What’s the difference between physical and chemical sunscreens? And which one should you choose?
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Sun exposure can accelerate ageing, cause skin burns, erythema (a skin reaction), skin cancer, melasmas (or sun spots) and other forms of hyperpigmentation – all triggered by solar ultraviolet radiation.
Approximately 80% of skin cancer cases in people engaged in outdoor activities are preventable by decreasing sun exposure. This can be done in lots of ways including wearing protective clothing or sunscreens.
But not all sunscreens work in the same way. You might have heard of “physical” and “chemical” sunscreens. What’s the difference and which one is right for you?
How sunscreens are classified
Sunscreens are grouped by their use of active inorganic and organic ultraviolet (UV) filters. Chemical sunscreens use organic filters such as cinnamates (chemically related to cinnamon oil) and benzophenones. Physical sunscreens (sometimes called mineral sunscreens) use inorganic filters such as titanium and zinc oxide.
These filters prevent the effects of UV radiation on the skin.
Organic UV filters are known as chemical filters because the molecules in them change to stop UV radiation reaching the skin. Inorganic UV filters are known as physical filters, because they work through physical means, such as blocking, scattering and reflection of UV radiation to prevent skin damage.
Nano versus micro
The effectiveness of the filters in physical sunscreen depends on factors including the size of the particle, how it’s mixed into the cream or lotion, the amount used and the refraction index (the speed light travels through a substance) of each filter.
When the particle size in physical sunscreens is large, it causes the light to be scattered and reflected more. That means physical sunscreens can be more obvious on the skin, which can reduce their cosmetic appeal.
Nanoparticulate forms of physical sunscreens (with tiny particles smaller than 100 nanometers) can improve the cosmetic appearance of creams on the skin and UV protection, because the particles in this size range absorb more radiation than they reflect. These are sometimes labelled as “invisible” zinc or mineral formulations and are considered safe.
So how do chemical sunscreens work?
Chemical UV filters work by absorbing high-energy UV rays. This leads to the filter molecules interacting with sunlight and changing chemically.
When molecules return to their ground (or lower energy) state, they release energy as heat, distributed all over the skin. This may lead to uncomfortable reactions for people with skin sensitivity.
Generally, UV filters are meant to stay on the epidermis (the first skin layer) surface to protect it from UV radiation. When they enter into the dermis (the connective tissue layer) and bloodstream, this can lead to skin sensitivity and increase the risk of toxicity. The safety profile of chemical UV filters may depend on whether their small molecular size allows them to penetrate the skin.
Chemical sunscreens, compared to physical ones, cause more adverse reactions in the skin because of chemical changes in their molecules. In addition, some chemical filters, such as dibenzoylmethane tend to break down after UV exposure. These degraded products can no longer protect the skin against UV and, if they penetrate the skin, can cause cell damage.
Due to their stability – that is, how well they retain product integrity and effectiveness when exposed to sunlight – physical sunscreens may be more suitable for children and people with skin allergies.
Although sunscreen filter ingredients can rarely cause true allergic dermatitis, patients with photodermatoses (where the skin reacts to light) and eczema have higher risk and should take care and seek advice.
What to look for
The best way to check if you’ll have a reaction to a physical or chemical sunscreen is to patch test it on a small area of skin.
And the best sunscreen to choose is one that provides broad-spectrum protection, is water and sweat-resistant, has a high sun protection factor (SPF), is easy to apply and has a low allergy risk.
Health authorities recommend sunscreen to prevent sun damage and cancer. Chemical sunscreens have the potential to penetrate the skin and may cause irritation for some people. Physical sunscreens are considered safe and effective and nanoparticulate formulations can increase their appeal and ease of use.
Yousuf Mohammed, Dermatology researcher, The University of Queensland and Khanh Phan, Postdoctoral research associate, Frazer Institute, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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If you’re worried about inflammation, stop stressing about seed oils and focus on the basics
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You’ve probably seen recent claims online seed oils are “toxic” and cause inflammation, cancer, diabetes and heart disease. But what does the research say?
