User login
A Healthy Dose of Superstition
Mr. Smith was once a nice guy.
These days, unfortunately, he’s anything but. The ravages of a neurodegenerative disease have left him demented, impulsive, and agitated.
His family is trying to find placement for him, and in the meantime I’m doing my best to keep his behavior controlled. Like many things in medicine, this is as much art as science. A tablet of this, a capsule of that, increase this slightly, add something for PRN use ... a witch’s brew of modern medicine.
Because of his worsening, his wife was calling us several times a week with updates, not in an annoying way but in an “I need help” way. I began answering the phone myself if I saw her number come up, because it was easier and faster for me to deal with her directly, and I knew she wasn’t calling for fun.
A few months ago I stopped a medication that didn’t seem to be doing much and started a different one.
And then things went quiet. His wife’s calls went from 3-4 a week to none.
This worried me. I mean, maybe the new medicine was working. ... but the sudden silence was deafening.
One week went by, then two ... I did a Google search to make sure he and his wife hadn’t died or been in the news.
Of course, I could have picked up the phone and called his wife, but why tempt fate?
Three weeks ... I was sure my MA, who handles far more calls than I do, had probably noticed this, too.
It would have been easy to mention it, but even with 16 years of school and 5 years of medical training, not to mention 3,000-4,000 years of hard-earned science behind me, there was the old grade school notion of jinxing myself. To say something is to invite trouble.
Four weeks. Finally, his wife called in and reached my MA. The medication had been working, but now was wearing off and the dose needed to be adjusted. So we did that.
Afterward I mentioned the time lapse to my MA, that I’d been afraid of jinxing it by saying something to her, and she told me she’d been thinking the same thing.
Funny when you think about it. We’re both educated people, believers in science, and (I hope) intelligent. We’re living in a (by human standards) technologically advanced time.
Yet, the old superstitions are still there, the idea that we somehow have magical control over time, space, random chance, and the actions of others by not talking about a phone call (or the lack of one).
Surprisingly (or maybe not), this is pretty normal. When on call we never say “quiet,” for fear of enraging the mysterious Call Gods. If needed, we use “the Q word.”
We still try not to walk under ladders, avoid stepping on sidewalk cracks, carry good luck charms, cross fingers, and fight over wishbones.
Superstitions such as saying “bless you” or “gesundheit” when someone sneezes are so ingrained into us that they’re now part of good manners and polite society.
I’ve worked in quite a few hospitals over the years. Not one of them had a room on any floor that ended in 13, always jumping from 12 to 14.
Civilization is roughly 10,000-15,000 years old. We have the internet and can travel to (relatively nearby) space and back. We have probes exploring — and even leaving — our solar system.
But
I’m going to knock on wood now.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Mr. Smith was once a nice guy.
These days, unfortunately, he’s anything but. The ravages of a neurodegenerative disease have left him demented, impulsive, and agitated.
His family is trying to find placement for him, and in the meantime I’m doing my best to keep his behavior controlled. Like many things in medicine, this is as much art as science. A tablet of this, a capsule of that, increase this slightly, add something for PRN use ... a witch’s brew of modern medicine.
Because of his worsening, his wife was calling us several times a week with updates, not in an annoying way but in an “I need help” way. I began answering the phone myself if I saw her number come up, because it was easier and faster for me to deal with her directly, and I knew she wasn’t calling for fun.
A few months ago I stopped a medication that didn’t seem to be doing much and started a different one.
And then things went quiet. His wife’s calls went from 3-4 a week to none.
This worried me. I mean, maybe the new medicine was working. ... but the sudden silence was deafening.
One week went by, then two ... I did a Google search to make sure he and his wife hadn’t died or been in the news.
Of course, I could have picked up the phone and called his wife, but why tempt fate?
Three weeks ... I was sure my MA, who handles far more calls than I do, had probably noticed this, too.
It would have been easy to mention it, but even with 16 years of school and 5 years of medical training, not to mention 3,000-4,000 years of hard-earned science behind me, there was the old grade school notion of jinxing myself. To say something is to invite trouble.
Four weeks. Finally, his wife called in and reached my MA. The medication had been working, but now was wearing off and the dose needed to be adjusted. So we did that.
Afterward I mentioned the time lapse to my MA, that I’d been afraid of jinxing it by saying something to her, and she told me she’d been thinking the same thing.
Funny when you think about it. We’re both educated people, believers in science, and (I hope) intelligent. We’re living in a (by human standards) technologically advanced time.
Yet, the old superstitions are still there, the idea that we somehow have magical control over time, space, random chance, and the actions of others by not talking about a phone call (or the lack of one).
Surprisingly (or maybe not), this is pretty normal. When on call we never say “quiet,” for fear of enraging the mysterious Call Gods. If needed, we use “the Q word.”
We still try not to walk under ladders, avoid stepping on sidewalk cracks, carry good luck charms, cross fingers, and fight over wishbones.
Superstitions such as saying “bless you” or “gesundheit” when someone sneezes are so ingrained into us that they’re now part of good manners and polite society.
I’ve worked in quite a few hospitals over the years. Not one of them had a room on any floor that ended in 13, always jumping from 12 to 14.
Civilization is roughly 10,000-15,000 years old. We have the internet and can travel to (relatively nearby) space and back. We have probes exploring — and even leaving — our solar system.
But
I’m going to knock on wood now.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Mr. Smith was once a nice guy.
These days, unfortunately, he’s anything but. The ravages of a neurodegenerative disease have left him demented, impulsive, and agitated.
His family is trying to find placement for him, and in the meantime I’m doing my best to keep his behavior controlled. Like many things in medicine, this is as much art as science. A tablet of this, a capsule of that, increase this slightly, add something for PRN use ... a witch’s brew of modern medicine.
Because of his worsening, his wife was calling us several times a week with updates, not in an annoying way but in an “I need help” way. I began answering the phone myself if I saw her number come up, because it was easier and faster for me to deal with her directly, and I knew she wasn’t calling for fun.
A few months ago I stopped a medication that didn’t seem to be doing much and started a different one.
And then things went quiet. His wife’s calls went from 3-4 a week to none.
This worried me. I mean, maybe the new medicine was working. ... but the sudden silence was deafening.
One week went by, then two ... I did a Google search to make sure he and his wife hadn’t died or been in the news.
Of course, I could have picked up the phone and called his wife, but why tempt fate?
Three weeks ... I was sure my MA, who handles far more calls than I do, had probably noticed this, too.
It would have been easy to mention it, but even with 16 years of school and 5 years of medical training, not to mention 3,000-4,000 years of hard-earned science behind me, there was the old grade school notion of jinxing myself. To say something is to invite trouble.
Four weeks. Finally, his wife called in and reached my MA. The medication had been working, but now was wearing off and the dose needed to be adjusted. So we did that.
Afterward I mentioned the time lapse to my MA, that I’d been afraid of jinxing it by saying something to her, and she told me she’d been thinking the same thing.
Funny when you think about it. We’re both educated people, believers in science, and (I hope) intelligent. We’re living in a (by human standards) technologically advanced time.
Yet, the old superstitions are still there, the idea that we somehow have magical control over time, space, random chance, and the actions of others by not talking about a phone call (or the lack of one).
