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Archive for the ‘Medical’ Category

The bias that blinds: Why doctors give some people dangerously different medical care

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Jessica Nordell writes in the Guardian:

I met Chris in my first month at a small, hard-partying Catholic high school in north-eastern Wisconsin, where kids jammed cigarettes between the fingers of the school’s lifesize Jesus statue and skipped mass to eat fries at the fast-food joint across the street. Chris and her circle perched somewhere adjacent to the school’s social hierarchy, and she surveyed the adolescent drama and absurdity with cool, heavy-lidded understanding. I admired her from afar and shuffled around the edges of her orbit, gleeful whenever she motioned for me to join her gang for lunch.

After high school, we lost touch. I went east; Chris stayed in the midwest. To pay for school at the University of Minnesota, she hawked costume jewellery at Dayton’s department store. She got married to a tall classmate named Adam and merged with the mainstream – became a lawyer, had a couple of daughters. She would go running at the YWCA and cook oatmeal for breakfast. Then in 2010, at the age of 35, she went to the ER with stomach pains. She struggled to describe the pain – it wasn’t like anything she’d felt before. The doctor told her it was indigestion and sent her home. But the symptoms kept coming back. She was strangely tired and constipated. She returned to the doctor. She didn’t feel right, she said. Of course you’re tired, he told her, you’re raising kids. You’re stressed. You should be tired. Frustrated, she saw other doctors. You’re a working mom, they said. You need to relax. Add fibre to your diet. The problems ratcheted up in frequency. She was anaemic, and always so tired. She’d feel sleepy when having coffee with a friend. Get some rest, she was told. Try sleeping pills.

By 2012, the fatigue was so overwhelming, Chris couldn’t walk around the block. She’d fall asleep at three in the afternoon. Her skin was turning pale. She felt pain when she ate. Adam suggested she see his childhood physician, who practised 40 minutes away. That doctor tested her blood. Her iron was so low, he thought she was bleeding internally. He scheduled a CT scan and a colonoscopy. When they revealed a golf ball-sized tumour, Chris felt, for a moment, relieved. She was sick. She’d been telling them all along. Now there was a specific problem to solve. But the relief was short-lived. Surgery six days later showed that the tumour had spread into her abdomen. At the age of 37, Chris had stage four colon cancer.

Historically, research about the roots of health disparities – differences in health and disease among different social groups – has sought answers in the patients: their behaviour, their status, their circumstances. Perhaps, the thinking went, some patients wait longer to seek help in the first place, or they don’t comply with doctors’ orders.

Maybe patients receive fewer interventions because that’s what they prefer. For Black Americans, health disparities have long been seen as originating in the bodies of the patients, a notion promoted by the racism of the 19th-century medical field. Medical journals published countless articles detailing invented physiological flaws of Black Americans; statistics pointing to increased mortality rates in the late 19th century were seen as evidence not of social and economic oppression and exclusion, but of physical inferiority.

In this century, research has increasingly focused on the social and environmental determinants of health, including the way differences in access to insurance and care also change health outcomes. The devastating disparate impact of Covid-19 on communities of colour vividly illuminates these factors: the disproportionate burden can be traced to a web of social inequities, including more dangerous working conditions, lack of access to essential resources, and chronic health conditions stemming from ongoing exposure to inequality, racism, exclusion and pollution. For trans people, particularly trans women of colour, the burden of disease is enormous. Trans individuals, whose marginalisation results in high rates of poverty, workplace discrimination, unemployment, and serious psychological distress, face much higher rates of chronic conditions such as asthma, chronic pulmonary obstructive disorder, depression and HIV than the cisgender population. A 2015 survey of nearly 28,000 trans individuals in the US found that one-third had not sought necessary healthcare because they could not afford it.

More recently, researchers have also begun looking at differences that originate in the providers – differences in how doctors and other healthcare professionals treat patients. And study after study shows that they treat some groups differently from others.

Black patients, for instance, are less likely than white patients to receive pain medication for the same symptoms, a pattern of disparate treatment that holds even for children. Researchers attribute this finding to false stereotypes that Black people don’t feel pain to the same degree as white people – stereotypes that date back to chattel slavery and were used to justify inhumane treatment. The problem pervades medical education, where “race” is presented as a risk factor for myriad diseases, rather than the accumulation of stressors linked to racism. Black immigrants from the Caribbean, for instance, have lower rates of hypertension and cardiovascular disease than US-born Black people, but after a couple of decades, their rates of illness increase toward those of the US-born Black population, a result generally attributed to the particular racism they encounter in the US.

Black patients are also given fewer therapeutic procedures, even when studies control for insurance, illness severity and type of hospital. For heart attacks, black people are less likely to receive guideline-based care; in intensive care units for heart failure, they are less likely to see a cardiologist, which is linked to survival.

These biases affect the quality of many other interactions in clinics. Doctors spend less time and build less emotional rapport with obese patients. Transgender people face overt prejudice and discrimination. The 2015 survey also found that in the preceding year, a third of respondents had had a negative encounter with a healthcare provider, including being refused treatment. Almost a quarter were so concerned about mistreatment that they avoided necessary healthcare. Transgender individuals can therefore face a dangerous choice: disclose their status as trans and risk discrimination, or conceal it and risk inappropriate treatment.

Even though medical providers are not generally intending to provide better treatment to some people at the expense of others, unexamined bias can create devastating harm.


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hris was told that her symptoms, increasingly unmanageable, were not serious. Women as a group receive fewer and less timely interventions, receive less pain treatment and are less frequently referred to specialists. One 2008 study of nearly 80,000 patients in more than 400 hospitals found that women having heart attacks experience dangerous treatment delays, and that once in the hospital they more often die. After a heart attack, women are less likely to be referred to cardiac rehabilitation or to be prescribed the right medication. Critically ill women older than 50 are less likely to receive life-saving interventions than men of the same age; women who have knee pain are 22 times less likely to be referred for a knee replacement than a man. A 2007 Canadian study of nearly 500,000 patients showed that after adjusting for the severity of illness, women spent a shorter time in the ICU and were less likely to receive life support; after age 50, they were also significantly more likely to die after a critical illness.

Women of colour are at particular risk for poor treatment. A 2019 analysis of their childbirth experiences found that they frequently encountered condescending, ineffective communication and disrespect from providers; some women felt bullied into having C-sections. Serena Williams’s childbirth story is by now well known: the tennis star has a history of blood clots, but when she recognised the symptoms and asked for immediate scans and treatment, the nurse and the doctor doubted her. Williams finally got what she needed, but ignoring women’s symptoms and distress contributes to higher maternal mortality rates among Black, Alaska Native and Native American women. Indeed, Black women alone in the US are three to four times more likely to die of complications from childbirth than white women.

There’s also a structural reason for inferior care: women have historically been excluded from much of medical research. The reasons are varied, ranging from a desire to protect childbearing women from drugs that could impair foetal development, via notions that women’s hormones could complicate research, to an implicit judgment that men’s lives were simply more worth saving. Many landmark studies on ageing and heart disease never included women; the all-men study of cardiovascular disease named MRFIT emerged from a mindset that male breadwinners having heart attacks was a national emergency, even though cardiovascular disease is also the leading cause of death for women. In one particularly egregious example, a 1980s study examining the effect of obesity on breast cancer and uterine cancer excluded women because men’s hormones were “simpler” and “cheaper” to study.

Basic to these practices was an operating assumption that men were the default humans, of which women were a subcategory that could safely be left out of studies. Of course, there’s a logical problem here: the assertion is that women are so complicated and different that they can’t be included in research, and yet also so similar that any findings should seamlessly extend to them. In the 90s, the US Congress insisted that medical studies funded by the National Institutes of Health should include women; earlier, many drug studies also left out women, an exclusion that may help explain why women are 50%-75% more likely to experience adverse side-effects from drugs.

As the sociologist Steven Epstein points out, medicine often starts with categories that are socially and politically relevant – but these are not always medically relevant. Relying on categories such as race risks erasing the social causes of health disparities and may entrench the false and damaging ideas that are inscribed in medical practice. At the same time, ignoring differences such as sex is perilous: as a result of their exclusion, women’s symptoms have not been medically well understood. Doctors were told, for example, that women present with “atypical symptoms” of heart attacks. In fact, these “atypical” symptoms are typical – for women. They were only “atypical” because they hadn’t been studied. Women and men also vary in their susceptibility to different diseases, and in the course and symptoms of those diseases. They respond to some drugs differently. Women’s kidneys filter waste more slowly, so some medications take longer to clear from the body.

This dearth of knowledge about women’s bodies has led doctors to see differences where none exist, and fail to see differences where they do. As the journalist Maya Dusenbery argues in her book Doing Harm, this ignorance also interacts perniciously with historical stereotypes.

When women’s understudied symptoms don’t match the textbooks, doctors label them “medically unexplained”. These symptoms may then be classified as psychological rather than physical in origin. The fact that so many of women’s symptoms are “medically unexplained” reinforces the stereotype that women’s symptoms are overreactions without a medical basis, and casts doubt over all women’s narratives of their own experiences. One study found that while men who have irritable bowel syndrome are more likely to receive scans, women tend to be offered tranquilisers and lifestyle advice. In response to her pain and fatigue, my friend Chris was told she should get some sleep.


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he doctor who finally ordered the right tests for Chris told her that he’d seen many young women in his practice whose diagnoses had been . . .

