Voluntary assisted dying is different to suicide. But federal laws conflate them and restrict access to telehealth
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Voluntary assisted dying is now lawful in every Australian state and will soon begin in the Australian Capital Territory.
However, it’s illegal to discuss it via telehealth. That means people who live in rural and remote areas, or those who can’t physically go to see a doctor, may not be able to access the scheme.
A federal private members bill, introduced to parliament last week, aims to change this. So what’s proposed and why is it needed?
What’s wrong with the current laws?
Voluntary assisted dying doesn’t meet the definition of suicide under state laws.
But the Commonwealth Criminal Code prohibits the discussion or dissemination of suicide-related material electronically.
This opens doctors to the risk of criminal prosecution if they discuss voluntary assisted dying via telehealth.
Successive Commonwealth attorneys-general have failed to address the conflict between federal and state laws, despite persistent calls from state attorneys-general for necessary clarity.
This eventually led to voluntary assistant dying doctor Nicholas Carr calling on the Federal Court of Australia to resolve this conflict. Carr sought a declaration to exclude voluntary assisted dying from the definition of suicide under the Criminal Code.
In November, the court declared voluntary assisted dying was considered suicide for the purpose of the Criminal Code. This meant doctors across Australia were prohibited from using telehealth services for voluntary assisted dying consultations.
Last week, independent federal MP Kate Chaney introduced a private members bill to create an exemption for voluntary assisted dying by excluding it as suicide for the purpose of the Criminal Code. Here’s why it’s needed.
Not all patients can physically see a doctor
Defining voluntary assisted dying as suicide in the Criminal Code disproportionately impacts people living in regional and remote areas. People in the country rely on the use of “carriage services”, such as phone and video consultations, to avoid travelling long distances to consult their doctor.
Other people with terminal illnesses, whether in regional or urban areas, may be suffering intolerably and unable to physically attend appointments with doctors.
The prohibition against telehealth goes against the principles of voluntary assisted dying, which are to minimise suffering, maximise quality of life and promote autonomy.
Jeffrey M Levine/Shutterstock
Doctors don’t want to be involved in ‘suicide’
Equating voluntary assisted dying with suicide has a direct impact on doctors, who fear criminal prosecution due to the prohibition against using telehealth.
Some doctors may decide not to help patients who choose voluntary assisted dying, leaving patients in a state of limbo.
The number of doctors actively participating in voluntary assisted dying is already low. The majority of doctors are located in metropolitan areas or major regional centres, leaving some locations with very few doctors participating in voluntary assisted dying.
It misclassifies deaths
In state law, people dying under voluntary assisted dying have the cause of their death registered as “the disease, illness or medical condition that was the grounds for a person to access voluntary assisted dying”, while the manner of dying is recorded as voluntary assisted dying.
In contrast, only coroners in each state and territory can make a finding of suicide as a cause of death.
In 2017, voluntary assisted dying was defined in the Coroners Act 2008 (Vic) as not a reportable death, and thus not suicide.
The language of suicide is inappropriate for explaining how people make a decision to die with dignity under the lawful practice of voluntary assisted dying.
There is ongoing taboo and stigma attached to suicide. People who opt for and are lawfully eligible to access voluntary assisted dying should not be tainted with the taboo that currently surrounds suicide.
So what is the solution?
The only way to remedy this problem is for the federal government to create an exemption in the Criminal Code to allow telehealth appointments to discuss voluntary assisted dying.
Chaney’s private member’s bill is yet to be debated in federal parliament.
If it’s unsuccessful, the Commonwealth attorney-general should pass regulations to exempt voluntary assisted dying as suicide.
A cooperative approach to resolve this conflict of laws is necessary to ensure doctors don’t risk prosecution for assisting eligible people to access voluntary assisted dying, regional and remote patients have access to voluntary assisted dying, families don’t suffer consequences for the erroneous classification of voluntary assisted dying as suicide, and people accessing voluntary assisted dying are not shrouded with the taboo of suicide when accessing a lawful practice to die with dignity.
Failure to change this will cause unnecessary suffering for patients and doctors alike.