Overall, if you’re worried about inflammation, cancer, diabetes and heart disease there are probably more important things to worry about than seed oils.
They may or may not play a role in inflammation (the research picture is mixed). What we do know, however, is that a high-quality diet rich in unprocessed whole foods (fruits, vegetables, nuts, seeds, grains and lean meats) is the number one thing you can to do reduce inflammation and your risk of developing diseases.
Rather than focusing on seed oils specifically, reduce your intake of processed foods more broadly and focus on eating fresh foods. So don’t stress out too much about using a bit of seed oils in your cooking if you are generally focused on all the right things.
What are seed oils?
Seed oils are made from whole seeds, such as sunflower seeds, flax seeds, chia seeds and sesame seeds. These seeds are processed to extract oil.
The most common seed oils found at grocery stores include sesame oil, canola oil, sunflower oil, flaxseed oil, corn oil, grapeseed oil and soybean oil.
Seed oils are generally affordable, easy to find and suitable for many dishes and cuisines as they often have a high smoke point.
However, most people consume seed oils in larger amounts through processed foods such as biscuits, cakes, chips, muesli bars, muffins, dipping sauces, deep-fried foods, salad dressings and margarines.
These processed foods are “discretionary”, meaning they’re OK to have occasionally. But they are not considered necessary for a healthy diet, nor recommended in our national dietary guidelines, the Australian Guide for Healthy Eating.
Seed oils often have a high smoke point.
Gleb Usovich/ShutterstockI’ve heard people say seed oils ‘promote inflammation’. Is that true?
There are two essential types of omega fatty acids: omega-3 and omega-6. These are crucial for bodily functions, and we must get them through our diet since our bodies cannot produce them.
While all oils contain varying levels of fatty acids, some argue an excessive intake of a specific omega-6 fatty acid in seed oils called “linoleic acid” may contribute to inflammation in the body.
There is some evidence linoleic acid can be converted to arachidonic acid in the body and this may play a role in inflammation. However, other research doesn’t support the idea reducing dietary linoleic acid affects the amount of arachidonic acid in your body. The research picture is not clear cut.
But if you’re keen to reduce inflammation, the best thing you can do is aim for a healthy diet that is:
- high in antioxidants (found in fruits and vegetables)
- high in “healthy”, unsaturated fatty acids (found in fatty fish, some nuts and olive oil, for example)
high in fibre (found in carrots, cauliflower, broccoli and leafy greens) and prebiotics (found in onions, leeks, asparagus, garlic and legumes)
low in processed foods.
If reducing inflammation is your goal, it’s probably more meaningful to focus on these basics than on occasional use of seed oils.
Choose foods high in fibre (like many vegetables) and prebiotics (like legumes).
Kiian Oksana/ShutterstockWhat about seed oils and heart disease, cancer or diabetes risk?
Some popular arguments against seed oils come from data from single studies on this topic. Often these are observational studies where researchers do not make changes to people’s diet or lifestyle.
To get a clearer picture, we should look at meta-analyses, where scientists combine all the data available on a topic. This helps us get a better overall view of what’s going on.
A 2022 meta-analysis of randomised controlled trials investigated the relationship between supplementation with omega-6 fatty acid (often found in seed oils) and cardiovascular disease risk (meaning disease relating to the heart and blood vessels).
The researchers found omega-6 intake did not affect the risk for cardiovascular disease or death but that further research is needed for firm conclusions. Similar findings were observed in a 2019 review on this topic.
The World Health Organization published a review and meta-analysis in 2022 of observational studies (considered lower quality evidence compared to randomised controlled trials) on this topic.
They looked at omega-6 intake and risk of death, cardiovascular disease, breast cancer, mental health conditions and type 2 diabetes. The findings show both advantages and disadvantages of consuming omega-6.
The findings reported that, overall, higher intakes of omega-6 were associated with a 9% reduced risk of dying (data from nine studies) but a 31% increased risk of postmenopausal breast cancer (data from six studies).