Continue reading. There’s much more, and it’s infuriating. It seems to have its roots in that a disproportionately large number of medical doctors and researchers are white men, an unknown number of whom are misogynistic and/or racist. I think an interesting study would be to take a large randomized sample of medical practitioners and researchers and administer a psychological test to determine the degree to which each is misogynistic or racist. I’m also wondering whether medical schools reinforce or combat those attitudes, or instead just ignore the problem. (I suspect they ignore the problem.)

Written by Leisureguy

25 September 2021 at 6:27 pm

Doctor who has lost over 100 patients to covid says some deny virus from their deathbeds: ‘I don’t believe you’

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For reassurance, read again the earlier post in which Steven Pinker talks about rationality. Andrea Salcedo reports in the Washington Post (gift article: no paywall):

Matthew Trunsky is used to people being angry at him.

As a pulmonologist and director of the palliative care unit at a Beaumont Health hospital in southeastern Michigan, Trunsky sees some of the facility’s sickest patients and is often the bearer of bad news.

He gets it. No one is prepared to hear a loved one is dying.

But when a well-regarded intensive care unit nurse told him during a recent shift that the wife of an unvaccinated covid patient had berated her when she informed the woman of her husband’s deteriorating condition, Trunsky, who has lost more than 100 patients to the coronavirus, reached his breaking point.

When he got home that evening, he made himself a sandwich and opened Facebook.

Still sporting his black scrubs, he began to vent. He wrote about a critically ill patient who disputed his covid-19 diagnosis. Another threatened to call his lawyer if he wasn’t given ivermectin, an anti-parasite drug that is not approved for treating covid. A third, Trunsky wrote, told the doctor they would rather die than take one of the vaccines.

One demanded a different doctor. “I don’t believe you,” he told the physician.

The physician added: “Of course the answer was to have been vaccinated — but they were not and now they’re angry at the medical community for their failure.”

Trunsky’s post detailing his interactions with eight covid patients and their relatives highlights the resistance and mistreatment some health-care workers across the United States face while caring for patients who have put off or declined getting vaccinated. Trunsky estimates that 9 out of every 10 covid patients he treats are unvaccinated.

His post — a plea for people to get vaccinated — also reveals the physical and emotional toll the pandemic has had on health-care workers, who have been on the front lines for over a year and a half. Roughly 3 out of 10 have considered leaving the profession, according to a Washington Post-Kaiser Family Foundation poll, and about 6 in 10 say stress from the pandemic has harmed their mental health.

Some doctors are refusing to treat unvaccinated patients. Last month,  . . .

Continue reading. No paywall.

What’s odd is that people will refuse to get a thoroughly tested and proven effective covid-19 vaccine as recommended by medical professionals, but will jump at the chance to take a horse medicine because they read something about it on Facebook. (Maybe some have rationality antibodies.)

I saw a cartoon wondering how it was that parents who could not do their kid’s 6th-grade math homework six months ago are now infectious-disease experts.

Written by Leisureguy

24 September 2021 at 2:02 pm

Best mask technique

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No one wants to get Covid. Tara Parker-Pope has an excellent article in the NY Times on a technique that greatly improves the efficacy of a mask. It’s a a gift article, so no paywall.

As new, more contagious variants of the novel coronavirus spread around the world, public health officials are advising us to upgrade our mask protection. One of the easiest ways to do that is to wear two masks at the same time. Here are answers to common questions about the dos and don’ts of double masking.

New variants of the coronavirus are more contagious. It may be that an infected person sheds greater quantities of virus, or it may be that it takes fewer viral particles to make you sick. Either way, a more contagious virus means we need to wear masks that do a better job of trapping infectious particles. Double-masking can improve the fit of your mask by closing gaps around the edges, and it creates multiple layers of protection against droplets coming in or out.

Wearing two disposable surgical masks together is not recommended. A standard surgical mask is a blue, rectangle-shaped mask made of paper-like material. While surgical masks are great filters against viral droplets, they tend to fit poorly, leaving gaps on the sides, which reduces their efficiency. Wearing two at the same time doesn’t solve the fit problem. Adding a cloth mask on top of a surgical mask helps close the gaps and creates a more snug fit. For help choosing a cloth mask, the team at Wirecutter, which is owned by The New York Times, has some recommendations. (The mask in the video is the Graf Lantz Zenbu Organic Cotton Face Mask.)

The N95 mask is the gold standard for medical masks, and the KN95, made in China, is similar. When worn correctly, both masks will filter 95 percent of the hardest-to-trap particles. If you have access to a genuine N95 or KN95 and it fits well, you don’t need to double mask. The problem is that the N95 and KN95 masks still are hard to come by, and the supply chain is loaded with counterfeits. While the Centers for Disease Control and Prevention does not recommend double-masking with an N95 or KN95, you need to be sure you have the real thing. If you’re not sure, or it doesn’t fit well, covering it with a cloth mask could help. (Another highly effective medical mask is the KF94, made in Korea. Counterfeits typically are not a problem with KF94s, and if it fits you well, you don’t need to double mask.)

The best way to double mask is to wear a surgical mask as the first layer and cover it with a cloth mask. Tightening your surgical mask is not required, but if it fits poorly, knotting the ear loops and tucking in the corners can improve its filtering efficiency by as much as 20 percent. For a longer demonstration on adjusting the fit of your surgical mask, you can watch this video from UNC Health.

\Do look at the link — there’s a good video of the technique.

Written by Leisureguy

23 September 2021 at 7:35 pm

Inside the Conservative Fever Swamp

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Michael A. Cohen (aka, the other Michael Cohen) has a good post on his site. It begins:

As a general rule, I usually don’t read the right-wing website, Breitbart. It is one of the by-products of having a functioning brain.

But I’m making an exception today because a recent piece on the site offers useful insight into the workings of the conservative mind — and the debilitating ideology of modern conservatism.

Last week Breitbart Editor-at-Large John Nolte penned a piece lamenting that conservatives are not getting vaccinated against COVID-19. He also touted the benefits of getting a shot. These days that kind of language on a right-wing website is to be applauded. But Nolte took his argument in a strange direction: he claims that Republicans are not getting vaccinated because of liberals.

According to Nolte, “leftists like (Howard) Stern and CNNLOL and Joe Biden and Nancy Pelosi and Anthony Fauci are deliberately looking to manipulate Trump supporters into not getting vaccinated.”

How are they doing this?

“If I wanted to use reverse psychology to convince people not to get a life-saving vaccination, I would do exactly what Stern and the left are doing… I would bully and taunt and mock and ridicule you for not getting vaccinated, knowing the human response would be, Hey, fuck you, I’m never getting vaccinated!” “And why is that a perfectly human response? Because no one ever wants to feel like they are being bullied or ridiculed or mocked or pushed into doing anything.

It’s a helluva thing when a conservative writer takes the position that his fellow ideologues are like immature children who are so super sensitive and insecure that they will refuse to get a life-saving vaccine simply because their political opponents think they should. But that is Nolte’s argument.

It is, in fact, not a 100 percent normal human response to refuse vaccination in this circumstance — particularly if the alternative is death. Less normal is believing that Anthony Fauci, Nancy Pelosi, or Joe Biden are bullying, mocking, or ridiculing conservatives to purposely hasten their deaths. Far less normal is giving a rat’s ass about anything Howard Stern says. Nolte criticizes Stern for mocking anti-vaxxer conservative radio hosts who have died from COVID-19 — and rightfully so. It’s gross. But honestly, who cares? And who in their right mind makes a health care decision based on something that Howard Stern said? According to Nolte, conservatives do.

“No one wants to cave to a piece of shit like that, or a scumbag like Fauci, or any of the scumbags at CNNLOL, so we don’t. And what’s the result? They’re all vaccinated, and we’re not! And when you look at the numbers, the only numbers that matter, which is who’s dying, it’s overwhelmingly the unvaccinated who are dying, and they have just manipulated millions of their political enemies into the unvaccinated camp …

In another column this week, Nolte went a step further and argued that  . . .

Continue reading. There’s more.

The crazy never stops, and the stupid sinks ever lower.

Written by Leisureguy

22 September 2021 at 5:36 pm

US Healthcare System: Their Baby Died in the Hospital. They Had Good Healthcare Insurance. Then Came the $257,000 Bill.

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Sarah Kliff reports in the NY Times (with no paywall on this article):

Brittany Giroux Lane gave birth to her daughter, Alexandra, a few days before Christmas in 2018. The baby had dark eyes and longish legs. She had also arrived about 13 weeks early, and weighed just two pounds.

Alexandra initially thrived in the neonatal intensive care unit at Mount Sinai West. Ms. Lane, 35, recalls the nurses describing her daughter as a “rock star” because she grew so quickly. But her condition rapidly worsened after an infection, and Alexandra died early on the morning of Jan. 15 at 25 days old.

A flurry of small medical bills from neonatologists and pediatricians quickly followed. Ms. Lane struggled to get her breast pump covered by insurance because, in the midst of a preterm birth, she hadn’t gone through the health plan’s prior approval process.

Last summer, Ms. Lane started receiving debt collection notices. The letters, sent by the health plan Cigna, said she owed the insurer over $257,000 for the bills it accidentally covered for Alexandra’s care after Ms. Lane switched health insurers.

Ms. Lane was flummoxed: It was Cigna that had received the initial bill for care and had paid Mount Sinai West. Now, Cigna was seeking the money it had overpaid the hospital by turning to the patient.