Michaela Estelle Okninski, Lecturer of Law, University of Adelaide; Marc Trabsky, Associate professor, La Trobe University, and Neera Bhatia, Associate Professor in Law, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Is fluoride really linked to lower IQ, as a recent study suggested? Here’s why you shouldn’t worry
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Fluoride is a common natural element found in water, soil, rocks and food. For the past several decades, fluoride has also been a cornerstone of dentistry and public health, owing to its ability to protect against tooth decay.
Water fluoridation is a population-based program where a precise, small amount of fluoride is added to public drinking water systems. Water fluoridation began in Australia in the 1950s. Today more than 90% of Australia’s population has access to fluoridated tap water.
But a recently published review found higher fluoride exposure is linked to lower intelligence quotient (IQ) in children. So how can we interpret the results?
Much of the data analysed in this review is poor quality. Overall, the findings don’t give us reason to be concerned about the fluoride levels in our water supplies.
TinnaPong/Shutterstock Not a new controversy
Tooth decay (also known as caries or cavities) can have negative effects on dental health, overall health and quality of life. Fluoride strengthens our teeth, making them more resistant to decay. There is scientific consensus water fluoridation is a safe, effective and equitable way to improve oral health.
Nonetheless, water fluoridation has historically been somewhat controversial.
A potential link between fluoride and IQ (and cognitive function more broadly) has been a contentious topic for more than a decade. This started with reports from studies in China and India.
But it’s important to note these studies were limited by poor methodology, and water in these countries had high levels of natural fluoride when the studies were conducted – many times higher than the levels recommended for water fluoridation programs. Also, the studies did not control for other contaminants in the water supply.
Recent reviews focusing on the level of fluoride used in water fluoridation have concluded fluoride is not linked to lower IQ.
Despite this, some have continued to raise concerns. The United States National Toxicology Program conducted a review of the potential link. However, this review did not pass the quality assessment by the US National Academies of Sciences, Engineering and Medicine due to significant limitations in the conduct of the review.
The authors followed through with their study and published it as an independent publication in the journal JAMA Paediatrics last week. This is the study which has been generating media attention in recent days.
What the study did
This study was a systematic review and meta-analysis, where the researchers evaluated 74 studies from different parts of the world.
A total of 52 studies were rated as having a high risk of bias, and 64 were cross-sectional studies, which often can’t provide evidence of causal relationship.
Most of the studies were conducted in developing countries, such as China (45), India (12), Iran (4), Mexico (4) and Pakistan (2). Only a few studies were conducted in developed countries with established public water systems, where regular monitoring and treatment of drinking water ensures it’s free from contaminants.
The vast majority of studies were conducted in populations with high to very high levels of natural fluoride and without water fluoridation programs, where fluoride levels are controlled within recommended levels.
The study concluded there was an inverse association between fluoride levels and IQ in children. This means those children who had a higher intake of fluoride had lower IQ scores than their counterparts.
Water fluoridation programs reduce the occurrence of cavities. Drazen Zigic/Shutterstock Limitations to consider
While this review combined many studies, there are several limitations that cast serious doubt over its conclusion. Scientists immediately raised concerns about the quality of the review, including in a linked editorial published in JAMA.
The low quality of the majority of included studies is a major concern, rendering the quality of the review equally low. Importantly, most studies were not relevant to the recommended levels of fluoride in water fluoridation programs.
Several included studies from countries with controlled public water systems (Canada, New Zealand, Taiwan) showed no negative effects. Other recent studies from comparable populations (such as Spain and Denmark) also have not shown any negative effect of fluoride on IQ, but they were not included in the meta-analysis.
For context, the review found there was no significant association with IQ when fluoride was measured at less than 1.5mg per litre in water. In Australia, the recommended levels of fluoride in public water supplies range from 0.6 to 1.1 mg/L.
Also, the primary outcome, IQ score, is difficult to collect. Most included studies varied widely on the methods used to collect IQ data and did not specify their focus on ensuring reliable and consistent IQ data. Though this is a challenge in most research on this topic, the significant variations between studies in this review raise further doubts about the combined results.