Surprisingly (or maybe not), this is pretty normal. When on call we never say “quiet,” for fear of enraging the mysterious Call Gods. If needed, we use “the Q word.”
We still try not to walk under ladders, avoid stepping on sidewalk cracks, carry good luck charms, cross fingers, and fight over wishbones.
Superstitions such as saying “bless you” or “gesundheit” when someone sneezes are so ingrained into us that they’re now part of good manners and polite society.
I’ve worked in quite a few hospitals over the years. Not one of them had a room on any floor that ended in 13, always jumping from 12 to 14.
Civilization is roughly 10,000-15,000 years old. We have the internet and can travel to (relatively nearby) space and back. We have probes exploring — and even leaving — our solar system.
But
I’m going to knock on wood now.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
Burnout and Work-Based Well-Being Programs
Since very few of us practice medicine without being either an employer or an employee, we should probably be paying more attention to research in industrial and employee relations, not an area most of us have studied. One of the hot topics for employers in these days of low unemployment is the question of whether to offer free wellness-enhancing programs companywide.
Almost by definition anything “free” has a good public relations aura surrounding it. Recent surveys have shown that a large chunk of the population is feeling stressed. If your boss is offering you a free opportunity to help you feel better about yourself, he/she must understand at least a bit of what you are going through.
From the employer’s standpoint these programs offer the potential for a double win. On one hand, offering a free well-being program is a perk the company can tout as it competes in the tight market for new employees. On the other hand, if the program is effective then the employees will be happier. And we all know that happy workers are more productive and less likely to leave and feed the expensive cycle of hiring and training new workers to replace the unhappy and disgruntled workers who have quit. Even if the employer’s total focus is on the company’s bottom line, offering a wellness program should pay a dividend.
Well ... this may be one of those situations where wishful thinking isn’t going to work. A recent study published in Industrial Relations Journal suggests that these well-being programs, which include employee mental services, may not be living up to their promise. In this large study of nearly 50,00 workers in the United Kingdom, the researcher discovered that workers who had been offered coaching and relaxation classes, internet-based apps, and courses in time management and financial health were “no better off” than their coworkers who had not participated in these programs. In fact, training programs in stress management and resilience appeared to possibly have had a negative effect.
In a New York Times article about this study, the British researcher recommends that employers who are interested in improving their worker’s mental health should turn their attention to “core organizational practices” meaning pay scales, work schedules, and performance reviews.
Not surprisingly, this study has raised some controversy. There are a lot of people invested emotionally and in some cases financially in programs similar to the ones that appeared to be ineffective in this study. Critics argue the study was too short, or too small, or failed to select programs with a proven track record.
Even given these potential flaws, physicians, particularly those who of us who feel they approaching burnout, should take this investigator’s message seriously. Certainly some of us could be doing a better job of building resilience into our lifestyles and may be helped by the kind of well-being programs tested in this study. However, the biggest contribution to the burnout phenomenon is coming from the work environments that are asking too much of even the most resilient among us. This study makes it clear that including work schedules, time-gobbling electronic systems, and short staffing. Trotting out a few feel-good mindfulness programs is not going to do the job.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Since very few of us practice medicine without being either an employer or an employee, we should probably be paying more attention to research in industrial and employee relations, not an area most of us have studied. One of the hot topics for employers in these days of low unemployment is the question of whether to offer free wellness-enhancing programs companywide.
Almost by definition anything “free” has a good public relations aura surrounding it. Recent surveys have shown that a large chunk of the population is feeling stressed. If your boss is offering you a free opportunity to help you feel better about yourself, he/she must understand at least a bit of what you are going through.
From the employer’s standpoint these programs offer the potential for a double win. On one hand, offering a free well-being program is a perk the company can tout as it competes in the tight market for new employees. On the other hand, if the program is effective then the employees will be happier. And we all know that happy workers are more productive and less likely to leave and feed the expensive cycle of hiring and training new workers to replace the unhappy and disgruntled workers who have quit. Even if the employer’s total focus is on the company’s bottom line, offering a wellness program should pay a dividend.
Well ... this may be one of those situations where wishful thinking isn’t going to work. A recent study published in Industrial Relations Journal suggests that these well-being programs, which include employee mental services, may not be living up to their promise. In this large study of nearly 50,00 workers in the United Kingdom, the researcher discovered that workers who had been offered coaching and relaxation classes, internet-based apps, and courses in time management and financial health were “no better off” than their coworkers who had not participated in these programs. In fact, training programs in stress management and resilience appeared to possibly have had a negative effect.
In a New York Times article about this study, the British researcher recommends that employers who are interested in improving their worker’s mental health should turn their attention to “core organizational practices” meaning pay scales, work schedules, and performance reviews.
Not surprisingly, this study has raised some controversy. There are a lot of people invested emotionally and in some cases financially in programs similar to the ones that appeared to be ineffective in this study. Critics argue the study was too short, or too small, or failed to select programs with a proven track record.
Even given these potential flaws, physicians, particularly those who of us who feel they approaching burnout, should take this investigator’s message seriously. Certainly some of us could be doing a better job of building resilience into our lifestyles and may be helped by the kind of well-being programs tested in this study. However, the biggest contribution to the burnout phenomenon is coming from the work environments that are asking too much of even the most resilient among us. This study makes it clear that including work schedules, time-gobbling electronic systems, and short staffing. Trotting out a few feel-good mindfulness programs is not going to do the job.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Since very few of us practice medicine without being either an employer or an employee, we should probably be paying more attention to research in industrial and employee relations, not an area most of us have studied. One of the hot topics for employers in these days of low unemployment is the question of whether to offer free wellness-enhancing programs companywide.
Almost by definition anything “free” has a good public relations aura surrounding it. Recent surveys have shown that a large chunk of the population is feeling stressed. If your boss is offering you a free opportunity to help you feel better about yourself, he/she must understand at least a bit of what you are going through.
From the employer’s standpoint these programs offer the potential for a double win. On one hand, offering a free well-being program is a perk the company can tout as it competes in the tight market for new employees. On the other hand, if the program is effective then the employees will be happier. And we all know that happy workers are more productive and less likely to leave and feed the expensive cycle of hiring and training new workers to replace the unhappy and disgruntled workers who have quit. Even if the employer’s total focus is on the company’s bottom line, offering a wellness program should pay a dividend.
Well ... this may be one of those situations where wishful thinking isn’t going to work. A recent study published in Industrial Relations Journal suggests that these well-being programs, which include employee mental services, may not be living up to their promise. In this large study of nearly 50,00 workers in the United Kingdom, the researcher discovered that workers who had been offered coaching and relaxation classes, internet-based apps, and courses in time management and financial health were “no better off” than their coworkers who had not participated in these programs. In fact, training programs in stress management and resilience appeared to possibly have had a negative effect.
In a New York Times article about this study, the British researcher recommends that employers who are interested in improving their worker’s mental health should turn their attention to “core organizational practices” meaning pay scales, work schedules, and performance reviews.
Not surprisingly, this study has raised some controversy. There are a lot of people invested emotionally and in some cases financially in programs similar to the ones that appeared to be ineffective in this study. Critics argue the study was too short, or too small, or failed to select programs with a proven track record.