One of the key findings from this review was about the ratio of omega-3 fatty acids to omega-6 fatty acids. A higher omega 6:3 ratio was associated with a greater risk of cognitive decline and ulcerative colitis (an inflammatory bowel condition).
A higher omega 3:6 ratio was linked to a 26% reduced risk of depression. These mixed outcomes may be a cause of confusion among health-conscious consumers about the health impact of seed oils.
Overall, the evidence suggests that a high intake of omega-6 fatty acids from seed oils is unlikely to increase your risk of death and disease.
However, more high-quality intervention research is needed.
The importance of increasing your omega-3 fatty acids
On top of the mixed outcomes, there is clear evidence increasing the intake of omega-3 fatty acids (often found in foods such as fatty fish and walnuts) is beneficial for health.
While some seed oils contain small amounts of omega-3s, they are not typically considered rich sources.
Flaxseed oil is an exception and is one of the few seed oils that is notably high in alpha-linolenic acid (sometimes shortened to ALA), an omega-3 fatty acid.
If you are looking to increase your omega-3 intake, it’s better to focus on other sources such as fatty fish (salmon, mackerel, sardines), chia seeds, hemp seeds, walnuts, and algae-based supplements. These foods are known for their higher omega-3 content compared to seed oils.
The bottom line
At the end of the day, it’s probably OK to include small quantities of seed oils in your diet, as long as you are mostly focused on eating fresh, unprocessed foods.
The best way to reduce your risk of inflammation, heart disease, cancer or diabetes is not to focus so much on seed oils but rather on doing your best to follow the Australian Guide for Healthy Eating.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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6 Daily Habits To Keep Your Brain Young & Sharp
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Without brain health, we do not have health. So here are six ways to keep it in order:
Food for thought
The six areas to focus on are as follows:
- Physical exercise: as we at 10almonds sometimes say, what’s good for the heart is good for the brain (because the brain is only as healthy as the circulation feeding it). For this reason, the recommendation here is for physical exercise that improves heart health—so, walking, running, swimming, dancing, etc.
- Healthy diet: shocking nobody, this is important too. Specifically, a diet rich in fruits, vegetables, and healthy proteins and fats is important—partly for the heart benefits that give indirect benefits to the brain, and partly because the brain is built of stuff and so we have to consume that stuff in order to rebuild it (omega-3s features strongly here, for instance). Remember to hydrate, too! The body can’t do anything without water.
- Good sleep: yes, the famous 7–9 hours sleep per night, and yes, even at your age, whatever that might be. This is important for memory consolidation, cell repair, toxin removal, and more. Sleep deprivation, on the other hand, leads to cognitive decline and brain shrinkage.
- Mental stimulation: ideally, engaging those parts of the brain you most wish to protect (e.g. language, memory, or whatever is most important to you).
- Social interaction: this one gets underestimated a lot, but it’s important to have meaningful conversations (not just polite smalltalk from a small menu of stock phrases), and that these should be two-way, i.e. involving both listening/reading and speaking/writing. Ideally, all four of those, which for most people means online and offline social interactions.
- Stress management: because chronic stress damages brain cells and accelerates cognitive decline, it’s important to manage that; practices like mindfulness meditation go a very long way and make a big difference.
For more on all of these, enjoy:
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Want to learn more?
You might also like to read:
The Physical Exercises That Build Your Brain ← this is different from just exercising for one’s heart and thus the brain by extension, and rather, is specific exercises that strengthen specific parts of the brain.
Take care!
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What We Don’t Talk About When We Talk About Fat – by Aubrey Gordon
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There are books aplenty to encourage and help you to lose weight. This isn’t one of those.
There are also books aplenty to encourage and help you to accept yourself and your body at the weight you are, and forge self-esteem. This isn’t one of those, either—in fact, it starts by assuming you already have that.
There are fair arguments for body neutrality, and fat acceptance. Very worthy also is the constant fight for bodily sovereignty.