No cause for alarm
Although no Australian studies were included in the review, Australia has its own studies investigating a potential link between fluoride exposure in early childhood and child development.
I’ve been involved in population-based longitudinal studies investigating a link between fluoride and child behavioural development and executive functioning and between fluoride and IQ. The IQ data in the second study were collected by qualified, trained psychologists – and calibrated against a senior psychologist – to ensure quality and consistency. Both studies have provided strong evidence fluoride exposure in Australia does not negatively impact child development.
This new review is not a reason to be concerned about fluoride levels in Australia and other developed countries with water fluoridation programs. Fluoride remains important in maintaining the public’s dental health, particularly that of more vulnerable groups.
That said, high and uncontrolled levels of fluoride in water supplies in less developed countries warrant attention. There are programs underway in a range of countries to reduce natural fluoride to the recommended level.
Loc Do, Professor of Dental Public Health, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Daily Stoic – by Ryan Holiday & Stephen Hanselman
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What’s this, a philosophy book in a health and productivity newsletter? Well, look at it this way: Aristotle basically wrote the “How To Win Friends And Influence People” of his day, and Plato before him wrote a book about management.
In this (chiefly modern!) book, we see what the later Stoic philosophers had to say about getting the most out of life—which is also what we’re about, here at 10almonds!
We tend to use the word “stoic” in modern English to refer to a person who is resolute in the face of hardship. The traditional meaning does encompass that, but also means a lot more: a whole, rounded, philosophy of life.
Philosophy in general is not an easy thing into which to “dip one’s toe”. No matter where we try to start, it seems, it turns out there were a thousand other things we needed to read first!
This book really gets around that. The format is:
- There’s a theme for each month
- Each month has one lesson per day
- Each daily lesson starts with some words from a renowned stoic philosopher, and then provides commentary on such
- The commentary provides a jumping-off point and serves as a prompt to actually, genuinely, reflect and apply the ideas.
Unlike a lot of “a year of…” day-by-day books, this is not light reading, by the way, and you are getting a weighty tome for your money.
But, the page-length daily lessons are indeed digestible—which, again, is what we like at 10almonds!
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How much time should you spend sitting versus standing? New research reveals the perfect mix for optimal health
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People have a pretty intuitive sense of what is healthy – standing is better than sitting, exercise is great for overall health and getting good sleep is imperative.
However, if exercise in the evening may disrupt our sleep, or make us feel the need to be more sedentary to recover, a key question emerges – what is the best way to balance our 24 hours to optimise our health?
Our research attempted to answer this for risk factors for heart disease, stroke and diabetes. We found the optimal amount of sleep was 8.3 hours, while for light activity and moderate to vigorous activity, it was best to get 2.2 hours each.
Finding the right balance
Current health guidelines recommend you stick to a sensible regime of moderate-to vigorous-intensity physical activity 2.5–5 hours per week.
However mounting evidence now suggests how you spend your day can have meaningful ramifications for your health. In addition to moderate-to vigorous-intensity physical activity, this means the time you spend sitting, standing, doing light physical activity (such as walking around your house or office) and sleeping.
Our research looked at more than 2,000 adults who wore body sensors that could interpret their physical behaviours, for seven days. This gave us a sense of how they spent their average 24 hours.
At the start of the study participants had their waist circumference, blood sugar and insulin sensitivity measured. The body sensor and assessment data was matched and analysed then tested against health risk markers — such as a heart disease and stroke risk score — to create a model.
Using this model, we fed through thousands of permutations of 24 hours and found the ones with the estimated lowest associations with heart disease risk and blood-glucose levels. This created many optimal mixes of sitting, standing, light and moderate intensity activity.
When we looked at waist circumference, blood sugar, insulin sensitivity and a heart disease and stroke risk score, we noted differing optimal time zones. Where those zones mutually overlapped was ascribed the optimal zone for heart disease and diabetes risk.
You’re doing more physical activity than you think
We found light-intensity physical activity (defined as walking less than 100 steps per minute) – such as walking to the water cooler, the bathroom, or strolling casually with friends – had strong associations with glucose control, and especially in people with type 2 diabetes. This light-intensity physical activity is likely accumulated intermittently throughout the day rather than being a purposeful bout of light exercise.
