon Health & Science University, said that as a resident in the early 2000s at a Catholic hospital she was able to secure permission — what she calls a “pope note” — to sterilize some patients with conditions such as gestational diabetes.

    Annie Iriye, a retired OB-GYN in Washington state, said that more than a decade ago she sought permission to administer medication to hasten labor for a patient experiencing a second-trimester miscarriage at a Catholic hospital. She said she was told no because the fetus had a heartbeat. The patient took 10 hours to deliver — time that would have been cut by half, Iriye said, had she been able to follow her own medical training and expertise. During that time, she said, the patient developed an infection.

    Iriye and Chin were part of an effort by reproductive rights groups and medical organizations that pushed for a state law to protect physicians if they act against Catholic hospital restrictions. The bill, which Washington enacted in 2021, was opposed by the Washington State Hospital Association, whose membership includes multiple large Catholic health systems.

    State lawmakers in Oregon in 2021 enacted legislation that beefed up powers to reject health care mergers if they would reduce access to the types of care constrained by Catholic directives. The hospital lobby has sued to block the statute. Washington state lawmakers introduced similar legislation last year, which the hospital association opposes.

    Hibner said Catholic hospitals are committed to instituting systemic changes that improve maternal and child health, including access to primary, prenatal, and postpartum care. “Those are the things that I think rural communities really need support and advocacy for,” he said.

    Maldonado, the nurse midwife, still thinks of her patient who was forced to stay pregnant with a baby who could not survive. “To feel like she was going to have to fight to have an abortion of a baby that she wanted?” Maldonado said. “It was just horrible.”

    KFF Health News data editor Holly K. Hacker contributed to this report.

    Click to open the methodology Methodology

    By Hannah Recht

    KFF Health News identified areas of the country where patients have only Catholic hospital options nearby. The “Ethical and Religious Directives for Catholic Health Care Services” — which are issued by the U.S. Conference of Catholic Bishops, all men — dictate how patients receive reproductive care at Catholic health facilities. In our analysis, we focused on hospitals where babies are born.

    We constructed a national database of hospital locations, identified which ones are Catholic or Catholic-affiliated, found how many babies are born at each, and calculated how many people live near those hospitals.

    Hospital Universe

    We identified hospitals in the 50 states and the District of Columbia using the American Hospital Association database from August 2023. We removed hospitals that had closed or were listed more than once, added hospitals that were not included, and corrected inaccurate or out-of-date information about ownership, primary service type, and location. We excluded federal hospitals, such as military and Indian Health Service facilities, because they are not open to everyone.

    Catholic Affiliation

    To identify Catholic hospitals, we used the Catholic Health Association’s member directory. We also counted as Catholic a handful of hospitals that are not part of this voluntary membership group but explicitly follow the Ethical and Religious Directives, according to their mission statements, websites, or promotional materials.

    We also tracked Catholic-affiliated hospitals: those that are owned or managed by a Catholic health system, such as CommonSpirit Health or Trinity Health, and are influenced by the religious directives but do not necessarily adhere to them in full. To identify Catholic-affiliated hospitals, we consulted health system and hospital websites, government documents, and news reports.

    We combined both Catholic and Catholic-affiliated hospitals for analysis, in line with previous research about the influence of Catholic directives on health care.

    Births

    To determine the share of births that occur at Catholic or Catholic-affiliated hospitals, we gathered the latest annual number of births by hospital from state health departments. Where recent data was not publicly available, we submitted records requests for the most recent complete year available.

    The resulting data covered births in 2022 for nine states and D.C., births in 2021 for 23 states, births in 2020 for nine states, and births in 2019 for one state. We used data from the 2021 American Hospital Association survey, the latest available at the time of analysis, for the eight remaining states that did not provide birth data in response to our requests. A small number of hospitals have recently opened or closed labor and delivery units. The vast majority of the rest record about the same number of births each year. This means that the results would not be substantially different if data from 2023 were available.

    We used this data to calculate the number of babies born in Catholic and Catholic-affiliated hospitals, as well as non-Catholic hospitals by state and nationally.

    We used hospitals’ Catholic status as of August 2023 in this analysis. In 10 cases where the hospital had already closed, we used Catholic status at the time of the closure.

    Because our analysis focuses on hospital care, we excluded births that occurred in non-hospital settings, such as homes and stand-alone birth centers, as well as federal hospitals.