Even given these potential flaws, physicians, particularly those who of us who feel they approaching burnout, should take this investigator’s message seriously. Certainly some of us could be doing a better job of building resilience into our lifestyles and may be helped by the kind of well-being programs tested in this study. However, the biggest contribution to the burnout phenomenon is coming from the work environments that are asking too much of even the most resilient among us. This study makes it clear that including work schedules, time-gobbling electronic systems, and short staffing. Trotting out a few feel-good mindfulness programs is not going to do the job.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at [email protected].
Cancer Deaths on Decline, But New Cancer Cases to Hit Record High This Year
Overall cancer mortality in the United States has continued to decline, with more than 4 million cancer deaths averted since 1991, according to the 2024 American Cancer Society (ACS) annual report on cancer trends.
The “good news is that we are continuing to see a decline in cancer mortality,” which follows the steady decline we’ve observed in cancer mortality over the past three decades, Rebecca Siegel, MPH, with ACS, and lead author of the new report, told this news organization.
However, these gains are “threatened by increasing incidence for many common cancers, including 6 of the top 10 most commonly diagnosed cancers,” Ms. Siegel said.
Overall, new cancer diagnoses are projected to top 2 million in 2024. That’s an average of 5480 new diagnoses each day or one person diagnosed every 15 seconds.
“In the US, the way our healthcare system is designed, we like to treat more than we like to prevent disease, and I would personally like to see a shift towards more emphasis on cancer prevention,” she added.
The full report was published in CA: A Cancer Journal for Clinicians.
Cancer Hitting at Younger Ages
Although advancing age remains the strongest determinate of cancer risk, the new data showed that cancer incidence is steadily increasing in younger populations.
What’s most alarming is the increase in cancer diagnoses in adults under 50 years.
Between 2015 and 2019, incidence rates increased by 0.6%-1% annually for breast, pancreas, and uterine corpus cancers, by 1%-2% annually for cervical cancer in women between 30 and 44 years, and by 2%-3% annually for prostate, kidney, melanoma, and human papillomavirus (HPV)–associated oral cancers, as well as liver cancer in women.
The continuing rise in colorectal cancer (CRC) incidence in younger adults, in particular, is “very concerning,” Ms. Siegel said, and has shifted mortality patterns among adults younger than 50 years.
In this group, CRC is now the leading cause of cancer death in men and the second-leading cause in women behind breast cancer — up from the fourth leading cause of cancer death in both younger men and women 2 decades ago.
The obesity epidemic is likely a contributing factor in rising CRC rates, “but it’s not the whole story,” Ms. Siegel told this news organization. “A lot of work is going on to try to uncover what exactly is causing an increased risk of colorectal cancer.”
The proportion of new cancers diagnosed in adults aged 50-64 years has also increased — from 25% in 1995 to 30% in 2019-2020 — while the proportion of new cancers diagnosed in adults aged 65 years and older fell from 61% to 58% in that time frame. Among this older population, the authors observed steep declines in the incidence of prostate cancer and smoking-related cancers.
“Every generation born after the 1950s has had higher cancer risk than the previous generation. That tells us is that there is some exposure that is yet unknown that is causing this increased risk,” Ms. Siegel noted.
To halt and reverse this trend, it will be important to increase screening uptake as well as awareness of noninvasive stool tests and follow-up care in younger adults, Ahmedin Jemal, PhD, with ACS, commented in a press release.
Other key findings in the report include the sharp decline in cervical cancer incidence rates in women in their 20s — the first cohort to receive the HPV vaccine — but increases of nearly 2% in women 30-44 years, highlighting the need for more screening in young women as well as broader uptake of the vaccine, the authors said.
After decades of increases, cancer incidence in children has leveled off, although rates continue to increase among adolescents aged 15-19 years. The largest increase was a 4% per year rise in thyroid cancer, much of which is likely due to overdiagnosis.
On the survival front, uterine cancer is the only cancer for which survival decreased over the past few decades.
Progress against cancer has been hampered by persistent and widespread cancer disparities. Mortality rates are twofold higher among Black patients with prostate, stomach, and endometrial cancers than among White patients, and twofold higher among Native Americans with liver, stomach, and kidney cancers.
Black women are more often diagnosed at more advanced stages (44% vs 23%) and have worse 5‐year survival rates (63% vs 84%) than White women.
“This report underscores the need for public policy interventions to help reduce these cancer disparities and save more lives,” Lisa Lacasse, with the ACS Cancer Action Network, said in the release. “We urge lawmakers at all levels of government to advance policies that ensure more people have health insurance coverage as well as improved access to and affordability of care, such as increased funding for cancer research and screening programs.”
The authors of a linked editorial noted that while the report shows continued progress in oncology overall, certain ethnic, racial, age, and geographic populations face a disproportionate burden of cancer incidence and mortality.
“Like others, we find these health disparities wholly unacceptable and agree with the National Cancer Plan and Biden Moonshot Initiative that bold and new collaborations and thinking will be needed to produce different outcomes,” the editorialists said.
Overall, the editorialists noted, “every 15 seconds presents a real reminder of the urgency to end cancer as we know it for everyone.”
A version of this article appeared on Medscape.com.
Overall cancer mortality in the United States has continued to decline, with more than 4 million cancer deaths averted since 1991, according to the 2024 American Cancer Society (ACS) annual report on cancer trends.
The “good news is that we are continuing to see a decline in cancer mortality,” which follows the steady decline we’ve observed in cancer mortality over the past three decades, Rebecca Siegel, MPH, with ACS, and lead author of the new report, told this news organization.
However, these gains are “threatened by increasing incidence for many common cancers, including 6 of the top 10 most commonly diagnosed cancers,” Ms. Siegel said.
Overall, new cancer diagnoses are projected to top 2 million in 2024. That’s an average of 5480 new diagnoses each day or one person diagnosed every 15 seconds.
“In the US, the way our healthcare system is designed, we like to treat more than we like to prevent disease, and I would personally like to see a shift towards more emphasis on cancer prevention,” she added.
The full report was published in CA: A Cancer Journal for Clinicians.
Cancer Hitting at Younger Ages
Although advancing age remains the strongest determinate of cancer risk, the new data showed that cancer incidence is steadily increasing in younger populations.
What’s most alarming is the increase in cancer diagnoses in adults under 50 years.
Between 2015 and 2019, incidence rates increased by 0.6%-1% annually for breast, pancreas, and uterine corpus cancers, by 1%-2% annually for cervical cancer in women between 30 and 44 years, and by 2%-3% annually for prostate, kidney, melanoma, and human papillomavirus (HPV)–associated oral cancers, as well as liver cancer in women.
The continuing rise in colorectal cancer (CRC) incidence in younger adults, in particular, is “very concerning,” Ms. Siegel said, and has shifted mortality patterns among adults younger than 50 years.
In this group, CRC is now the leading cause of cancer death in men and the second-leading cause in women behind breast cancer — up from the fourth leading cause of cancer death in both younger men and women 2 decades ago.
The obesity epidemic is likely a contributing factor in rising CRC rates, “but it’s not the whole story,” Ms. Siegel told this news organization. “A lot of work is going on to try to uncover what exactly is causing an increased risk of colorectal cancer.”