Our experimental evidence shows that interrupting our sitting regularly with light-physical activity (such as taking a 3–5 minute walk every hour) can improve our metabolism, especially so after lunch.
While the moderate-to-vigorous physical activity time might seem a quite high, at more than 2 hours a day, we defined it as more than 100 steps per minute. This equates to a brisk walk.
It should be noted that these findings are preliminary. This is the first study of heart disease and diabetes risk and the “optimal” 24 hours, and the results will need further confirmation with longer prospective studies.
The data is also cross-sectional. This means that the estimates of time use are correlated with the disease risk factors, meaning it’s unclear whether how participants spent their time influences their risk factors or whether those risk factors influence how someone spends their time.
Australia’s adult physical activity guidelines need updating
Australia’s physical activity guidelines currently only recommend exercise intensity and time. A new set of guidelines are being developed to incorporate 24-hour movement. Soon Australians will be able to use these guidelines to examine their 24 hours and understand where they can make improvements.
While our new research can inform the upcoming guidelines, we should keep in mind that the recommendations are like a north star: something to head towards to improve your health. In principle this means reducing sitting time where possible, increasing standing and light-intensity physical activity, increasing more vigorous intensity physical activity, and aiming for a healthy sleep of 7.5–9 hours per night.
Beneficial changes could come in the form of reducing screen time in the evening or opting for an active commute over driving commute, or prioritising an earlier bed time over watching television in the evening.
It’s also important to acknowledge these are recommendations for an able adult. We all have different considerations, and above all, movement should be fun.
Christian Brakenridge, Postdoctoral research fellow at Swinburne University Centre for Urban Transitions, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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This Chair Rocks: A Manifesto Against Ageism – by Ashton Applewhite
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It’s easy to think of ageism as being 80% “nobody will hire me because I am three years away from standard retirement age”, but it’s a lot more pervasive than that. And some of it, perhaps the most insidious, is the ageism that we can sometimes internalize without thinking it through.
10almonds readers love to avoid/reverse aging (and this reviewer is no different!), but it’s good once in a while to consider our priorities and motivations, for example:
- There is merit in being able to live without disability or discomfort
- There is harm in feeling a need to pass for younger than we are
And yet, even things such as disabilities are, Applewhite fairly argues, not to be feared. Absolutely avoided if reasonably possible of course, yes, but if they happen they happen and it’s good that we be able to make our peace with that, because most people have at least some kind of disability before the end, and can still strive to make the most of the precious gift that is life. The goal can and should be to play the hand we’re dealt and to live as well as we can—whatever that latter means for us personally.
Many people’s life satisfaction goes up in later years, and Applewhite hypothesizes that while some of that can be put down to circumstances (often no longer overwhelmed with work etc, often more financially stable), a lot is a matter of having come to terms with “losing” youth and no longer having that fear. Thus, a new, freer age of life begins.
The book does cover many other areas too, more than we can list here (but for example: ranging from pro/con brain differences to sex and intimacy), and the idea that long life is a team sport, and that we should not fall into the all-American trap of putting independence on a pedestal. Reports of how aging works with close-knit communities in the supercentenarian Blue Zones can be considered to quash this quite nicely, for instance.
The style is casual and entertaining, and yet peppered with scholarly citations, which stack up to 30 pages of references at the back.
Bottom line: getting older is a privilege that not everyone gets to have, so who are we to squander it? This book shares a vital sense of perspective, and is a call-to-arms for us all to do better, together.
Click here to check out This Chair Rocks, and indeed rock it!
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Feeding your baby butter won’t help them sleep through the night, whatever TikTok says
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Sleep is the holy grail for new parents. So no wonder many tired parents are looking for something to help their babies sleep.
A TikTok trend claims giving your baby a tablespoon or two of butter in the evening will help them sleep more at night.
As we’ll see, butter is just the latest food that promises to help babies sleep at night. But no single food can do this.
So if you’re a new parent and desperate for a good night’s sleep, here’s what to try instead.
BaLL LunLa/Shutterstock Is my baby’s sleep normal?