“For them, it’s just business, but for us it means constantly going through the trauma of reliving our daughter’s death,” said Clayton Lane, Alexandra’s father and Ms. Lane’s husband. “It means facing threats of financial ruin. It’s so unjust and infuriating.”

Medical billing experts who reviewed the case described it as a dispute between a large hospital and a large insurer, with the patient stuck in the middle. The experts say such cases are not frequent but speak to the wider lack of predictability in American medical billing, with patients often having little idea what their care will cost until a bill turns up in the mail months later.

Congress passed a ban on surprise medical bills last year, which will go into effect in 2022. It outlaws a certain type of surprise bill: those that patients receive from an out-of-network provider unexpectedly involved in their care. There are plenty of other types of bills that surprise patients, such as those received by the Lanes, that are likely to persist.

Continue reading. There’s much more, and there’s no paywall on this: gift article.

Written by Leisureguy

21 September 2021 at 8:03 pm

Salty Diet Helps Gut Bugs Fight Cancer in Mice

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A while back I cut way back on my salt intake — and I overdid it, which resulted in woozy spells. Salt is in fact a necessary nutrient, but like many nutrients, too little and too much are both bad news (cf. iodine, zinc, iron, vitamin A, and so on). So I resumed a moderate salt intake. I still buy no-salt-added canned tomatoes, vegetable stock, and canned beans, and I don’t eat highly processed foods or bread or cheese, all of which are high in salt. But I do add a modest amount of salt in cooking, and that has worked.

Sophie Fessl has an interesting article in The Scientist on some unexpected benefits of salt in the diet:

In mice, a diet high in salt suppresses tumor growth—but only when gut microbes are there to stimulate immune cells, a September 10 study in Science Advances reports. The findings raise tantalizing questions about the role of diet and gut microbes in human cancers, and may point to new avenues for therapeutic development.

While the study isn’t the first to connect a high-salt diet to shrinking tumors, “[the authors] have shown a unique mechanistic role of high salt induced gut microbiome changes as the central phenomenon behind their observed anti-cancer effect,” writes Venkataswarup Tiriveedhi, a biologist at Tennessee State University who has studied the effect of salt on cancer progression but was not involved in the study, in an email to The Scientist.

Amit Awasthi, an immunologist with the Translational Health Science and Technology Institute in India and corresponding author of the study, says he and his colleagues pursued this line of inquiry because previous research had linked high salt intake with autoimmune diseases, suggesting that increased salt stimulates immune cells. Meanwhile, tumors are well known to grow in immune-suppressive environments. Awasthi recalls wondering with his team: “If we put salt in the mice’s diet, maybe [the immune system in] the tumor environment becomes activated,” suppressing cancerous growth.

Indeed, a 2019 Frontiers in Immunology study from a European team led by Hasselt University immunologist Markus Kleinewietfeld reported that high-salt diets inhibited tumor growth in mice. When Awasthi and his colleagues carried out similar experiments, implanting mice with B16F10 skin melanoma cells and then feeding the tumor transplant mice diets with different salt levels, they got similar results: tumors grew slower in mice who were fed a high-salt diet.

That led to what Awasthi calls an “obvious question”: How does the immune system respond to dietary salt? To answer that, the team dissected the tumor sites and found that immune cells known as natural killer (NK) cells were enriched in the mice fed the high-salt diet compared with mice fed diets with normal or slightly elevated salt levels. When the NK cells were removed, the high-salt diet no longer led to tumor regression—an effect that wasn’t seen after depleting both T and B cells.

To drill into why salt had this effect on NK cells, Awasthi and his colleagues looked in the literature and found studies reporting that high-salt diets alter the gut microbiome, as well as others that found the gut microbiome modulates patients’ response to cancer immunotherapy. To test for a role of the resident gut bacteria in the effects of a high-salt diet on cancer growth, the researchers gave the mice antibiotics before feeding them the different diets. Sure enough, a high-salt diet no longer suppressed tumor growth. But that wasn’t all: when the team transplanted fecal material from mice fed a high-salt diet into microbe-free mice, they were surprised to find that tumors shrank, Awasthi recalls.

See “Does the Microbiome Help the Body Fight Cancer?”

The researchers looked at the diversity of species in the mice’s gut and saw an increased abundance of Bifidobacterium species in mice fed a high-salt diet. Moreover, the tumors of these mice showed a sixfold increase in Bifidobacterium abundance compared with the tumors of mice on a normal diet. According to Awasthi, that suggests “Bifidobacterium is leaking out from the gut and actually reaching the tumor site,” likely the result of salt-induced gut permeability.

In mice fed a normal diet, injection of Bifidobacterium into tumors led to tumor regression, an effect that disappeared if the researchers removed the animals’ NK cells, they reported. Awasthi says that might mean there’s a way to capitalize on the tumor-fighting qualities of a high-salt diet while avoiding the potential downsides, such as autoimmune issues or hypertension: “we can replace the salt with the Bifidobacterium.

Kleinewietfeld says the new study is in line with  . . .

Continue reading.

Written by Leisureguy

20 September 2021 at 6:23 pm

At Rikers Island, Inmates Locked in Showers Without Food and Defecating in Bags

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The US is really amazing. New York City is supposed a city of wealth and culture and represents to much of the world what the US is. In the Intercept Nick Pinto reports on how New York City treats those entrusted to its care:

JAIL OFFICIALS KNEW that state legislators were going to be touring Rikers Island on September 13. But if they made any effort to disguise the degree of degradation and danger that pervades New York City’s jail complex, it didn’t show. Lawmakers and the people who accompanied them returned from their visit visibly shaken.

“There’s a segregated intake unit that we walked through where they have people held in showers,” said Alice Fontier, managing director for Neighborhood Defender Services, who toured one Rikers building, the Otis Bantum Correctional Center, with lawmakers. “It’s about 2 feet wide by 6 feet. There is no toilet. They’ve given them plastic bags to use for feces and urine. And they’re sitting in the cells with their own bodily waste locked into these conditions. This is the most horrific thing I’ve seen in my life. I’ve been coming to this jail since 2008. This is unlike anything that has ever happened here.”

Rikers has been a festering wound in New York City for about as long as it has existed as a jail complex. Cut off from the rest of the city by water on all sides and accessible only by a long causeway, New York’s island gulag has always been out of sight and out of mind. Periodically, a snapshot of conditions inside will escape the island’s event horizon, as in 2014 when then-U.S. Attorney Preet Bharara issued a scathing report describing Rikers as a place “more inspired by ‘Lord of the Flies’ than any legitimate philosophy of humane detention.”

Bharara’s report helped buttress the movement to close Rikers once and for all, a movement to which Mayor Bill de Blasio was a late joiner in 2017, during his reelection campaign.

Since that time, de Blasio has responded to alarms about conditions on Rikers Island by falling back on his commitment to close the complex — but only closing it sometime years in the future, long after he has left office. The mayor has not visited the island jails at all since winning his second term.

Recent events, though, forced de Blasio to pay closer attention. In the last eight months, 10 people have died in custody on the island, five of them taking their own lives. Covid-19 is once again on the rise on Rikers. On September 10, the chief medical officer on Rikers wrote a letter to New York City Council, warning that “in 2021 we have witnessed a collapse in basic jail operations, such that today I do not believe the City is capable of safely managing the custody of those it is charged with incarcerating in its jails.”

As de Blasio belatedly rolls out a plan for addressing the crisis on Rikers, he is casting responsibility for the condition in his jails variously on the Covid-19 pandemic, prison guards, state government, prosecutors, and the judiciary. But while the unfolding human catastrophe is indeed a tragedy with deep origins and many authors, it is also the predictable conclusion of de Blasio’s own policies and politics.

Even as he has taken credit for the long-term plan to eventually close Rikers, the mayor has embraced a pressure campaign by his police commissioner that seeks to roll back carceral system reforms and re-entrench bail and gratuitous pretrial detention in New York’s criminal system.

In the conscience-shocking crisis on Rikers Island, de Blasio is reaping the whirlwind for his acquiescence to an agenda of mass incarceration.

MUCH OF THE coverage of the crisis on Rikers has focused on a cascading staffing crisis. In recent weeks, accounts circulated of housing units going whole days without any guards at all. By the city government’s estimates, on any given day, fully 35 percent of staff are unavailable to work. On September 15, according to New York City officials, 789 jail employees called in sick, 68 were out for a “personal emergency,” and 93 were simply absent without leave.

As guards sick out, their colleagues find their own working conditions declining even further. Corrections officers increasingly work double, triple, and even quadruple shifts. On many housing units, there are no officers on the floor. The number of assaults — against incarcerated people and staff alike — is going up. . .

Continue reading. There’s much more and no paywall.

Written by Leisureguy

19 September 2021 at 4:51 pm

New Evidence of Corruption at Epa Chemicals Division

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Sharon Lerner reports in the Intercept:

Scientists at the Environmental Protection Agency have provided The Intercept with new information showing that senior staff have made chemicals appear safer — sometimes dodging restrictions on their use — by minimizing the estimates of how much is released into the environment.

The EPA gauges the potential risk posed by a chemical using two measures: how toxic the agency considers it and how much of the substance the public will likely be exposed to. Whistleblowers from the EPA’s New Chemicals Division have already provided The Intercept with evidence that managers and other officials were pressuring them to assess chemicals to be less toxic than they actually are — and sometimes removing references to their harms from chemical assessments.