The proportion of new cancers diagnosed in adults aged 50-64 years has also increased — from 25% in 1995 to 30% in 2019-2020 — while the proportion of new cancers diagnosed in adults aged 65 years and older fell from 61% to 58% in that time frame. Among this older population, the authors observed steep declines in the incidence of prostate cancer and smoking-related cancers.
“Every generation born after the 1950s has had higher cancer risk than the previous generation. That tells us is that there is some exposure that is yet unknown that is causing this increased risk,” Ms. Siegel noted.
To halt and reverse this trend, it will be important to increase screening uptake as well as awareness of noninvasive stool tests and follow-up care in younger adults, Ahmedin Jemal, PhD, with ACS, commented in a press release.
Other key findings in the report include the sharp decline in cervical cancer incidence rates in women in their 20s — the first cohort to receive the HPV vaccine — but increases of nearly 2% in women 30-44 years, highlighting the need for more screening in young women as well as broader uptake of the vaccine, the authors said.
After decades of increases, cancer incidence in children has leveled off, although rates continue to increase among adolescents aged 15-19 years. The largest increase was a 4% per year rise in thyroid cancer, much of which is likely due to overdiagnosis.
On the survival front, uterine cancer is the only cancer for which survival decreased over the past few decades.
Progress against cancer has been hampered by persistent and widespread cancer disparities. Mortality rates are twofold higher among Black patients with prostate, stomach, and endometrial cancers than among White patients, and twofold higher among Native Americans with liver, stomach, and kidney cancers.
Black women are more often diagnosed at more advanced stages (44% vs 23%) and have worse 5‐year survival rates (63% vs 84%) than White women.
“This report underscores the need for public policy interventions to help reduce these cancer disparities and save more lives,” Lisa Lacasse, with the ACS Cancer Action Network, said in the release. “We urge lawmakers at all levels of government to advance policies that ensure more people have health insurance coverage as well as improved access to and affordability of care, such as increased funding for cancer research and screening programs.”
The authors of a linked editorial noted that while the report shows continued progress in oncology overall, certain ethnic, racial, age, and geographic populations face a disproportionate burden of cancer incidence and mortality.
“Like others, we find these health disparities wholly unacceptable and agree with the National Cancer Plan and Biden Moonshot Initiative that bold and new collaborations and thinking will be needed to produce different outcomes,” the editorialists said.
Overall, the editorialists noted, “every 15 seconds presents a real reminder of the urgency to end cancer as we know it for everyone.”
A version of this article appeared on Medscape.com.
Overall cancer mortality in the United States has continued to decline, with more than 4 million cancer deaths averted since 1991, according to the 2024 American Cancer Society (ACS) annual report on cancer trends.
The “good news is that we are continuing to see a decline in cancer mortality,” which follows the steady decline we’ve observed in cancer mortality over the past three decades, Rebecca Siegel, MPH, with ACS, and lead author of the new report, told this news organization.
However, these gains are “threatened by increasing incidence for many common cancers, including 6 of the top 10 most commonly diagnosed cancers,” Ms. Siegel said.
Overall, new cancer diagnoses are projected to top 2 million in 2024. That’s an average of 5480 new diagnoses each day or one person diagnosed every 15 seconds.
“In the US, the way our healthcare system is designed, we like to treat more than we like to prevent disease, and I would personally like to see a shift towards more emphasis on cancer prevention,” she added.
The full report was published in CA: A Cancer Journal for Clinicians.
Cancer Hitting at Younger Ages
Although advancing age remains the strongest determinate of cancer risk, the new data showed that cancer incidence is steadily increasing in younger populations.
What’s most alarming is the increase in cancer diagnoses in adults under 50 years.
Between 2015 and 2019, incidence rates increased by 0.6%-1% annually for breast, pancreas, and uterine corpus cancers, by 1%-2% annually for cervical cancer in women between 30 and 44 years, and by 2%-3% annually for prostate, kidney, melanoma, and human papillomavirus (HPV)–associated oral cancers, as well as liver cancer in women.
The continuing rise in colorectal cancer (CRC) incidence in younger adults, in particular, is “very concerning,” Ms. Siegel said, and has shifted mortality patterns among adults younger than 50 years.
In this group, CRC is now the leading cause of cancer death in men and the second-leading cause in women behind breast cancer — up from the fourth leading cause of cancer death in both younger men and women 2 decades ago.
The obesity epidemic is likely a contributing factor in rising CRC rates, “but it’s not the whole story,” Ms. Siegel told this news organization. “A lot of work is going on to try to uncover what exactly is causing an increased risk of colorectal cancer.”
The proportion of new cancers diagnosed in adults aged 50-64 years has also increased — from 25% in 1995 to 30% in 2019-2020 — while the proportion of new cancers diagnosed in adults aged 65 years and older fell from 61% to 58% in that time frame. Among this older population, the authors observed steep declines in the incidence of prostate cancer and smoking-related cancers.
“Every generation born after the 1950s has had higher cancer risk than the previous generation. That tells us is that there is some exposure that is yet unknown that is causing this increased risk,” Ms. Siegel noted.
To halt and reverse this trend, it will be important to increase screening uptake as well as awareness of noninvasive stool tests and follow-up care in younger adults, Ahmedin Jemal, PhD, with ACS, commented in a press release.
Other key findings in the report include the sharp decline in cervical cancer incidence rates in women in their 20s — the first cohort to receive the HPV vaccine — but increases of nearly 2% in women 30-44 years, highlighting the need for more screening in young women as well as broader uptake of the vaccine, the authors said.
After decades of increases, cancer incidence in children has leveled off, although rates continue to increase among adolescents aged 15-19 years. The largest increase was a 4% per year rise in thyroid cancer, much of which is likely due to overdiagnosis.
On the survival front, uterine cancer is the only cancer for which survival decreased over the past few decades.
Progress against cancer has been hampered by persistent and widespread cancer disparities. Mortality rates are twofold higher among Black patients with prostate, stomach, and endometrial cancers than among White patients, and twofold higher among Native Americans with liver, stomach, and kidney cancers.
Black women are more often diagnosed at more advanced stages (44% vs 23%) and have worse 5‐year survival rates (63% vs 84%) than White women.
“This report underscores the need for public policy interventions to help reduce these cancer disparities and save more lives,” Lisa Lacasse, with the ACS Cancer Action Network, said in the release. “We urge lawmakers at all levels of government to advance policies that ensure more people have health insurance coverage as well as improved access to and affordability of care, such as increased funding for cancer research and screening programs.”
The authors of a linked editorial noted that while the report shows continued progress in oncology overall, certain ethnic, racial, age, and geographic populations face a disproportionate burden of cancer incidence and mortality.
“Like others, we find these health disparities wholly unacceptable and agree with the National Cancer Plan and Biden Moonshot Initiative that bold and new collaborations and thinking will be needed to produce different outcomes,” the editorialists said.
Overall, the editorialists noted, “every 15 seconds presents a real reminder of the urgency to end cancer as we know it for everyone.”
A version of this article appeared on Medscape.com.