Babies need help to fall asleep, through feeding, movement (like rocking) or touch (like a cuddle or massage).
Newborn babies also do not know night from day. Melatonin in breastmilk helps babies sleep more at night until they start to make this sleep-inducing hormone themselves. Bottlefed newborn babies do not have access to this melatonin. Regardless of how you feed your baby, it can take several months for them to develop a sleep pattern with longer stretches at night.
Babies also sleep lighter than older children and adults. Light sleep helps ensure they continue breathing, protecting them from SIDS (sudden infant death syndrome). It also means they wake easily and often.
The idea that babies should sleep deeply, alone and for long stretches, goes against their physiology. So “sleeping like a baby” usually means waking quite a lot at night.
Yet, many parents have been asked whether their baby is sleeping through the night and is a “good baby”. The perception is that if a baby doesn’t sleep for long stretches at night, it must be “bad”.
This may lead parents to say their babies sleep longer than they really do, setting unrealistic expectations for other new parents.
Could feeding butter do any harm?
The social pressure around baby sleep can add stress and anxiety for new parents. So the Tiktok trend about feeding babies butter may seem tempting.
But giving babies any solid food before they are around six months old is not recommended. Babies’ digestive systems are not ready for solid food until they are around six months and feeding them before this can cause constipation or make them more likely to catch an illness. For this reason alone, you should not give your young baby butter.
From about six months old, babies should be offered nutritious, iron-rich solid foods. Butter doesn’t fit this bill because it is almost all saturated fat. If butter replaces more nutritious foods, babies may not get the vitamins and minerals they need.
Butter is just the latest food claimed to help babies sleep better at night. Pixel-Shot/Shutterstock Butter is the latest in a long line of beliefs about certain foods making babies sleep longer at night. It was once thought that adding cereal or crushed arrowroot biscuits in bottle of milk before bedtime would make them sleep longer. Research found this did not increase sleep at all.
Similarly, there is no evidence that giving babies butter before bed makes them sleep longer.
In fact, research shows the foods babies eat make no difference to night waking.
What else can I try?
Waking overnight doesn’t necessarily mean a baby is hungry. And stopping breastfeeds or bottle feeds overnight doesn’t necessarily reduce night waking.
Your baby could be too hot or cold, or need a nappy change. But some babies continue to wake at night even without an obvious problem.
The good news is, sleeping is a skill babies develop naturally as they grow.
Behavioural sleep interventions, known as “sleep training”, are not very effective in increasing overnight sleep. In one study, sleep training did not reduce the number of night wakes and only increased the length of the longest sleep by about 16 minutes. Sleep training is especially not recommended for babies under six months.
The good news is that babies do eventually get the hang of sleeping at night. Miljan Zivkovic/Shutterstock Look after yourself
If you’re missing out on sleep at night, try to have small naps during the day while your baby sleeps. Ask friends and family to do some chores to allow you to nap.
If your baby is crying and you find yourself getting overwhelmed it is OK to put your baby down somewhere safe (like a cot or baby mat) and take some time to settle yourself.
If your baby’s sleep pattern changes significantly or they haven’t slept at all for more than a day, or if your baby seems to have pain or a fever see your doctor, or family and child health nurse, as soon as possible.
Some helpful resources
If you think your baby is not sleeping well because of a breastfeeding problem, the Australian Breastfeeding Association has a national helpline. The association can also advise on co-sleeping.
The charity Little Sparklers provides peer support for parents, including someone to chat to, about baby sleep. It also has helpful resources.
UNICEF has resources about caring for your baby at night. And the UK-based Baby Sleep Info Source (Basis) provides evidence-based information about babies and sleep.
Karleen Gribble, Adjunct Professor, School of Nursing and Midwifery, Western Sydney University; Naomi Hull, PhD candidate, Sydney School of Public Health, University of Sydney, and Nina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What you need to know about the new weight loss drug Zepbound
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In a recent poll, KFF found that nearly half of U.S. adults were interested in taking a weight management drug like the increasingly popular Ozempic, Wegovy, and Mounjaro.