These are worthy causes, but they’re for the most-part not what our author concerns herself with here. Instead, she cares for a different and very practical goal: fat justice.
In a world where you may be turned away from medical treatment if you are over a certain size, told to lose half your bodyweight before you can have something you need, she demands better. The battle extends further than healthcare though, and indeed to all areas of life.
Ultimately, she argues, any society that will disregard the needs of the few because they’re a marginal demographic, is a society that will absolutely fail you if you ever differ from the norm in some way.
All in all, an important (and for many, perhaps eye-opening) book to read if you are fat, care about fat people, are a person of any size, or care about people in general.
Pick Up Your Copy of “What We Don’t Talk About When We Talk About Fat”, on Amazon Today!
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Yes, you do need to clean your tongue. Here’s how and why
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Has your doctor asked you to stick out your tongue and say “aaah”? While the GP assesses your throat, they’re also checking out your tongue, which can reveal a lot about your health.
The doctor will look for any changes in the tongue’s surface or how it moves. This can indicate issues in the mouth itself, as well as the state of your overall health and immunity.
But there’s no need to wait for a trip to the doctor. Cleaning your tongue twice a day can help you check how your tongue looks and feels – and improve your breath.
luisrsphoto/Shutterstock What does a healthy tongue look like?
Our tongue plays a crucial role in eating, talking and other vital functions. It is not a single muscle but rather a muscular organ, made up of eight muscle pairs that help it move.
The surface of the tongue is covered by tiny bumps that can be seen and felt, called papillae, giving it a rough surface.
These are sometimes mistaken for taste buds – they’re not. Of your 200,000-300,000 papillae, only a small fraction contain taste buds. Adults have up to 10,000 taste buds and they are invisible to the naked eye, concentrated mainly on the tip, sides and back of the tongue. https://www.youtube.com/embed/uYvpUl7li9Y?wmode=transparent&start=0
A healthy tongue is pink although the shade may vary from person to person, ranging from dark to light pink.
A small amount of white coating can be normal. But significant changes or discolouration may indicate a disease or other issues.
How should I clean my tongue?
Cleaning your tongue only takes around 10-15 seconds, but it’s is a good way to check in with your health and can easily be incorporated into your teeth brushing routine.
Build-up can occur if you stop brushing or scraping your tongue even for a few days. Anthony Shkraba/Pexels You can clean your tongue by gently scrubbing it with a regular toothbrush. This dislodges any food debris and helps prevent microbes building up on its rough textured surface.
Or you can use a special tongue scraper. These curved instruments are made of metal or plastic, and can be used alone or accompanied by scrubbing with your toothbrush.
Your co-workers will thank you as well – cleaning your tongue can help combat stinky breath. Tongue scrapers are particularly effective at removing the bacteria that commonly causes bad breath, hidden in the tongue’s surface.
What’s that stuff on my tongue?
So, you’re checking your tongue during your twice-daily clean, and you notice something different. Noting these signs is the first step. If you observe any changes and they worry you, you should talk to your GP.
Here’s what your tongue might be telling you.
White coating
Developing a white coating on the tongue’s surface is one of the most common changes in healthy people. This can happen if you stop brushing or scraping the tongue, even for a few days.
In this case, food debris and microbes have accumulated and caused plaque. Gentle scrubbing or scraping will remove this coating. Removing microbes reduces the risk of chronic infections, which can be transferred to other organs and cause serious illnesses.
Scrubbing or scraping your tongue only takes around ten seconds and can be done while brushing your teeth. Ketut Subiyanto/Pexels Yellow coating
This may indicate oral thrush, a fungal infection that leaves a raw surface when scrubbed.
Oral thrush is common in elderly people who take multiple medications or have diabetes. It can also affect children and young adults after an illness, due to the temporary suppression of the immune system or antibiotic use.
If you have oral thrush, a doctor will usually prescribe a course of anti-fungal medication for at least a month.