High Salt Intake Linked to Increased Risk for Kidney Disease
People who habitually add salt to their meals at the table may unknowingly be risking their kidneys, according to a study utilizing UK Biobank data. Chronic salt additions are associated with an elevated risk of developing chronic kidney disease (CKD), as revealed by researchers led by Rui Tang, a doctoral candidate in epidemiology at Tulane University in New Orleans, Louisiana. The study was published in JAMA Network Open.
Large Study Sample
In a population-based cohort study comprising over 460,000 UK Biobank participants aged 37-73 years, the researchers explored the association between adding table salt to food and increased CKD risk.
Participants indicated how often they added salt to their meals: Never or rarely, sometimes, often, or always. The follow-up period exceeded a decade, and median duration was 11.8 years. During this time, approximately 22,000 new CKD cases were documented. Data analysis revealed a significantly higher CKD risk among those who frequently added salt.
The extent of risk elevation varied with the frequency of salt additions. Even occasional salters had a 7% higher risk than those who never or rarely added salt. For frequent salters, the risk increased by 12%, and for those who always added salt, it rose to 29%. These results were adjusted for age and gender.
Worse Overall Health
The research group noted that individuals who frequently added salt were generally less healthy, adopting an unhealthier lifestyle and having lower socioeconomic status. They exhibited higher body mass index (BMI), were more likely to smoke, had diabetes or cardiovascular diseases, and had reduced estimated glomerular filtration rate (eGFR) at the beginning of the study. Moreover, their Townsend Deprivation Index, indicating material deprivation, was higher.
Considering these factors, the researchers adjusted the results not only for age and gender but also for ethnicity, Townsend Deprivation Index, eGFR, BMI, smoking status, alcohol consumption, physical activity, elevated cholesterol levels, diabetes, cardiovascular diseases, hypertension, infectious diseases, immune system disorders, and the use of nephrotoxic medications.
Association Persists
Even after accounting for these factors, a significant, albeit attenuated, association between salt additions and CKD risk remained. The risk increased by 2% for occasional salters, 5% for frequent salters, and 6% for those who always added salt.
The research group concluded that adding salt to meals could be associated with an increased risk for CKD in the general population. However, they highlighted several limitations that should be considered when interpreting the study results.
Reducing Salt
Primarily, self-reported frequency of salt addition doesn’t precisely reflect actual salt consumption. While earlier studies validated the accuracy of this variable, the researchers acknowledged the possibility that frequent salt addition may merely be a marker for an unhealthy lifestyle.
Nevertheless, the authors speculated that reducing the frequency of salt additions to meals could contribute to lowering CKD risk in the general population. They suggested validating their results in post hoc analyses or follow-up studies from clinical trials.
This article was translated from the Medscape German edition. A version of this article appeared on Medscape.com.
People who habitually add salt to their meals at the table may unknowingly be risking their kidneys, according to a study utilizing UK Biobank data. Chronic salt additions are associated with an elevated risk of developing chronic kidney disease (CKD), as revealed by researchers led by Rui Tang, a doctoral candidate in epidemiology at Tulane University in New Orleans, Louisiana. The study was published in JAMA Network Open.
Large Study Sample
In a population-based cohort study comprising over 460,000 UK Biobank participants aged 37-73 years, the researchers explored the association between adding table salt to food and increased CKD risk.
Participants indicated how often they added salt to their meals: Never or rarely, sometimes, often, or always. The follow-up period exceeded a decade, and median duration was 11.8 years. During this time, approximately 22,000 new CKD cases were documented. Data analysis revealed a significantly higher CKD risk among those who frequently added salt.
The extent of risk elevation varied with the frequency of salt additions. Even occasional salters had a 7% higher risk than those who never or rarely added salt. For frequent salters, the risk increased by 12%, and for those who always added salt, it rose to 29%. These results were adjusted for age and gender.
Worse Overall Health
The research group noted that individuals who frequently added salt were generally less healthy, adopting an unhealthier lifestyle and having lower socioeconomic status. They exhibited higher body mass index (BMI), were more likely to smoke, had diabetes or cardiovascular diseases, and had reduced estimated glomerular filtration rate (eGFR) at the beginning of the study. Moreover, their Townsend Deprivation Index, indicating material deprivation, was higher.
Considering these factors, the researchers adjusted the results not only for age and gender but also for ethnicity, Townsend Deprivation Index, eGFR, BMI, smoking status, alcohol consumption, physical activity, elevated cholesterol levels, diabetes, cardiovascular diseases, hypertension, infectious diseases, immune system disorders, and the use of nephrotoxic medications.
Association Persists
Even after accounting for these factors, a significant, albeit attenuated, association between salt additions and CKD risk remained. The risk increased by 2% for occasional salters, 5% for frequent salters, and 6% for those who always added salt.
The research group concluded that adding salt to meals could be associated with an increased risk for CKD in the general population. However, they highlighted several limitations that should be considered when interpreting the study results.
Reducing Salt
Primarily, self-reported frequency of salt addition doesn’t precisely reflect actual salt consumption. While earlier studies validated the accuracy of this variable, the researchers acknowledged the possibility that frequent salt addition may merely be a marker for an unhealthy lifestyle.
Nevertheless, the authors speculated that reducing the frequency of salt additions to meals could contribute to lowering CKD risk in the general population. They suggested validating their results in post hoc analyses or follow-up studies from clinical trials.
This article was translated from the Medscape German edition. A version of this article appeared on Medscape.com.
People who habitually add salt to their meals at the table may unknowingly be risking their kidneys, according to a study utilizing UK Biobank data. Chronic salt additions are associated with an elevated risk of developing chronic kidney disease (CKD), as revealed by researchers led by Rui Tang, a doctoral candidate in epidemiology at Tulane University in New Orleans, Louisiana. The study was published in JAMA Network Open.
Large Study Sample
In a population-based cohort study comprising over 460,000 UK Biobank participants aged 37-73 years, the researchers explored the association between adding table salt to food and increased CKD risk.
Participants indicated how often they added salt to their meals: Never or rarely, sometimes, often, or always. The follow-up period exceeded a decade, and median duration was 11.8 years. During this time, approximately 22,000 new CKD cases were documented. Data analysis revealed a significantly higher CKD risk among those who frequently added salt.
The extent of risk elevation varied with the frequency of salt additions. Even occasional salters had a 7% higher risk than those who never or rarely added salt. For frequent salters, the risk increased by 12%, and for those who always added salt, it rose to 29%. These results were adjusted for age and gender.
Worse Overall Health
The research group noted that individuals who frequently added salt were generally less healthy, adopting an unhealthier lifestyle and having lower socioeconomic status. They exhibited higher body mass index (BMI), were more likely to smoke, had diabetes or cardiovascular diseases, and had reduced estimated glomerular filtration rate (eGFR) at the beginning of the study. Moreover, their Townsend Deprivation Index, indicating material deprivation, was higher.
Considering these factors, the researchers adjusted the results not only for age and gender but also for ethnicity, Townsend Deprivation Index, eGFR, BMI, smoking status, alcohol consumption, physical activity, elevated cholesterol levels, diabetes, cardiovascular diseases, hypertension, infectious diseases, immune system disorders, and the use of nephrotoxic medications.