Now new documents, including meeting summaries, internal emails, and screenshots from the EPA’s computer system, along with interviews with whistleblowers and other EPA scientists, show that the agency’s New Chemicals Division has avoided calculating the exposure to — and thus the risk posed by — hundreds of chemicals and have repeatedly resisted calls to change that policy even after scientists have shown that it puts the public at risk.

Call It “Negligible”

Since 1995, the EPA has operated under the assumption that chemicals emitted below certain cutoff levels are safe. Whether a toxic chemical is emitted through the smokestacks of an industrial plant, via leaks in its machinery, or from a leaky landfill into groundwater, the agency requires scientists to quantify the precise risk posed by the chemical only if the release (and thus likely human exposure) reaches certain thresholds. If the releases from both smokestacks and leaks are below the thresholds, the chemical is given a pass. In recent years, however, scientists have shown that some of the chemicals allowed onto the market using this loophole do in fact present a danger, particularly to the people living in “fence-line communities” near industrial plants.

In 2018, several EPA scientists became worried that the use of these exposure thresholds could leave the public vulnerable to health risks. Their concern was heightened by an email that a manager in the Office of Pollution Prevention and Toxics sent in October of that year, instructing the scientists to change the language they used to classify chemicals that were exempted from risk calculation because they were deemed to have low exposure levels. Up to that point, they had described them in reports as “below modeling thresholds.” From then on, the manager explained, the scientists were to include the words “expects to be negligible” — a phrase that implies there’s no reason for concern.

Several scientists who worked on calculating chemical risks believed that there was in fact reason for concern and that the use of the thresholds leaves the public vulnerable to health effects, including cancer. And after being instructed to refer to exposures they hadn’t actually measured or modeled as “negligible,” the scientists proposed dropping or lowering the cutoffs and running the calculations for each individual chemical — a task that would add only minutes to the assessment process. But the managers refused to heed their request, which would have not only changed how chemicals were assessed moving forward but would have also had implications for hundreds of assessments in the past.

“They told us that the use of the thresholds was a policy decision and, as such, we could not simply stop applying them,” one of the scientists who worked in the office explained to The Intercept.

The issue resurfaced in May 2020 when a scientist presented the case of a single chemical the agency was then considering allowing onto the market. Although it fell into the “negligible” category using the cutoffs that had been set decades previously, when the scientists calculated the exposure levels using an alternate EPA model, which is designed to gauge the risk of airborne chemicals, it became clear that the chemical did pose a risk of damaging the human nervous system. The chemical is still going through the approval process.

In February, a small group of scientists reviewed the safety thresholds set by the EPA for all of the 368 new chemicals submitted to the agency in 2020. They found that more than half could pose risks even in cases in which the agency had already described exposure as “negligible” and thus had not calculated specific risk. Again, the scientists brought the exposure threshold issue to the attention of managers in the New Chemicals Division, briefing them on their analysis and requesting that the use of the outdated cutoffs be stopped. But they received no response to their proposal. Seven months later, the thresholds remain in use and the risk posed by chemicals deemed to have low exposure levels is still not being calculated and included in chemical assessments, according to EPA scientists who spoke with The Intercept.

The internal struggles over exposure present yet another example of managers and senior staff working to undermine the agency’s mission, according to the EPA scientists. “Our work on new chemicals often felt like an exercise in finding ways to approve new chemicals rather than reviewing them for approval,” said one of two scientists who filed new disclosures to the EPA inspector general on August 31 about the issue. The detailed account of corruption within the New Chemicals Division that four whistleblowers previously submitted to members of Congress, the EPA inspector general, and The Intercept also included information on the ongoing problems caused by the use of the exposure thresholds.”

“It all comes down to money,” said Kyla Bennett, director of science policy for Public Employees for Environmental Responsibility, or PEER, the organization representing the whistleblowers, who pointed out that risk values above the agency’s accepted cutoffs require the EPA to impose limits that may make a chemical harder to use — and sell. “Companies don’t want warning labels, they don’t want restrictions.”

It’s unclear why some senior staff and managers within the EPA’s New Chemicals Division seem to feel an obligation not to burden the companies they regulate with restrictions. “That’s the $64,000 question,” said Bennett, who pointed out that EPA staffers may enhance their post-agency job prospects within the industry if they stay in the good graces of chemical companies. She also noted that managers’ performance within the division is assessed partly based on how many chemicals they approve. “The bean counting is driving their actions,” said Bennett. “The performance metrics should be, how many chemicals did you prevent from going onto the market, rather than how many did you get onto the market.”

In response to questions about this story, the EPA  . . .

Continue reading. There’s more, and no paywall.

Written by Leisureguy

19 September 2021 at 4:42 pm

When Wall Street came to coal country: how a big-money gamble scarred Appalachia

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Mountaintop-removal coal mining in West Virginia

Evan Osnos reports in the Guardian:

Once or twice a generation, Americans rediscover Appalachia. Sometimes, they come to it through caricature – the cartoon strip Li’l Abner or the child beauty pageant star Honey Boo Boo or, more recently, Buckwild, a reality show about West Virginia teenagers, which MTV broadcast with subtitles. Occasionally, the encounter is more compassionate. In 1962, the social critic Michael Harrington published The Other America, which called attention to what he described as a “vicious circle of poverty” that “twists and deforms the spirit”.

Around the turn of this century, hedge funds in New York and its environs took a growing interest in coalmines. Coal never had huge appeal to Wall Street investors – mines were dirty, old-fashioned and bound up by union contracts that made them difficult to buy and sell. But in the late 1990s, the growing economies of Asia began to consume more and more energy, which investors predicted would drive up demand halfway around the world, in Appalachia. In 1997, the Hobet mine, a 25-year-old operation in rural West Virginia, was acquired for the first time by a public company, Arch Coal. It embarked on a major expansion, dynamiting mountaintops and dumping the debris into rivers and streams. As the Hobet mine grew, it consumed the ridges and communities around it. Seen from the air, the mine came to resemble a giant grey amoeba – 22 miles from end to end – eating its way across the mountains.

Up close, the effects were far more intimate. When Wall Street came to coal country, it triggered a cascade of repercussions that were largely invisible to the outside world but of existential importance to people nearby.

Down a hillside from the Hobet mine, the Caudill family had lived and hunted and farmed for a century. Their homeplace, as they called it, was 30 hectares (75 acres) of woods and water. The Caudills were hardly critics of mining; many were miners themselves. John Caudill was an explosives expert until one day, in the 30s, a blast went off early and left him blind. His mining days were over, but his land was abundant, and John and his wife went on to have 10 children. They grew potatoes, corn, lettuce, tomatoes, beets and beans; they hunted game in the forests and foraged for berries and ginseng. Behind the house, a hill was dense with hemlocks, ferns and peach trees.

One by one, the Caudill kids grew up and left for school and work. They settled into the surrounding towns, but stayed close enough to return to the homeplace on weekends. John’s grandson, Jerry Thompson, grew up a half-hour down a dirt road. “I could probably count on one hand the number of Sundays I missed,” he said. His grandmother’s menu never changed: fried chicken, mashed potatoes, green beans, corn and cake. “You’d just wander the property for hours. I would have a lot of cousins there, and we would ramble through the barns and climb up the mountains and wade in the creek and hunt for crawdads.”

Before long, the Hobet mine surrounded the land on three sides, and Arch Coal wanted to buy the Caudills out. Some were eager to sell. “We’re not wealthy people, and some of us are better off than others,” Thompson said. One cousin told him, “I’ve got two boys I got to put through college. I can’t pass this up because I’ll never see $50,000 again.” He thought, “He’s right; it was a good decision for him.”

In the end, nine family members agreed to sell, but six refused, and Jerry was one of them. Arch sued all of them, arguing that storing coalmine debris constituted, in legal terms, “the highest and best use of the property”. The case reached the West Virginia supreme court, where a justice asked, sceptically, “The highest and best use of the land is dumping?”

Phil Melick, a lawyer for the company, replied: “It has become that.” He added: “The use of land changes over time. The value of land changes over time.”

Surely, the justice said, the family’s value of the property was not simply economic? It was, Melick maintained. “It has to be measured economically,” he said, “or it can’t be measured at all.”


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To their surprise, the Caudills won their case, after a fashion. They could keep 10 hectares – but the victory was fleeting. Beneath their feet, the land was becoming unrecognisable. Chemicals produced by the mountaintop mine were redrawing the landscape in a bizarre tableau. In streams, the leaves and sticks developed a thick copper crust from the buildup of carbonate, and rocks turned an inky black from deposits of manganese. In the Mud River, which ran beside the Caudills’ property, a US Forest Service biologist collected fish larvae with two eyes on one side of the head. He traced the disfigurements to selenium, a byproduct of mining, and warned, in a report, of an ecosystem “on the brink of a major toxic event”. (In 2010, the journal Science published a study of 78 West Virginia streams near mountaintop-removal mines, which found that nearly all of them had elevated levels of selenium.)