Black coating
Smoking or consuming a lot of strong-coloured food and drink – such as tea and coffee, or dishes with tumeric – can cause a furry appearance. This is known as a black hairy tongue. It’s not hair, but an overgrowth of bacteria which may indicate poor oral hygiene.
Smoking can add to poor oral hygiene and make the tongue look black. Sophon Nawit/Shutterstock Pink patches
Pink patches surrounded by a white border can make your tongue look like a map – this is called “geographic tongue”. It’s not known what causes this condition, which usually doesn’t require treatment.
Pain and inflammation
A red, sore tongue can indicate a range of issues, including:
- nutritional deficiencies such as folic acid or vitamin B12
- diseases including pernicious anaemia, Kawasaki disease and scarlet fever
- inflammation known as glossitis
- injury from hot beverages or food
- ulcers, including cold sores and canker sores
- burning mouth syndrome.
Dryness
Many medications can cause dry mouth, also called xerostomia. These include antidepressants, anti-psychotics, muscle relaxants, pain killers, antihistamines and diuretics. If your mouth is very dry, it may hurt.
What about cancer?
White or red patches on the tongue that can’t be scraped off, are long-standing or growing need to checked out by a dental professional as soon as possible, as do painless ulcers. These are at a higher risk of turning into cancer, compared to other parts of the mouth.
Oral cancers have low survival rates due to delayed detection – and they are on the rise. So checking your tongue for changes in colour, texture, sore spots or ulcers is critical.
Dileep Sharma, Professor and Head of Discipline – Oral Health, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Alpha, beta, theta: what are brain states and brain waves? And can we control them?
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There’s no shortage of apps and technology that claim to shift the brain into a “theta” state – said to help with relaxation, inward focus and sleep.
But what exactly does it mean to change one’s “mental state”? And is that even possible? For now, the evidence remains murky. But our understanding of the brain is growing exponentially as our methods of investigation improve.
Brain-measuring tech is evolving
Currently, no single approach to imaging or measuring brain activity gives us the whole picture. What we “see” in the brain depends on which tool we use to “look”. There are myriad ways to do this, but each one comes with trade-offs.
We learnt a lot about brain activity in the 1980s thanks to the advent of magnetic resonance imaging (MRI).
Eventually we invented “functional MRI”, which allows us to link brain activity with certain functions or behaviours in real time by measuring the brain’s use of oxygenated blood during a task.
We can also measure electrical activity using EEG (electroencephalography). This can accurately measure the timing of brain waves as they occur, but isn’t very accurate at identifying which specific areas of the brain they occur in.
Alternatively, we can measure the brain’s response to magnetic stimulation. This is very accurate in terms of area and timing, but only as long as it’s close to the surface.
What are brain states?
All of our simple and complex behaviours, as well as our cognition (thoughts) have a foundation in brain activity, or “neural activity”. Neurons – the brain’s nerve cells – communicate by a sequence of electrical impulses and chemical signals called “neurotransmitters”.
Neurons are very greedy for fuel from the blood and require a lot of support from companion cells. Hence, a lot of measurement of the site, amount and timing of brain activity is done via measuring electrical activity, neurotransmitter levels or blood flow.
We can consider this activity at three levels. The first is a single-cell level, wherein individual neurons communicate. But measurement at this level is difficult (laboratory-based) and provides a limited picture.
As such, we rely more on measurements done on a network level, where a series of neurons or networks are activated. Or, we measure whole-of-brain activity patterns which can incorporate one or more so-called “brain states”.
According to a recent definition, brain states are “recurring activity patterns distributed across the brain that emerge from physiological or cognitive processes”. These states are functionally relevant, which means they are related to behaviour.
Brain states involve the synchronisation of different brain regions, something that’s been most readily observed in animal models, usually rodents. Only now are we starting to see some evidence in human studies.
Various kinds of states
The most commonly-studied brain states in both rodents and humans are states of “arousal” and “resting”. You can picture these as various levels of alertness.