Association Persists
Even after accounting for these factors, a significant, albeit attenuated, association between salt additions and CKD risk remained. The risk increased by 2% for occasional salters, 5% for frequent salters, and 6% for those who always added salt.
The research group concluded that adding salt to meals could be associated with an increased risk for CKD in the general population. However, they highlighted several limitations that should be considered when interpreting the study results.
Reducing Salt
Primarily, self-reported frequency of salt addition doesn’t precisely reflect actual salt consumption. While earlier studies validated the accuracy of this variable, the researchers acknowledged the possibility that frequent salt addition may merely be a marker for an unhealthy lifestyle.
Nevertheless, the authors speculated that reducing the frequency of salt additions to meals could contribute to lowering CKD risk in the general population. They suggested validating their results in post hoc analyses or follow-up studies from clinical trials.
This article was translated from the Medscape German edition. A version of this article appeared on Medscape.com.
Robotic Garment Improves Stride in Patient With Parkinson’s Disease
A wearable, soft, robotic device could help patients with Parkinson’s disease (PD) walk without experiencing freezing of gait (FoG), early research suggested.
The robotic apparel, worn around the hips and thighs, gently pushes the hips as the leg swings, facilitating a longer stride and preventing FoG, a common disorder in PD that affects nearly all patients over the disease course.
The small, proof-of-concept study included one person with PD. But investigators noted the reduction in freezing and falls and improvement in walking distance and speed was dramatic. Incidence of FoG decreased from 63% to just 6% when the patient wore the robotic garment outdoors. Wearing the device indoors eliminated freezing altogether.
“We demonstrate proof-of-concept that FoG can be averted using a soft robotic device — a machine that aims to apply physical assistance to movement with minimal restriction, a fundamentally different approach to rigid exoskeletons,” lead investigators Conor Walsh, PhD, and Terry Ellis, PhD, PT, told this news organization.
Walsh is a professor at Harvard John A. Paulson School of Engineering and Applied Sciences in Boston, and Ellis is a professor and chair of the physical therapy department and director of the Center for Neurorehabilitation, Boston University, Boston, Massachusetts.
The study was published online on January 5, 2024, in Nature Medicine.
Disabling Disturbance
From a biomechanical perspective, FoG is manifested by an overt breakdown in spatial and temporal mechanics of walking. The impaired limb coordination occurs during the “swing phase” of the gait cycle.
There are currently no interventions that prevent FoG. Available treatment interventions include pharmacotherapy, such as dopamine replacement; deep brain stimulation (DBS) of the subthalamic nucleus; and behavioral interventions, such as cueing strategies. All have shown only modest effects in reducing FoG and, in some cases, might even worsen it, the investigators noted.
“This challenge led us to become interested in leveraging soft wearable robots to deliver mechanical cues to disrupt aberrant gait mechanics and prevent FOG in people with PD,” Dr. Walsh and Dr. Ellis said.
“Wearable robots” have been used to augment kinematics in neurologic conditions, such as stroke, cerebral palsy, and spinal cord injury. Harnessing this technology to address FoG required “a collaboration between engineers, rehabilitation scientists, physical therapists, biomechanists, and apparel designers,” the researchers said.
The wearable robotic device uses cable-driven actuators, which enable physical movement by converting electrical energy into mechanical force, and sensors worn around the waist and thighs. Using motion data collected by the sensors, algorithms estimate the phase of the walking cycle and generate assistive forces in concert with biological muscles.
Real-World Testing
The researchers tested the robotic garment on a 73-year-old man with idiopathic PD of 10-year duration. The man’s ongoing pharmacologic treatment included 1.5 tablets of 25- to 100-mg carbidopa/levodopa taken four times per day, one tablet of 100-mg amantadine twice per day, and one tablet of 200-mg entacapone taken four times per day.
He had also undergone DBS to the globus pallidus internus and utilized behavioral strategies. Despite these interventions, he continued to endure more than 10 episodes of FoG per day and numerous falls.
The patient tended to use walls to stabilize himself when walking. Freezing episodes were observed mostly when he walked in open hallways, turned, walked outdoors, and when he tried to walk and talk simultaneously.
The research was conducted over a 6-month period, with a total of five study sessions that consisted of walking trials. Four were administered in the laboratory. The fifth was conducted in a real-world outdoor community setting.
During the first visit, a biomechanical analysis of walking was performed under single-task conditions during the medication-on phase.
Testing was usually conducted during medication-on phase and under single-task conditions. But testing conditions also included attention-demanding dual tasks and single-task walking during the medication-off phase.
The researchers compared the effects of the assistance of the robotic apparel to no apparel and with the apparel turned off. They measured the percentage of time spent freezing and the total distance walked.
Robust Response
The participant demonstrated a “robust response” to the robotic apparel. With the garment’s assistance, FoG was eliminated when worn indoors, and walking distance increased by 55%. The participant walked faster and had a 25% reduction in gait variability.
These beneficial effects were repeated across multiple days as well as different types of provoking conditions and environmental contexts. When the device was tried outdoors, FoG decreased from 63% to 6% of the time. The patient was also able to simultaneously walk and talk without freezing.
“When the device assisted with hip flexion during the terminal stance phase of walking (when lifting the toe), FoG was instantaneously eliminated during inner walking, accompanied by clinically significant improvement in walking speeds and distance,” Dr. Walsh and Dr. Ellis reported.
The approach “suggests the potential benefits of a ‘bottom-up’ rather than a ‘top-down’ solution to treating gait freezing,” they commented. “We see that restoring almost-normal biomechanics alters the peripheral dynamics of gait and may influence the central processing of gait control.”
Bringing Hope
Rebecca Gilbert MD, PhD, chief mission officer, American Parkinson Disease Association, said this new approach is “exciting.”
Whether the benefits will be as robust in other people with PD “remains to be seen,” said Dr. Gilbert, who was not involved with the study.
“The paper states that multiple experimental variables utilizing the device could potentially be adjusted to serve different people with PD, and these will need to be tested in clinical trials as well,” Dr. Gilbert said.
Additionally, “the device itself is complex and may be challenging to get on and off without help, which may limit its usability in the community,” Dr. Gilbert noted.
Although more work is needed, the study “represents a remarkable proof of concept that brings hope to those with FoG,” she added.
These “promising findings prompt further investigation to validate the effects of the robotic apparel on a broader range of individuals with PD experiencing FoG and across various FoG phenotypes and environments and task contexts, complemented with FoG metrics that include quantification of the severity of the freezing episodes,” Walsh and Ellis added.
This study was based on work supported by the National Science Foundation, the National Institutes of Health, and the Massachusetts Technology Collaborative, Collaborative Research and Development Matching Grant. This work was also partially funded by the John A. Paulson School of Engineering and Applied Sciences at Harvard University as well as received financial support from the Samsung Scholarship.
A version of this article appeared on Medscape.com.
A wearable, soft, robotic device could help patients with Parkinson’s disease (PD) walk without experiencing freezing of gait (FoG), early research suggested.
The robotic apparel, worn around the hips and thighs, gently pushes the hips as the leg swings, facilitating a longer stride and preventing FoG, a common disorder in PD that affects nearly all patients over the disease course.