This was more than just the usual tradeoff between profit and pollution, another turn in the cycle of industry and cleanup. Mountaintop removal was, fundamentally, a more destructive realm of technology. It had barely existed until the 90s, and it took some time before scientists could measure the effects on the land and the people. For ecologists, the southern Appalachians was a singular domain – one of the most productive, diverse temperate hardwood forests on the planet. For aeons, the hills had contained more species of salamander than anywhere else, and a lush canopy that attracts neotropical migratory birds across thousands of miles to hatch their next generation. But a mountaintop mine altered the land from top to bottom: after blasting off the peaks – which miners call the “overburden” – bulldozers pushed the debris down the hillsides, where it blanketed the streams and rivers. Rainwater filtered down through a strange human-made stew of metal, pyrite, sulphur, silica, salts and coal, exposed to the air for the first time. The rain mingled with the chemicals and percolated down the hills, funnelling into the brooks and streams and, finally, into the rivers on the valley floor, which sustained the people of southern West Virginia. 

Emily Bernhardt, a Duke University biologist, who spent years tracking the effects of the Hobet mine, told me: “The aquatic insects coming out of these streams are loaded with selenium, and then the spiders that are eating them become loaded with selenium, and it causes deformities in fish and birds.” The effects distorted the food chain. Normally, tiny insects hatched in the water would fly into the woods, sustaining toads, turtles and birds. But downstream, scientists discovered that some species had been replaced by flies usually found in wastewater treatment plants. By 2009, the damage was impossible to ignore. In a typical study, biologists tracking a migratory bird called the cerulean warbler found that its population had fallen by 82% in 40 years. The 2010 report in Science concluded that the impacts of mountaintop-removal mining on water, biodiversity and forest productivity were “pervasive and irreversible”. Mountaintop mines had buried more than 1,000 miles of streams across Appalachia, and, according to the EPA, altered 2,200 sq miles of land – an area bigger than Delaware.

Before long, scientists discovered impacts on the people, too. Each explosion at the top of a mountain released elements usually kept underground – lead, arsenic, selenium, manganese. The dust floated down on to the drinking water, the back-yard furniture, and through the open windows. Researchers led by Michael Hendryx, a professor of public health at West Virginia University, published startling links between mountaintop mines and health problems of those in proximity to it, including cancer, cardiovascular disease and birth defects. Between 1979 and 2005, the 70 Appalachian counties that relied most on mining had recorded, on average, more than 2,000 excess deaths each year. Viewed one way, those deaths were the cost of progress, the price of prosperity that coal could bring. But Hendryx also debunked that argument: the deaths cost $41bn a year in expenses and lost income, which was $18bn more than coal had earned the counties in salaries, tax revenue and other economic benefits. Even in the pure economic terms that the companies used, Hendryx observed, mountaintop mining had been a terrible deal for the people who lived there.


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O
ne afternoon, I hiked up through the woods behind the Caudills’ house to see the changes in the land. By law, mines are required to “remediate” their terrain, returning it to an approximation of its former condition. But, far from the public eye, the standards can be comically lax. After climbing through the trees for a while, I emerged into a sun-drenched bowl of . . .

Continue reading. There’s much more.

Written by Leisureguy

18 September 2021 at 11:26 am

Old Rockin’ Chair’s Got Me … and it does a world of good.

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A reader reminded me (thanks, Joanne!) that rocking chairs have significant health benefits. And those are not all — there are more. And specifically for elderly women. (Some overlap will be seen. You can find more with a search.)

Moreover, rocking chairs can be not only comfortable and healthful but also beautiful (example at right from Brian Boggs Handmade Furniture, profiled in Craftsmanship magazine).

At one time, every front porch — remember those — had at least one rocking chair, and the front porch at the general store would have a line of them. There’s no doubt that they are relaxing — a grateful pause in the hurly-burly of daily life — and they they actually carry serious health benefits when used consistently over time is a big bonus. (I found it reassuring that inthe first article linked above it was stated that dementia patients improved by having less agitation and greater calmness after using a rocking chair for six weeks. That time span — not an instant change, but a gradual change, at the speed of growth — makes intuitive sense, whereas a claim of instant improvement would arouse suspicion as being contrary to the nature of rocking-chair time.)

At any rate, the season of gifts is not far off, and it occurs to me that a good rocking chair would be an excellent gift to oneself or even to another. 

Written by Leisureguy

17 September 2021 at 12:36 pm

A Boy Went to a COVID-Swamped ER. He Waited for Hours. Then His Appendix Burst.

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Those who refuse to get the COVID vaccine and refuse to wear masks are putting not just themselves at risk but others as well. Refusing to heed public health measures is an aggressive act against society that is also a danger to self.

Jenny Deam reports in ProPublica:

What first struck Nathaniel Osborn when he and his wife took their son, Seth, to the emergency room this summer was how packed the waiting room was for a Wednesday at 1 p.m.

The Florida hospital’s emergency room was so crowded there weren’t enough chairs for the family to all sit as they waited. And waited.

Hours passed and 12-year-old Seth’s condition worsened, his body quivering from the pain shooting across his lower belly. Osborn said his wife asked why it was taking so long to be seen. A nurse rolled her eyes and muttered, “COVID.”

Seth was finally diagnosed with appendicitis more than six hours after arriving at Cleveland Clinic Martin Health North Hospital in late July. Around midnight, he was taken by ambulance to a sister hospital about a half-hour away that was better equipped to perform pediatric emergency surgery, his father said.

But by the time the doctor operated in the early morning hours, Seth’s appendix had burst — a potentially fatal complication.

As the nation’s hospitals fill and emergency rooms overflow with critically ill COVID-19 patients, it is the non-COVID-19 patients, like Seth, who have become collateral damage. They, too, need emergency care, but the sheer number of COVID-19 cases is crowding them out. Treatment has often been delayed as ERs scramble to find a bed that may be hundreds of miles away.

Some health officials now worry about looming ethical decisions. Last week, Idaho activated a “crisis standard of care,” which one official described as a “last resort.” It allows overwhelmed hospitals to ration care, including “in rare cases, ventilator (breathing machines) or intensive care unit (ICU) beds may need to be used for those who are most likely to survive, while patients who are not likely to survive may not be able to receive one,” the state’s website said.

The federal government’s latest data shows Alabama is at 100% of its intensive care unit capacity, with Texas, Georgia, Mississippi and Arkansas at more than 90% ICU capacity. Florida is just under 90%.

It’s the COVID-19 cases that are dominating. In Georgia, 62% of the ICU beds are now filled with just COVID-19 patients. In Texas, the percentage is nearly half.

To have so many ICU beds pressed into service for a single diagnosis is “unheard of,” said Dr. Hasan Kakli, an emergency room physician at Bellville Medical Center in Bellville, Texas, about an hour from Houston. “It’s approaching apocalyptic.”

In Texas, state data released Monday showed there were only 319 adult and 104 pediatric staffed ICU beds available across a state of 29 million people.

Hospitals need to hold some ICU beds for other patients, such as those recovering from major surgery or other critical conditions such as stroke, trauma or heart failure.

“This is not just a COVID issue,” said Dr. Normaliz Rodriguez, pediatric emergency physician at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida. “This is an everyone issue.”

While the latest hospital crisis echoes previous pandemic spikes, there are troubling differences this time around.

Before, localized COVID-19 hot spots led to bed shortages, but there were usually hospitals in the region not as affected that could accept a transfer.

Now, as the highly contagious delta variant envelops swaths of low-vaccination states all at once, it becomes harder to find nearby hospitals that are not slammed.

“Wait times can now be measured in days,” said Darrell Pile, CEO of the SouthEast Texas Regional Advisory Council, which helps coordinate patient transfers across a 25-county region.

Recently, Dr. Cedric Dark, a Houston emergency physician and assistant professor of emergency medicine at Baylor College of Medicine, said he saw a critically ill COVID-19 patient waiting in the emergency room for an ICU bed to open. The doctor worked eight hours, went home and came in the next day. The patient was still waiting. . .

Continue reading. There’s more, and no paywall.

And from another report:

Enyart is at least the fifth conservative radio talk-show host to have died of covid-19 in the last six weeks after speaking out against vaccination and masking. The others are Marc Bernier, 65, a longtime host in Florida; Phil Valentine, 61, a popular host in Tennessee; Jimmy DeYoung, 81, a nationally syndicated Christian preacher also based in Tennessee; and Dick Farrel, 65, who had worked for stations in Miami and Palm Beach, Fla., as well as for the conservative Newsmax TV channel.

Written by Leisureguy

15 September 2021 at 1:27 pm

Diet may affect risk and severity of COVID-19

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Tracy Hampton writes in The Harvard Gazette:

Although metabolic conditions such as obesity and Type 2 diabetes have been linked to an increased risk of COVID-19, as well as an increased risk of experiencing serious symptoms once infected, the impact of diet on these risks is unknown. In a recent study led by researchers at Harvard-affiliated Massachusetts General Hospital (MGH) and published in Gut, people whose diets were based on healthy plant-based foods had lower risks on both counts. The beneficial effects of diet on COVID-19 risk seemed especially relevant in individuals living in areas of high socioeconomic deprivation.

“Previous reports suggest that poor nutrition is a common feature among groups disproportionately affected by the pandemic, but data on the association between diet and COVID-19 risk and severity are lacking,” says lead author Jordi Merino, a research associate at the Diabetes Unit and Center for Genomic Medicine at MGH and an instructor in medicine at Harvard Medical School.

For the study, Merino and his colleagues examined data on 592,571 participants of the smartphone-based COVID-19 Symptom Study. Participants lived in the U.K. and the U.S., and they were recruited from March 24, 2020 and followed until Dec. 2, 2020. At the start of the study, participants completed a questionnaire that asked about their dietary habits before the pandemic. Diet quality was assessed using a healthful Plant-Based Diet Score that emphasizes healthy plant foods such as fruits and vegetables.