Studies show environmental factors and activity influence our brain states. Activities or environments with high cognitive demands drive “attentional” brain states (so-called task-induced brain states) with increased connectivity. Examples of task-induced brain states include complex behaviours such as reward anticipation, mood, hunger and so on.
In contrast, a brain state such as “mind-wandering” seems to be divorced from one’s environment and tasks. Dropping into daydreaming is, by definition, without connection to the real world.
We can’t currently disentangle multiple “states” that exist in the brain at any given time and place. As mentioned earlier, this is because of the trade-offs that come with recording spatial (brain region) versus temporal (timing) brain activity.
Brain states vs brain waves
Brain state work can be couched in terms such as alpha, delta and so forth. However, this is actually referring to brain waves which specifically come from measuring brain activity using EEG.
EEG picks up on changing electrical activity in the brain, which can be sorted into different frequencies (based on wavelength). Classically, these frequencies have had specific associations:
- gamma is linked with states or tasks that require more focused concentration
- beta is linked with higher anxiety and more active states, with attention often directed externally
- alpha is linked with being very relaxed, and passive attention (such as listening quietly but not engaging)
- theta is linked with deep relaxation and inward focus
- and delta is linked with deep sleep.
Brain wave patterns are used a lot to monitor sleep stages. When we fall asleep we go from drowsy, light attention that’s easily roused (alpha), to being relaxed and no longer alert (theta), to being deeply asleep (delta).
Can we control our brain states?
The question on many people’s minds is: can we judiciously and intentionally influence our brain states?
For now, it’s likely too simplistic to suggest we can do this, as the actual mechanisms that influence brain states remain hard to detangle. Nonetheless, researchers are investigating everything from the use of drugs, to environmental cues, to practising mindfulness, meditation and sensory manipulation.
Controversially, brain wave patterns are used in something called “neurofeedback” therapy. In these treatments, people are given feedback (such as visual or auditory) based on their brain wave activity and are then tasked with trying to maintain or change it. To stay in a required state they may be encouraged to control their thoughts, relax, or breathe in certain ways.
The applications of this work are predominantly around mental health, including for individuals who have experienced trauma, or who have difficulty self-regulating – which may manifest as poor attention or emotional turbulence.
However, although these techniques have intuitive appeal, they don’t account for the issue of multiple brain states being present at any given time. Overall, clinical studies have been largely inconclusive, and proponents of neurofeedback therapy remain frustrated by a lack of orthodox support.
Other forms of neurofeedback are delivered by MRI-generated data. Participants engaging in mental tasks are given signals based on their neural activity, which they use to try and “up-regulate” (activate) regions of the brain involved in positive emotions. This could, for instance, be useful for helping people with depression.
Another potential method claimed to purportedly change brain states involves different sensory inputs. Binaural beats are perhaps the most popular example, wherein two different wavelengths of sound are played in each ear. But the evidence for such techniques is similarly mixed.
Treatments such as neurofeedback therapy are often very costly, and their success likely relies as much on the therapeutic relationship than the actual therapy.
On the bright side, there’s no evidence these treatment do any harm – other than potentially delaying treatments which have been proven to be beneficial.
Susan Hillier, Professor: Neuroscience and Rehabilitation, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Doctors Are as Vulnerable to Addiction as Anyone. California Grapples With a Response
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BEVERLY HILLS, Calif. — Ariella Morrow, an internal medicine doctor, gradually slid from healthy self-esteem and professional success into the depths of depression.
Beginning in 2015, she suffered a string of personal troubles, including a shattering family trauma, marital strife, and a major professional setback. At first, sheer grit and determination kept her going, but eventually she was unable to keep her troubles at bay and took refuge in heavy drinking. By late 2020, Morrow could barely get out of bed and didn’t shower or brush her teeth for weeks on end. She was up to two bottles of wine a day, alternating it with Scotch whisky.