The small, proof-of-concept study included one person with PD. But investigators noted the reduction in freezing and falls and improvement in walking distance and speed was dramatic. Incidence of FoG decreased from 63% to just 6% when the patient wore the robotic garment outdoors. Wearing the device indoors eliminated freezing altogether.
“We demonstrate proof-of-concept that FoG can be averted using a soft robotic device — a machine that aims to apply physical assistance to movement with minimal restriction, a fundamentally different approach to rigid exoskeletons,” lead investigators Conor Walsh, PhD, and Terry Ellis, PhD, PT, told this news organization.
Walsh is a professor at Harvard John A. Paulson School of Engineering and Applied Sciences in Boston, and Ellis is a professor and chair of the physical therapy department and director of the Center for Neurorehabilitation, Boston University, Boston, Massachusetts.
The study was published online on January 5, 2024, in Nature Medicine.
Disabling Disturbance
From a biomechanical perspective, FoG is manifested by an overt breakdown in spatial and temporal mechanics of walking. The impaired limb coordination occurs during the “swing phase” of the gait cycle.
There are currently no interventions that prevent FoG. Available treatment interventions include pharmacotherapy, such as dopamine replacement; deep brain stimulation (DBS) of the subthalamic nucleus; and behavioral interventions, such as cueing strategies. All have shown only modest effects in reducing FoG and, in some cases, might even worsen it, the investigators noted.
“This challenge led us to become interested in leveraging soft wearable robots to deliver mechanical cues to disrupt aberrant gait mechanics and prevent FOG in people with PD,” Dr. Walsh and Dr. Ellis said.
“Wearable robots” have been used to augment kinematics in neurologic conditions, such as stroke, cerebral palsy, and spinal cord injury. Harnessing this technology to address FoG required “a collaboration between engineers, rehabilitation scientists, physical therapists, biomechanists, and apparel designers,” the researchers said.
The wearable robotic device uses cable-driven actuators, which enable physical movement by converting electrical energy into mechanical force, and sensors worn around the waist and thighs. Using motion data collected by the sensors, algorithms estimate the phase of the walking cycle and generate assistive forces in concert with biological muscles.
Real-World Testing
The researchers tested the robotic garment on a 73-year-old man with idiopathic PD of 10-year duration. The man’s ongoing pharmacologic treatment included 1.5 tablets of 25- to 100-mg carbidopa/levodopa taken four times per day, one tablet of 100-mg amantadine twice per day, and one tablet of 200-mg entacapone taken four times per day.
He had also undergone DBS to the globus pallidus internus and utilized behavioral strategies. Despite these interventions, he continued to endure more than 10 episodes of FoG per day and numerous falls.
The patient tended to use walls to stabilize himself when walking. Freezing episodes were observed mostly when he walked in open hallways, turned, walked outdoors, and when he tried to walk and talk simultaneously.
The research was conducted over a 6-month period, with a total of five study sessions that consisted of walking trials. Four were administered in the laboratory. The fifth was conducted in a real-world outdoor community setting.
During the first visit, a biomechanical analysis of walking was performed under single-task conditions during the medication-on phase.
Testing was usually conducted during medication-on phase and under single-task conditions. But testing conditions also included attention-demanding dual tasks and single-task walking during the medication-off phase.
The researchers compared the effects of the assistance of the robotic apparel to no apparel and with the apparel turned off. They measured the percentage of time spent freezing and the total distance walked.
Robust Response
The participant demonstrated a “robust response” to the robotic apparel. With the garment’s assistance, FoG was eliminated when worn indoors, and walking distance increased by 55%. The participant walked faster and had a 25% reduction in gait variability.
These beneficial effects were repeated across multiple days as well as different types of provoking conditions and environmental contexts. When the device was tried outdoors, FoG decreased from 63% to 6% of the time. The patient was also able to simultaneously walk and talk without freezing.
“When the device assisted with hip flexion during the terminal stance phase of walking (when lifting the toe), FoG was instantaneously eliminated during inner walking, accompanied by clinically significant improvement in walking speeds and distance,” Dr. Walsh and Dr. Ellis reported.
The approach “suggests the potential benefits of a ‘bottom-up’ rather than a ‘top-down’ solution to treating gait freezing,” they commented. “We see that restoring almost-normal biomechanics alters the peripheral dynamics of gait and may influence the central processing of gait control.”
Bringing Hope
Rebecca Gilbert MD, PhD, chief mission officer, American Parkinson Disease Association, said this new approach is “exciting.”
Whether the benefits will be as robust in other people with PD “remains to be seen,” said Dr. Gilbert, who was not involved with the study.
“The paper states that multiple experimental variables utilizing the device could potentially be adjusted to serve different people with PD, and these will need to be tested in clinical trials as well,” Dr. Gilbert said.
Additionally, “the device itself is complex and may be challenging to get on and off without help, which may limit its usability in the community,” Dr. Gilbert noted.
Although more work is needed, the study “represents a remarkable proof of concept that brings hope to those with FoG,” she added.
These “promising findings prompt further investigation to validate the effects of the robotic apparel on a broader range of individuals with PD experiencing FoG and across various FoG phenotypes and environments and task contexts, complemented with FoG metrics that include quantification of the severity of the freezing episodes,” Walsh and Ellis added.
This study was based on work supported by the National Science Foundation, the National Institutes of Health, and the Massachusetts Technology Collaborative, Collaborative Research and Development Matching Grant. This work was also partially funded by the John A. Paulson School of Engineering and Applied Sciences at Harvard University as well as received financial support from the Samsung Scholarship.
A version of this article appeared on Medscape.com.
A wearable, soft, robotic device could help patients with Parkinson’s disease (PD) walk without experiencing freezing of gait (FoG), early research suggested.
The robotic apparel, worn around the hips and thighs, gently pushes the hips as the leg swings, facilitating a longer stride and preventing FoG, a common disorder in PD that affects nearly all patients over the disease course.
The small, proof-of-concept study included one person with PD. But investigators noted the reduction in freezing and falls and improvement in walking distance and speed was dramatic. Incidence of FoG decreased from 63% to just 6% when the patient wore the robotic garment outdoors. Wearing the device indoors eliminated freezing altogether.
“We demonstrate proof-of-concept that FoG can be averted using a soft robotic device — a machine that aims to apply physical assistance to movement with minimal restriction, a fundamentally different approach to rigid exoskeletons,” lead investigators Conor Walsh, PhD, and Terry Ellis, PhD, PT, told this news organization.
Walsh is a professor at Harvard John A. Paulson School of Engineering and Applied Sciences in Boston, and Ellis is a professor and chair of the physical therapy department and director of the Center for Neurorehabilitation, Boston University, Boston, Massachusetts.
The study was published online on January 5, 2024, in Nature Medicine.
Disabling Disturbance
From a biomechanical perspective, FoG is manifested by an overt breakdown in spatial and temporal mechanics of walking. The impaired limb coordination occurs during the “swing phase” of the gait cycle.
There are currently no interventions that prevent FoG. Available treatment interventions include pharmacotherapy, such as dopamine replacement; deep brain stimulation (DBS) of the subthalamic nucleus; and behavioral interventions, such as cueing strategies. All have shown only modest effects in reducing FoG and, in some cases, might even worsen it, the investigators noted.