During follow-up, 31,831 participants developed COVID-19. Compared with individuals in the lowest quartile of the diet score, those in the highest quartile had a 9 percent lower risk of developing COVID-19 and a 41 percent lower risk of developing severe COVID-19. “These findings were consistent across a range of sensitivity analysis accounting for other healthy behaviors, social determinants of health and community virus transmission rates,” says Merino.

“Although we cannot emphasize enough the importance of getting vaccinated and wearing a mask in crowded indoor settings, our study suggests that individuals can also potentially reduce their risk of getting COVID-19 or having poor outcomes by paying attention to their diet,” says co-senior author Andrew Chan, a gastroenterologist and chief of the Clinical and Translational Epidemiology Unit at MGH.

The researchers also found a synergistic relationship between poor diet and increased socioeconomic deprivation with COVID-19 risk that was higher than the sum of the risk associated with each factor alone.

“Our models estimate that nearly a third of COVID-19 cases would have been prevented if one of two exposures — diet or deprivation — were not present,” says Merino.

The results also suggest that  . . .

Continue reading.

Written by Leisureguy

13 September 2021 at 4:52 pm

Plant-Based Diet Tied to Better Urological Health in Men

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The subtitle of this article will also be of interest to many men:

Eat more plants for your prostate and your erections

Mike Bassett, Staff Writer, writes in MedPage Today:

Men interested in preserving their urological health may benefit from eating more vegetables and fruits, researchers reported.

A trio of studies presented at the American Urological Association (AUA) virtual meeting suggested that plant-based diets were associated with a decreased risk of erectile dysfunction (ED), lower PSA rates, and possibly a lower rate of total and fatal prostate cancer among younger men.

“We can summarize this session succinctly,” said AUA press conference moderator Stacy Loeb, MD, of NYU Langone Health in New York City, who also presented one of the studies.

“Eat more plants for your prostate and your erections,” she advised.

Plant-Based Protection

Investigators at the University of Miami (UMiami) Miller School of Medicine used the National Health and Nutrition Examination Survey (NHANES) to evaluate the association between a plant-based diet and PSA levels. Using Food Frequency Questionnaire dietary data they calculated a plant-based diet index (PDI) and healthful plant-based diet index (hPDI).

Ali Mouzannar, MD, reported that in a cohort of 1,399 men, those with a higher consumption of healthy plant-based diet (high hPDI scores) had a decreased probability of having an elevated PSA (OR 0.47, 95% CI 0.24-0.95).

“It seems plant-based diets have protective effects against prostate cancer,” Mouzannar said during the press session. “We still need more insight and more clinical trials to establish the causative effect, but there have been multiple associations between lower risk of prostate cancer, lower risk of elevated PSA with a plant-based diet.”

He added that “it also works the other way around — meat has been shown to be associated with a high rate of aggressive prostate cancer, and high risk of recurrence.”

In a second UMiami-based study, Ruben Blachman-Braun, MD, Ranjith Ramasany, MD, and colleagues used NHANES data base to evaluate 2,549 men, 57.4% of whom had some degree of ED. He reported that risk factors, such as increased age, BMI, hypertension, diabetes, and history of stroke, were all strongly associated with the risk of ED.

“However, increasing plant-based consumption was associated with a decreased risk of erectile dysfunction,” Blachman-Braun pointed out (OR 0.98, 95% CI 0.96 0.99).

Loeb and colleagues conducted a prospective study involving 27,243 men, who were followed up to 28 years, in the Health Follow-up study.

They found that in men ages ≤65 at diagnosis, greater overall consumption of plant-based diet was associated with a lower risk of advanced prostate cancer (HR 0.68, 95% CI 0.42-1.10). Among younger men, greater consumption of a healthful plant-based diet was associated with lower risks of total prostate cancer (HR 0.81 95% CI 0.70-0.95), and fatal disease (HR 0.53, 95% CI 0.32-0.90).

“This is really encouraging given the many health and environmental benefits of plant-based diets,” Loeb said. “And we believe they should be recommended for men who are concerned about the risks of prostate cancer.”

‘A Win-Win’

On the issue of the environmental impact of following plant-based diets, Mouzannar noted that higher meat consumption is associated with greenhouse gas emissions, water issues, decreased biodiversity. “There is a significant effect in following plant-based diets,” he said. “Whether that’s in individuals by promoting a healthy lifestyle and decreasing the risk of multiple cancers — in addition to prostate cancer, specifically — or the environmental effects.” . . .

Continue reading.

Written by Leisureguy

13 September 2021 at 4:06 pm

The role meat may play in triggering Parkinson’s disease, and the role fiber may play in protecting against it.

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Written by Leisureguy

13 September 2021 at 3:02 pm

Why Americans Die So Much

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Derek Thompson writes in the Atlantic:

America has a death problem.

No, I’m not just talking about the past year and a half, during which COVID-19 deaths per capita in the United States outpaced those in similarly rich countries, such as Canada, Japan, and France. And I’m not just talking about the past decade, during which drug overdoses skyrocketed in the U.S., creating a social epidemic of what are often called “deaths of despair.”

I’m talking about the past 30 years. Before the 1990s, average life expectancy in the U.S. was not much different than it was in Germany, the United Kingdom, or France. But since the 1990s, American life spans started falling significantly behind those in similarly wealthy European countries.

According to a new working paper released by the National Bureau of Economic Research, Americans now die earlier than their European counterparts, no matter what age you’re looking at. Compared with Europeans, American babies are more likely to die before they turn 5, American teens are more likely to die before they turn 20, and American adults are more likely to die before they turn 65. At every age, living in the United States carries a higher risk of mortality. This is America’s unsung death penalty, and it adds up. Average life expectancy surged above 80 years old in just about every Western European country in the 2010s, including Portugal, Spain, France, Italy, Germany, the U.K., Denmark, and Switzerland. In the U.S., by contrast, the average life span has never exceeded 79—and now it’s just taken a historic tumble.

Why is the U.S. so much worse than other developed countries at performing the most basic function of civilization: keeping people alive?

“Europe has better life outcomes than the United States across the board, for white and Black people, in high-poverty areas and low-poverty areas,” Hannes Schwandt, a Northwestern University professor who co-wrote the paper, told me. “It’s important that we collect this data, so that people can ask the right questions, but the data alone does not tell us what the cause of this longevity gap is.”

Finding a straightforward explanation is hard, because there are so many differences between life in the U.S. and Europe. Americans are more likely to kill one another with guns, in large part because Americans have more guns than residents of other countries do. Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. Americans also have higher rates of death from infectious disease and pregnancy complications. But what has that got to do with guns, or commuting?

By collecting data on American life spans by ethnicity and by income at the county level—and by comparing them with those of European countries, locality by locality—Schwandt and the other researchers made three important findings.

First, Europe’s mortality rates are shockingly similar between rich and poor communities. Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. “Health improvements among infants, children, and youth have been disseminated within European countries in a way that includes even the poorest areas,” the paper’s authors write.

But in the U.S., which has the highest poverty and inequality of just about any country in the Organization for Economic Cooperation and Development, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too.

Second, even rich Europeans are outliving rich Americans. “There is an American view that egalitarian societies have more equality, but it’s all one big mediocre middle, whereas the best outcomes in the U.S. are the best outcomes in the world,” Schwandt said. But this just doesn’t seem to be the case for longevity. White Americans living in the richest 5 percent of counties still die earlier than Europeans in similarly low-poverty areas; life spans for Black Americans were shorter still. (The study did not examine other American racial groups.) “It says something negative about the overall health system of the United States that even after we grouped counties by poverty and looked at the richest 10th percentile, and even the richest fifth percentile, we still saw this longevity gap between Americans and Europeans,” he added. In fact, Europeans in extremely impoverished areas seem to live longer than Black or white Americans in the richest 10 percent of counties.

Third,  . . .

Continue reading. There’s more, including this interesting factoid:

Air pollution has declined more than 70 percent since the 1970s, according to the EPA, and most of that decline happened during the 30-year period of this mortality research.

Related, via a post this morning by Kevin Drum:

Drum notes:

The US death rate from COVID-19 is no longer skyrocketing, but it’s still going up. Our mortality rate is 150% above Britain and more than 1000% higher than Germany.

I imagine the primary causes are widespread refusal (especially in Red states) to wear masks, to avoid crowds, and to be vaccinated, all obvious steps that significantly reduce the likelihood of infection and thus reduce the likelihood of death.

Note this headline in the NY Times this morning: “The U.S. is falling to the lowest vaccination rates of the world’s wealthiest democracies.” From that article:

. . . Canada leads the G7 countries in vaccination rates, with almost three-quarters of its population at least partially vaccinated as of Thursday, according to Our World in Data. France, Italy and Britain follow, with percentages between 70 and 73. Germany’s rate is just ahead of Japan’s, at around 65 percent.

The U.S. vaccination curve has leveled dramatically since an initial surge in the first half of this year, when the vaccine first became widely available. In a push to vaccinate the roughly 80 million Americans who are eligible for shots but have not gotten them, President Biden on Thursday mandated that two-thirds of American workers, including health care workers and the vast majority of federal employees, be vaccinated against the coronavirus.