“I can understand why there would be widespread interest in these medications,” says Dr. Alyssa Lampe Dominguez, an endocrinologist and clinical assistant professor at the University of Southern California. “Obesity is a chronic disease that is very difficult to treat. And a lot of the medications that we previously used weren’t as effective.”
Now, there’s a new option available: In November 2023, the FDA approved Zepbound, another weight management medication, developed by the pharmaceutical company Eli Lilly. Zepbound is different from other drugs in many ways, including the fact that it’s proven to be the most effective option so far.
Keep reading to find out more about Zepbound, including who can take it, its side effects, and more.
What is Zepbound?
Zepbound, one of the brand names for tirzepatide, is an injectable drug with a maximum dosage of 15 mg per week. It’s based on incretin, a hormone that’s naturally released in the gut after a meal. (Mounjaro is another brand name for tirzepatide.)
Tirzepatide is considered a dual agonist because it activates the two primary incretin hormones: the glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) hormones.
According to Dr. Katherine H. Saunders, an obesity medicine physician at Weill Cornell Medicine and co-founder of Intellihealth, tirzepatide is involved with several processes that regulate blood sugar, slow the removal of food from the stomach, and affect brain areas involved in appetite.
This means that people taking the medication feel less hungry and get fuller faster, leading to less food intake and, ultimately, weight loss.
How is Zepbound different from Ozempic?
The medications are different in many ways. Ozempic and Wegovy, which are both brand names for semaglutide, only target the GLP-1 hormone. Studies have shown that Zepbound can lead to a higher percentage of total body weight loss than semaglutide medications. In addition to being more effective, there is some evidence that Zepbound is overall more tolerable than Ozempic or Wegovy.
“I have seen overall lower rates in severity of side effects with the tirzepatide medications. Mounjaro [tirzepatide] in particular is the one that I’ve used up until this point, but there’s a thought that the GIP component of the medication actually decreases nausea,” adds Lampe Dominguez. “Anecdotally, patients that I have switched from semaglutide or Ozempic to Mounjaro say that they have less side effects with Mounjaro.”
How is Zepbound different from Mounjaro?
Zepbound and Mounjaro are the same medication—tirzepatide—but they’re approved for different conditions. Zepbound is FDA-approved for weight loss, while Mounjaro is approved for type 2 diabetes. (However, Mounjaro is also at times prescribed off-label for weight loss.)
What are some of Zepbound’s side effects?
According to the FDA, side effects include nausea, vomiting, diarrhea, constipation, stomach discomfort and pain, fatigue, and burping. See a more comprehensive list of side effects here.
Who can take Zepbound?
Zepbound is FDA-approved for adults with obesity (a BMI of 30 or greater) or who have a BMI of 27 or greater with at least one weight-related condition, like high blood pressure, type 2 diabetes, or high cholesterol.
“I tend to advise patients who don’t meet those criteria to not take these medications because we really don’t know what the risks are,” says Lampe Dominguez, adding that people with lower BMI weren’t included in the medication’s studies. “We don’t know if there are specific risks to using this medication at a lower body mass index [or] if there might be some negative outcomes.”
Both doctors agree that it’s important for people who are interested in starting any weight loss medication to talk to their doctors about the potential risks and benefits. For instance, the FDA notes that Zepbound has caused thyroid tumors in rats, and while it’s unknown if this could also happen to humans, the agency said the medication shouldn’t be used in patients with a personal or family history of medullary thyroid cancer.
“Zepbound is a powerful medication that can lead to severe side effects, vitamin deficiencies, a complete lack of appetite, or too much weight loss if prescribed without the appropriate personalization, education, and close monitoring,” says Saunders.
“With all of these medications, and particularly with Zepbound, we would want to make sure that [patients] don’t have a family history of a specific type of thyroid cancer called medullary thyroid cancer,” says Lampe Dominguez.
How long should people take Zepbound for?
“Anti-obesity medications like Zepbound are not meant for short-term weight loss, but long-term treatment of obesity, which is a chronic disease,” explains Saunders. “We prepare our patients to be on the medication (or some type of medical obesity treatment) long term for their chronic disease, which is only controlled for the duration of time they’re being treated.”
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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