Sitting in her well-appointed home on a recent autumn afternoon, adorned in a bright lavender dress, matching lipstick, and a large pearl necklace, Morrow traced the arc of her surrender to alcohol: “I’m not going to drink before 5 p.m. I’m not going to drink before 2. I’m not going to drink while the kids are home. And then, it was 10 o’clock, 9 o’clock, wake up and drink.”
As addiction and overdose deaths command headlines across the nation, the Medical Board of California, which licenses MDs, is developing a new program to treat and monitor doctors with alcohol and drug problems. But a fault line has appeared over whether those who join the new program without being ordered to by the board should be subject to public disclosure.
Patient advocates note that the medical board’s primary mission is “to protect healthcare consumers and prevent harm,” which they say trumps physician privacy.
The names of those required by the board to undergo treatment and monitoring under a disciplinary order are already made public. But addiction medicine professionals say that if the state wants troubled doctors to come forward without a board order, confidentiality is crucial.
Public disclosure would be “a powerful disincentive for anybody to get help” and would impede early intervention, which is key to avoiding impairment on the job that could harm patients, said Scott Hambleton, president of the Federation of State Physician Health Programs, whose core members help arrange care and monitoring of doctors for substance use disorders and mental health conditions as an alternative to discipline.
But consumer advocates argue that patients have a right to know if their doctor has an addiction. “Doctors are supposed to talk to their patients about all the risks and benefits of any treatment or procedure, yet the risk of an addicted doctor is expected to remain a secret?” Marian Hollingsworth, a volunteer advocate with the Patient Safety Action Network, told the medical board at a Nov. 14 hearing on the new program.
Doctors are as vulnerable to addiction as anyone else. People who work to help rehabilitate physicians say the rate of substance use disorders among them is at least as high as the rate for the general public, which the federal Substance Abuse and Mental Health Services Administration put at 17.3% in a Nov. 13 report.
Alcohol is a very common drug of choice among doctors, but their ready access to pain meds is also a particular risk.
“If you have an opioid use disorder and are working in an operating room with medications like fentanyl staring you down, it’s a challenge and can be a trigger,” said Chwen-Yuen Angie Chen, an addiction medicine doctor who chairs the Well-Being of Physicians and Physicians-in-Training Committee at Stanford Health Care. “It’s like someone with an alcohol use disorder working at a bar.”
From Pioneer to Lagger
California was once at the forefront of physician treatment and monitoring. In 1981, the medical board launched a program for the evaluation, treatment, and monitoring of physicians with mental illness or substance use problems. Participants were often required to take random drug tests, attend multiple group meetings a week, submit to work-site surveillance by colleagues, and stay in the program for at least five years. Doctors who voluntarily entered the program generally enjoyed confidentiality, but those ordered into it by the board as part of a disciplinary action were on the public record.
The program was terminated in 2008 after several audits found serious flaws. One such audit, conducted by Julianne D’Angelo Fellmeth, a consumer interest lawyer who was chosen as an outside monitor for the board, found that doctors in the program were often able to evade the random drug tests, attendance at mandatory group therapy sessions was not accurately tracked, and participants were not properly monitored at work sites.
Today, MDs who want help with addiction can seek private treatment on their own or in many cases are referred by hospitals and other health care employers to third parties that organize treatment and surveillance. The medical board can order a doctor on probation to get treatment.
In contrast, the California licensing boards of eight other health-related professions, including osteopathic physicians, registered nurses, dentists, and pharmacists, have treatment and monitoring programs administered under one master contract by a publicly traded company called Maximus Inc. California paid Maximus about $1.6 million last fiscal year to administer those programs.
When and if the final medical board regulations are adopted, the next step would be for the board to open bidding to find a program administrator.
Fall From Grace
Morrow’s troubles started long after the original California program had been shut down.
The daughter of a prominent cosmetic surgeon, Morrow grew up in Palm Springs in circumstances she describes as “beyond privileged.” Her father, David Morrow, later became her most trusted mentor.