Written by Leisureguy

13 September 2021 at 1:11 pm

Why Silicon Valley’s Optimization Mindset Sets Us Up for Failure

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Rob Reich, Mehran Sahami, and Jeremy M. Weinstein wrote the book System Error: Where Big Tech Went Wrong and How We Can Rebootand TIME has a column adapted from Chapter 1 of the book.

About the authors:

Reich directs Stanford University’s Center for Ethics in Society and is associate director of its new Institute for Human-Centered Artificial Intelligence. Sahami is a computer science professor at Stanford and helped redesign the undergraduate computer science curriculum. Weinstein launched President Obama’s Open Government Partnership and returned to Stanford in 2015 as a professor of political science, where he now leads Stanford Impact Labs.

The column begins:

n 2013 a Silicon Valley software engineer decided that food is an inconvenience—a pain point in a busy life. Buying food, preparing it, and cleaning up afterwards struck him as an inefficient way to feed himself. And so was born the idea of Soylent, Rob Rhinehart’s meal replacement powder, described on its website as an International Complete Nutrition Platform. Soylent is the logical result of an engineer’s approach to the “problem” of feeding oneself with food: there must be a more optimal solution.

It’s not hard to sense the trouble with this crushingly instrumental approach to nutrition.

Soylent may optimize meeting one’s daily nutritional needs with minimal cost and time investment. But for most people, food is not just a delivery mechanism for one’s nutritional requirements. It brings gustatory pleasure. It provides for social connection. It sustains and transmits cultural identity. A world in which Soylent spells the end of food also spells the degradation of these values.

Maybe you don’t care about Soylent; it’s just another product in the marketplace that no one is required to buy. If tech workers want to economize on time spent grocery shopping or a busy person faces the choice between grabbing an unhealthy meal at a fast-food joint or bringing along some Soylent, why should anyone complain? In fact, it’s a welcome alternative for some people.

But the story of Soylent is powerful because it reveals the optimization mindset of the technologist. And problems arise when this mindset begins to dominate—when the technologies begin to scale and become universal and unavoidable.

That mindset is inculcated early in the training of technologists. When developing an algorithm, computer science courses often define the goal as providing an optimal solution to a computationally-specified problem. And when you look at the world through this mindset, it’s not just computational inefficiencies that annoy. Eventually, it becomes a defining orientation to life as well. As one of our colleagues at Stanford tells students, everything in life is an optimization problem.

The desire to optimize can favor some values over others. And the choice of which values to favor, and which to sacrifice, are made by the optimizers who then impose those values on the rest of us when their creations reach great scale. For example, consider that Facebook’s decisions about how content gets moderated or who loses their accounts are the rules of expression for more than three billion people on the platform; Google’s choices about what web pages to index determine what information most users of the internet get in response to searches. The small and anomalous group of human beings at these companies create, tweak, and optimize technology based on their notions of how it ought to be better. Their vision and their values about technology are . . .

Continue reading.

The concluding paragraphs:

Several years ago, one of us received an invitation to a small dinner. Founders, venture capitalists, researchers at a secretive tech lab, and two professors assembled in the private dining room of a four-star hotel in Silicon Valley. The host—one of the most prominent names in technology—thanked everyone for coming and reminded us of the topic we’d been invited to discuss: “What if a new state were created to maximize science and tech progress powered by commercial models—what would that run like? Utopia? Dystopia?”

The conversation progressed, with enthusiasm around the table for the establishment of a small nation-state dedicated to optimizing the progress of science and technology. Rob raised his hand to speak. “I’m just wondering, would this state be a democracy? What’s the governance structure here?” The response was quick: “Democracy? No. To optimize for science, we need a beneficent technocrat in charge. Democracy is too slow, and it holds science back.”

Written by Leisureguy

11 September 2021 at 6:17 pm

A somewhat comforting thought: A large proportion of Americans have always experienced difficulty in thinking clearly

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A group of people observing a doctor as he vaccinates a man in an 1870s illustration called “Vaccinating the Poor,” by Solomon Eytinge Jr. via National Library of Medicine

Maggie Astor writes in the NY Times:

As disease and death reigned around them, some Americans declared that they would never get vaccinated and raged at government efforts to compel them. Anti-vaccination groups spread propaganda about terrible side effects and corrupt doctors. State officials tried to ban mandates, and people made fake vaccination certificates to evade inoculation rules already in place.

The years were 1898 to 1903, and the disease was smallpox. News articles and health board reports describe crowds of parents marching to schoolhouses to demand that their unvaccinated children be allowed in, said Michael Willrich, a professor of history at Brandeis University, with some even burning their own arms with nitric acid to mimic the characteristic scar left by the smallpox vaccine.

“People went to some pretty extraordinary lengths not to comply,” said Professor Willrich, who wrote “Pox: An American History,” a book about the civil liberties battles prompted by the epidemic.

If it all sounds familiar, well, there is nothing new under the sun: not years that feel like centuries, not the wailing and gnashing of teeth over masks, and not vaccine mandates either.

As the coronavirus overwhelms hospitals across the South and more than 650,000 Americans — an increasing number of them children — lie dead, the same pattern is emerging. On Thursday, President Biden announced that he would move to require most federal workers and contractors to be vaccinated and, more sweepingly, that all employers with 100 or more employees would have to mandate vaccines or weekly testing. Colleges, businesses and local governments have enacted mandates at a steady pace, and conservative anger has built accordingly.

On Monday, Representative Jim Jordan, Republican of Ohio, tweeted that vaccine mandates were “un-American.” In reality, they are a time-honored American tradition.

But to be fair, so is public fury over them.

“We’re really seeing a lot of echoes of the smallpox era,” said Elena Conis, an associate professor and historian of medicine at the University of California, Berkeley. “Mandates elicit resistance. They always have.”

The roots of U.S. vaccine mandates predate both the U.S. and vaccines. The colonies sought to prevent disease outbreaks by quarantining ships from Europe and sometimes, in the case of smallpox, requiring inoculations: a crude and much riskier predecessor to vaccinations in which doctors rubbed live smallpox virus into broken skin to induce a relatively mild infection that would guard against severe infection later. They were a source of enormous fear and anger.

In January 1777, George Washington mandated inoculations for the soldiers under his command in the Continental Army, writing that if smallpox were to break out, “we should have more to dread from it, than from the Sword of the Enemy.” Notably, it was in large part the soldiers’ desires that overcame his resistance to a mandate.

“They were the ones calling for it,” said Andrew Wehrman, an associate professor of history at Central Michigan University who studies the politics of medicine in the colonial and revolutionary eras. “There’s no record that I have seen — and I’ve looked — of any soldier turning it down, protesting it.”

Buoyed by the success of the mandate, Washington wrote to his brother in June 1777 that he was upset by a Virginia law restricting inoculations. “I would rather move for a Law to compell the Masters of Families to inoculate every Child born within a certain limitted time under severe Penalties,” he wrote.

Over the next century, many local governments did exactly that. Professor Wehrman this week tweeted an example of what, in an interview, he said was a “ubiquitous” phenomenon: The health board in Urbana, Ohio, Jordan’s hometown, enacted a requirement in 1867 that in any future epidemic, “the heads of families must see that all the members of their families have been vaccinated.”

But by the end of the 1800s, opposition was louder and more widespread. Some states, particularly in the West, introduced laws prohibiting vaccine mandates. Others narrowly passed mandates after intense debate.

The reasons for resistance were myriad: Some Americans opposed mandates on the grounds of personal liberty; some because they believed lawmakers were in cahoots with vaccine makers; and some because of safety concerns that were, to be fair, more grounded in reality than the modern equivalent. Vaccines then were not regulated the way they are now, and there were documented cases of doses contaminated with tetanus.

The government’s response resembled what, today, are wild conspiracy theories. Contrary to the assertions of some on the far right, the Biden administration has never suggested going door to door to force people to take coronavirus vaccines. But in the 1890s and 1900s, that actually happened: Squads of men would enter people’s homes in the middle of the night, breaking down doors if necessary, to inject people with smallpox vaccines. 

Legally speaking, the Supreme Court . . .

Continue reading. There’s more.

I’ll point out that the deadly scourge of smallpox, which killed millions upon millions, was ended by vaccines. Smallpox is now an extinct disease — no thanks to anti-vaxxers.

Written by Leisureguy

9 September 2021 at 4:49 pm

Ilan Stavans on Don Quixote

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Bronze statues of Don Quixote and Sancho Panza, at the Plaza de España in Madrid, Spain. 2010. Photo by רנדום.

I am a big fan of the book Don Quixote, and I am just one fan among millions of others. (Indeed, it is probably time to read the book again.) In Octavian, Ilan Stevens writes about the book:

More than 400 years ago, an aging and obscure Spaniard named Miguel de Cervantes published a novel that would change the course of literature (and come to be regarded as perhaps the greatest of all novels by numerous critics): The Ingenious Gentleman Don Quixote of La Mancha, more commonly known as Don Quixote. Rich, strange, nearly infinite in its influence, the book offers us a profound understanding both of humans and of the stories they tell. This brilliant essay by Ilan Stavans  critic, essayist, translator, Octavian board member, and publisher of Restless Books imagines the Quixote as a nation unto itself, one whose ambassadors have spread its magic through space and time. 


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It has been described as the most influential novel in the history of the form. It is also among the bulkiest, longer even than David Foster Wallace’s Infinite Jest. It is the steadiest of bestsellers, only outshined by the Bible (speaking of which, the 19th-century French critic Charles Augustin Sainte-Beuve once called it “the secular Bible of humanity”). It has been translated into English a total of twenty times, more than any other novel. The first appeared in 1613, while its author Miguel de Cervantes was still alive.