    Several states suppressed data from hospitals with fewer than 10 births due to privacy restrictions. Because those numbers were so low, this suppression had a negligible effect on state-level totals.

    Drive-Time Analysis

    We obtained hospitals’ geographic coordinates based on addresses in the AHA dataset using HERE’s geocoder. For addresses that could not be automatically geocoded with a high degree of certainty, we verified coordinates manually using hospital websites and Google Maps.

    We calculated the areas within 30, 60, and 90 minutes of travel time from each birth hospital that was open in August 2023 using tools from HERE. We included only hospitals that had 10 or more births as a proxy for hospitals that have labor and delivery units, or where births regularly occur.

    The analysis focused on the areas with hospitals within an hour’s drive. Researchers often define hospital deserts as places where one would have to drive an hour or more for hospital care. (For example: [1] “Disparities in Access to Trauma Care in the United States: A Population-Based Analysis,” [2] “Injury-Based Geographic Access to Trauma Centers,” [3] “Trends in the Geospatial Distribution of Inpatient Adult Surgical Services Across the United States,” [4] “Access to Trauma Centers in the United States.”)

    We combined the drive-time areas to see which areas of the United States have only Catholic or Catholic-affiliated birth hospitals nearby, both Catholic and non-Catholic, non-Catholic only, or none. We then joined these areas to the 2021 census block group shapefile from IPUMS NHGIS and removed water bodies using the U.S. Geological Survey’s National Hydrography Dataset to calculate the percentage of each census block group that falls within each hospital access category. We calculated the number of people in each area using the 2021 “American Community Survey” block group population totals. For example, if half of a block group’s land area had access to only Catholic or Catholic-affiliated hospitals, then half of the population was counted in that category.

    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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  • Anti-Aging Myths This Dermatologist Wants You To Stop Believing

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    Dermatologist Dr. Sam Ellis lays all bare:

    Bare-faced lies?

    Obviously, we are hearing from a dermatologist here, so the focus is on skin aging specifically. We may well also not want to age our brain, joints, etc, but that’s not what this one is about.

    So, without further ado, here are the myths she wants to bust:

    • “Medical grade skincare”: the term “medical grade” is a marketing term and does not indicate superior efficacy or better ingredients.
    • “Expensive skincare is more effective”: price does not always correlate with effectiveness; some high-end products justify their cost, but many do not.
    • “More products = better results”: using too many products can reduce effectiveness and cause irritation; a simple routine with sunscreen and a retinoid is key.
    • “Drink more water for better skin”: if you’re dehydrated, then yes, hydrate—but drinking excessive water does not improve skin appearance beyond normal hydration levels.
    • “You don’t need anti-aging products until you see signs of aging”: starting skincare early, especially sun protection, helps maintain youthful skin longer.
    • “Wrinkles are the first signs of aging”: hyperpigmentation and sagging are often more significant early indicators of aging than wrinkles.
    • “Skincare is all you need for anti-aging”: by “skincare” here she means creams, lotions, tonics, etc, and recommends other treatments such as laser treatment and even Botox*.
    • “Non-prescription retinoids are a waste of time”: over-the-counter retinoids like retinol and retinal can still be effective alternatives to prescription retinoids.
    • “You must use retinoids every night”: retinoids are effective even when used a few times per week, depending on individual tolerance.

    *We’re not convinced about the Botox; we’ll have to do a deep-dive research review one of these days!

    For more on each of these, enjoy:

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    Want to learn more?

    You might also like:

    Retinoids: Retinol vs Retinal vs Retinoic Acid vs..?

    Take care!

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  • Under Pressure: A Guide To Controlling High Blood Pressure – by Dr. Frita Fisher

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    Hypertension kills a lot of people, and does so with little warning—it can be asymptomatic before it gets severe enough to cause harm, and once it causes harm, well, one heart attack or stroke is already one too many.

    Aimed more squarely at people in the 35–45 danger zone (young enough to not be getting regular blood pressure checks, old enough that it may have been building up for decades), this is a very good primer on blood pressure, factors affecting it, what goes wrong, what to do about it, and how to make a good strategy for managing it for life.

    The style is easy-reading, making this short (91 pages) book a very quick read, but an informative one.

    Bottom line: if you are already quite knowledgeable about blood pressure and blood pressure management, this one’s probably not for you. But if you’re in the category of “what do those numbers mean again?”, then this is a very handy book to have, to get you up to speed so that you can handle things as appropriate.

    Click here to check out Under Pressure, and get/keep yours under control!

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