But her charmed life began to fall apart in 2015, when her father and mother, Linda Morrow, were indicted on federal insurance fraud charges in a well-publicized case. In 2017, the couple fled to Israel in an attempt to escape criminal prosecution, but later they were both arrested and returned to the United States to face prison sentences.
The legal woes of Morrow’s parents, later compounded by marital problems related to the failure of her husband’s business, took a heavy toll on Morrow. She was in her early 30s when the trouble with her parents started, and she was working 16-hour days to build a private medical practice, with two small children at home. By the end of 2019, she was severely depressed and turning increasingly to alcohol. Then, the loss of her admitting privileges at a large Los Angeles hospital due to inadequate medical record-keeping shattered what remained of her self-confidence.
Morrow, reflecting on her experience, said the very strengths that propel doctors through medical school and keep them going in their careers can foster a sense of denial. “We are so strong that our strength is our greatest threat. Our power is our powerlessness,” she said. Morrow ignored all the flashing yellow lights and even the red light beyond which serious trouble lay: “I blew through all of it, and I fell off the cliff.”
By late 2020, no longer working, bedridden by depression, and drinking to excess, she realized she could no longer will her way through: “I finally said to my husband, ‘I need help.’ He said, ‘I know you do.’”
Ultimately, she packed herself off to a private residential treatment center in Texas. Now sober for 21 months, Morrow said the privacy of the addiction treatment she chose was invaluable because it shielded her from professional scrutiny.
“I didn’t have to feel naked and judged,” she said.
Morrow said her privacy concerns would make her reluctant to join a state program like the one being considered by the medical board.
Physician Privacy vs. Patient Protection
The proposed regulations would spare doctors in the program who were not under board discipline from public disclosure as long as they stayed sober and complied with all the requirements, generally including random drug tests, attendance at group sessions, and work-site monitoring. If the program put a restriction on a doctor’s medical license, it would be posted on the medical board’s website, but without mentioning the doctor’s participation in the program.
Yet even that might compromise a doctor’s career since “having a restricted license for unspecified reasons could have many enduring personal and professional implications, none positive,” said Tracy Zemansky, a clinical psychologist and president of the Southern California division of Pacific Assistance Group, which provides support and monitoring for physicians.
Zemansky and others say doctors, just like anyone else, are entitled to medical privacy under federal law, as long as they haven’t caused harm.
Many who work in addiction medicine also criticized the proposed new program for not including mental health problems, which often go hand in hand with addiction and are covered by physician health programs in other states.
“To forgo mental health treatment, I think, is a grave mistake,” Morrow said. For her, depression and alcoholism were inseparable, and the residential program she attended treated her for both.
Another point of contention is money. Under the current proposal, doctors would bear all the costs of the program.
The initial clinical evaluation, plus the regular random drug tests, group sessions, and monitoring at their work sites could cost participants over $27,000 a year on average, according to estimates posted by the medical board. And if they were required to go for 30-day inpatient treatment, that would add an additional $40,000 — plus nearly $36,000 in lost wages.
People who work in the field of addiction medicine believe that is an unfair burden. They note that most programs for physicians in other states have outside funding to reduce the cost to participants.
“The cost should not be fully borne by the doctors, because there are many other people that are benefiting from this, including the board, malpractice insurers, hospitals, the medical association,” said Greg Skipper, a semi-retired addiction medicine doctor who ran Alabama’s state physician health program for 12 years. In Alabama, he said, those institutions contribute to the program, significantly cutting the amount doctors have to pay.
The treatment program that Morrow attended in spring of 2021, at The Menninger Clinic in Houston, cost $80,000 for a six-week stay, which was covered by a concerned family member. “It saved my life,” she said.
Though Morrow had difficulty maintaining her sobriety in the first year after treatment, she has now been sober since April 2, 2022. These days, Morrow regularly attends therapy and Alcoholics Anonymous and has pivoted to become an addiction medicine doctor.
“I am a better doctor today because of my experience — no question,” Morrow said. “I am proud to be a doctor who’s an alcoholic in recovery.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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