Don Quixote of La Mancha, in other words, is a book one should love without restraint. It is moody and unpredictable. It is formally idiosyncratic. It moves easily between the highest and lowest of tonal registers. It possesses an uncanny ability to weed out unwelcome readers. Its 381,104 words, 8,207 periods, 40,617 commas, 690 exclamation points, 960 question marks, and 2,046 semi-colons draw those readers it does welcome into a labyrinth not only of signs but of images and emotions. To find one’s way through this requires intellectual stamina, psychological alertness, and — paradoxically — a willing credulity. After all, the book is a collection of bizarre episodes, some comic, some pathetic, some utterly disengaged from the rest, all connected by the thread of its two wandering protagonists, a slim, laid-back hidalgo who does nothing but spend his idle hours reading tales of adventure, and his squire, Sancho Panza, an almost illiterate field laborer and family man who believes he’s a practical fellow when he isn’t. It’s hard to know which of the two is more cuckoo: the foolish señor who is convinced he can change the world by becoming a superhero, or the silly employee who wastes his time following him.

This already complex structure exists, as well, in four dimensions — it changes with time. Come to the book when you are young and you will discover in it the endless ebullience of youth; read it again in your fifties (about the age of its protagonist, Don Quixote de la Mancha, also known as the Knight of the Mournful Countenance) and you will see a subtle and empathetic portrayal of a man in the grip of a midlife crisis. Return again in your old age, and find the Quixote transformed into a book on how to deal with the end that awaits us all, a well-tempered look into the face of death.

This year marks the 400th anniversary of Cervantes completing the novel’s manuscript. If the definition of a classic is a book that passes the test of time, this one has succeeded with flying colors. But I want to propose a different definition: a classic is a book capable of building a nation around itself. This one has. The world may be divided by flags, currencies, borders, and governments, but the realest nations congregate around mythologies. Unquestionably there is a Quixote nation, made up of the millions of readers who have fallen under its spell. It includes an assortment of admirable names: Lord Byron, Gustave Flaubert, Fyodor Dostoyevsky, Franz Kafka, William Faulkner, Jorge Luis Borges, Orson Welles, Salvador Dalí, Miguel de Unamuno, and Pablo Picasso (whose 1955 ink study, also undertaken as an anniversary commemoration, of the knight and his squire still amazes the eye today). George Washington, who helped build his own republic of the imagination, read the book and loved it. But more admirable than these are the countless readers of the book whose names are lost to history — the true creators of a homeland for the knight and his servant.

The Quixote’s birth was far from certain. Prior to starting work on what would become his magnum opus, Cervantes was a soldier (he fought in the Battle of Lepanto against the Turks, a heroic yet humbling experience: he was injured and lost much of the use of his left arm), a captive at war, and a lousy tax collector who ended up in jail for mishandling funds. He was also a rather limited author, a poet and playwright (he also wrote novellas), whom, I suspect, posterity would ignore if, about a decade before his death in 1616 at 69, he hadn’t stumbled on the idea of exploring the limits of parody. Still, he was penniless in the end, never suspecting for a minute the global impact his work would have. Indeed, I often imagine the surprise on his face (none of the portraits available were done while he was alive) had he realized the whole period he belonged to would be called “the age of Cervantes.” Not the age of Lope de Vega, the most successful and prolific of all playwrights who were his contemporaries? Not Quevedo or Góngora, two astonishing sonnetists?

The majority of readers, at least American readers, first learn of Don Quixote through Man of La Mancha, a syrupy and formulaic Broadway musical that in most ways could not be more distant from the antinomian spirit of the book. The one consolation to be drawn from this fact is that, for all its flaws, Man of La Mancha does manage to communicate an essential truth about the novel — the essential truth, in fact: both are driven by the restless and infinite imagination of Don Quixote, who dreams, in the words of the song, the impossible dream. (One is tempted to quote Picasso here: “Everything you can imagine is real.”) Indeed, no book addresses with a more penetrating eye the freedom dreams grant us. (Sorry, Freud!) Consider the arch-famous episode of the windmills, which should be seen as a clash between a decrepit feudalist and the most innovative energy technology of the time. Don Quixote is convinced these magisterial structures are giants whose intent is to conquer the earth, whereas Sancho knows (and so does the narrator) that they are far more mundane than that. Or the puppet theater performing a tale of adventure and submission which the knight confuses with real events, jumping on the stage and destroying the marionettes. Or the group of prisoners in transit whom Don Quixote liberates because he believes them to be innocent. Or the Cave of Montesinos, a dark and frightening place where Don Quixote has a mystical experience. The list of such incidents is long.

True, Cervantes wasn’t a good stylist. There are bumpy parts in Don Quixote, in which the author seems asleep at the wheel. He is sometimes repetitive. He forgets crucial details, such as the name of Sancho’s wife, calling her variously Juana and Teresa. But novels, especially lasting ones, don’t need to be perfect. What they need to be, of course, is . . .

Continue reading. There’s much more.

And read — or listen to — Don Quixote. The Edith Grossman translation is serviceable.

Written by Leisureguy

9 September 2021 at 10:36 am

John Mulaney tells Seth Meyers about his eventful year

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I found this absorbing.

Written by Leisureguy

8 September 2021 at 4:36 pm

It’s possible to help more positive images pop into your mind

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Simon Blackwell, a post-doctoral researcher in the Mental Health Research and Treatment Center at Ruhr University Bochum in Germany, writes in Psyche:

Sometimes, the most interesting research findings are the ones you were not looking for. This happened to me in late 2007 when I was interviewing a participant about her experience of a study she had just completed that involved imagining positive scenarios every day at home for one week. The focus of the interview was about how helpful she’d found the sessions, what she thought of their length and frequency and so on. It wasn’t until my standard final question, ‘Is there anything else you’d like to mention?’, that the participant gave a reply – ‘Well, there was this one thing…’ – that completely changed my perspective on the depression intervention we were developing, and that continues to have a significant influence on my research to this day.

The woman, a graduate student in her 20s who was experiencing an episode of major depression, described to me how, during the study, certain mental images had begun popping into her mind spontaneously as she had been going about her day-to-day life. For most people, spontaneous mental imagery of various kinds is a common experience. Many of these images are associated with a phenomenon termed ‘mental time travel’, in which we relive events from the past or ‘pre-live’ possible events in the future. For example, hearing a particular song might trigger a memory from your childhood or youth, which could range from a still ‘picture’ in your mind’s eye, to a more complex immersive scene including sights, sounds, smells and the emotions you experienced at the time. Or, on a long Friday at work, you might find your mind wandering off and repeatedly playing out whatever it is you plan to do to unwind at the end of the day. My research participant’s description suggested that, inadvertently, our intervention seemed to have influenced these processes.

This was a particularly intriguing possibility for various reasons. Spontaneous mental imagery of future events is thought to serve important functions in daily life, for example in the context of planning, decision-making and guiding our ongoing behaviour. Via such imagery flashing into your mind, even if just briefly, you can experience a brief ‘pre-experiencing’ of an event, a taste of how it might be and how you might feel – for example, how enjoyable it could be. This can not only lift your mood in the moment, but lead to changes in your behaviour – you might take steps to make it more likely that the pictured event will indeed occur. In fact, some research has found that generating positive mental imagery of events or activities can lead to increased engagement in goal-directed behaviour, including increased engagement in exercise or completion of tasks that people had been putting off.

It’s worth noting that there is huge variation between people, both in the frequency with which they experience spontaneous imagery in daily life, and the quality of the imagery experienced. For example, research has found that people who are more optimistic tend to experience more positive and vivid future-oriented thoughts in daily life – they can easily see a positive future in their mind’s eye. Conversely, research indicates the opposite pattern for people who are depressed or have chronic low mood: they experience spontaneous positive future-oriented imagery less often, and it tends to be less vivid; in extreme cases, they might be completely unable to imagine anything positive happening in their future, even if they try.

It is easy to see how these differences in the experience of spontaneous mental imagery could have an impact in daily life. Imagery-rich mental time travel appears to be a ‘default’ activity that the mind turns to when it is otherwise unoccupied, meaning that such spontaneous imagery can be thought of as providing a kind of ‘background music’ to your life; the extent to which this imagery is relatively positive or negative could therefore have a broad impact on your mood and general outlook over the course of a day. The frequency and characteristics of spontaneous imagery might be even more consequential than the mental imagery we generate on purpose. Data from observational studies, in which participants kept a diary of spontaneous thoughts in daily life, suggest that spontaneously occurring future-oriented thoughts have a greater impact on emotion and behaviour than deliberate thoughts.

Returning to the participant who had such an impact on my work, the depression intervention she’d completed included a series of training sessions, during which she and the other participants listened to audio descriptions of mostly everyday situations structured such that the outcome was uncertain (ie, things might go well or badly), but in fact they always resolved positively. As they listened to the recordings, the participants had to imagine themselves in the scenarios as they unfolded. Our rationale for the study was that, via repeated practice imagining positive outcomes for initially ambiguous situations in the training, participants would start automatically imagining positive outcomes for the similarly ambiguous situations they encountered in their daily life, counteracting the negative thinking styles that characterise depression.

For example, a scenario might begin: . . .

Continue reading. There’s more.

Written by Leisureguy

8 September 2021 at 2:12 pm

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