“This challenge led us to become interested in leveraging soft wearable robots to deliver mechanical cues to disrupt aberrant gait mechanics and prevent FOG in people with PD,” Dr. Walsh and Dr. Ellis said.
“Wearable robots” have been used to augment kinematics in neurologic conditions, such as stroke, cerebral palsy, and spinal cord injury. Harnessing this technology to address FoG required “a collaboration between engineers, rehabilitation scientists, physical therapists, biomechanists, and apparel designers,” the researchers said.
The wearable robotic device uses cable-driven actuators, which enable physical movement by converting electrical energy into mechanical force, and sensors worn around the waist and thighs. Using motion data collected by the sensors, algorithms estimate the phase of the walking cycle and generate assistive forces in concert with biological muscles.
Real-World Testing
The researchers tested the robotic garment on a 73-year-old man with idiopathic PD of 10-year duration. The man’s ongoing pharmacologic treatment included 1.5 tablets of 25- to 100-mg carbidopa/levodopa taken four times per day, one tablet of 100-mg amantadine twice per day, and one tablet of 200-mg entacapone taken four times per day.
He had also undergone DBS to the globus pallidus internus and utilized behavioral strategies. Despite these interventions, he continued to endure more than 10 episodes of FoG per day and numerous falls.
The patient tended to use walls to stabilize himself when walking. Freezing episodes were observed mostly when he walked in open hallways, turned, walked outdoors, and when he tried to walk and talk simultaneously.
The research was conducted over a 6-month period, with a total of five study sessions that consisted of walking trials. Four were administered in the laboratory. The fifth was conducted in a real-world outdoor community setting.
During the first visit, a biomechanical analysis of walking was performed under single-task conditions during the medication-on phase.
Testing was usually conducted during medication-on phase and under single-task conditions. But testing conditions also included attention-demanding dual tasks and single-task walking during the medication-off phase.
The researchers compared the effects of the assistance of the robotic apparel to no apparel and with the apparel turned off. They measured the percentage of time spent freezing and the total distance walked.
Robust Response
The participant demonstrated a “robust response” to the robotic apparel. With the garment’s assistance, FoG was eliminated when worn indoors, and walking distance increased by 55%. The participant walked faster and had a 25% reduction in gait variability.
These beneficial effects were repeated across multiple days as well as different types of provoking conditions and environmental contexts. When the device was tried outdoors, FoG decreased from 63% to 6% of the time. The patient was also able to simultaneously walk and talk without freezing.
“When the device assisted with hip flexion during the terminal stance phase of walking (when lifting the toe), FoG was instantaneously eliminated during inner walking, accompanied by clinically significant improvement in walking speeds and distance,” Dr. Walsh and Dr. Ellis reported.
The approach “suggests the potential benefits of a ‘bottom-up’ rather than a ‘top-down’ solution to treating gait freezing,” they commented. “We see that restoring almost-normal biomechanics alters the peripheral dynamics of gait and may influence the central processing of gait control.”
Bringing Hope
Rebecca Gilbert MD, PhD, chief mission officer, American Parkinson Disease Association, said this new approach is “exciting.”
Whether the benefits will be as robust in other people with PD “remains to be seen,” said Dr. Gilbert, who was not involved with the study.
“The paper states that multiple experimental variables utilizing the device could potentially be adjusted to serve different people with PD, and these will need to be tested in clinical trials as well,” Dr. Gilbert said.
Additionally, “the device itself is complex and may be challenging to get on and off without help, which may limit its usability in the community,” Dr. Gilbert noted.
Although more work is needed, the study “represents a remarkable proof of concept that brings hope to those with FoG,” she added.
These “promising findings prompt further investigation to validate the effects of the robotic apparel on a broader range of individuals with PD experiencing FoG and across various FoG phenotypes and environments and task contexts, complemented with FoG metrics that include quantification of the severity of the freezing episodes,” Walsh and Ellis added.
This study was based on work supported by the National Science Foundation, the National Institutes of Health, and the Massachusetts Technology Collaborative, Collaborative Research and Development Matching Grant. This work was also partially funded by the John A. Paulson School of Engineering and Applied Sciences at Harvard University as well as received financial support from the Samsung Scholarship.
A version of this article appeared on Medscape.com.
No Compelling Evidence of Pancreatic Cancer Risk With GLP-1s
TOPLINE:
New data provide no support for an increased risk for pancreatic cancer with use of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) for up to 7 years, although longer-term data are needed, researchers said.
METHODOLOGY:
- Some studies have raised concern about a possible increased risk for pancreatitis and pancreatic cancer in patients taking a GLP-1 RA.
- Investigators behind this population-based cohort study assessed the association of GLP-1 RA treatment with pancreatic cancer incidence over a median of 7 years in 543,595 adults (mean age, 59.9 years; 51% women) with type 2 diabetes.
- Treatment with basal insulin was used as an active comparator.
- The analyses accounted for major confounding factors and time-related biases and adjusted for treatment with other glucose-lowering medications and a history of pancreatitis.
TAKEAWAY:
- During the study period, 33,377 patients (6.1%) used GLP-1 RAs and 106,849 (19.7%) used basal insulin, with 1665 of all patients diagnosed with pancreatic cancer.
- There was no evidence that GLP-1 RA use increased pancreatic cancer risk compared with basal insulin.
- The estimated hazard ratio (HR) for pancreatic cancer associated with incremental use of one defined daily dose per day of GLP-1 RA compared with basal insulin in years 5-7 was 0.50 (95% CI, 0.15-1.71).
- New-user and prevalent new-user analyses showed HRs from year 5 onward following initiation of a GLP-1 RA vs basal insulin was 0.52 (95% CI, 0.19-1.41) and 0.75 (95% CI, 0.37-1.53), respectively.
IN PRACTICE:
Using several analytical approaches, these findings do not suggest an increase in pancreatic cancer incidence over 7 years following the start of GLP-1 RA treatment, according to the investigation. “However, monitoring for pancreatic cancer risk beyond 7 years following initiation of treatment is still required,” the authors wrote.
SOURCE:
The study, with first author Rachel Dankner, MD, MPH, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel, was published online on January 4, 2024, in JAMA Network Open.
LIMITATIONS:
Data on the exact type of GLP-1 RA were not available. The analyses accounted for history of pancreatitis but not alcohol use or exposure to pesticides/chemicals. Because of the risk for bias due to reverse causation, an emphasis was placed on drug effects several years after their initiation. However, this reduced the number of pancreatic cancer cases available and led to estimated HRs with wider CIs.
DISCLOSURES:
The study received no specific funding. The authors disclosed no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
New data provide no support for an increased risk for pancreatic cancer with use of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) for up to 7 years, although longer-term data are needed, researchers said.
METHODOLOGY:
- Some studies have raised concern about a possible increased risk for pancreatitis and pancreatic cancer in patients taking a GLP-1 RA.
- Investigators behind this population-based cohort study assessed the association of GLP-1 RA treatment with pancreatic cancer incidence over a median of 7 years in 543,595 adults (mean age, 59.9 years; 51% women) with type 2 diabetes.
- Treatment with basal insulin was used as an active comparator.
- The analyses accounted for major confounding factors and time-related biases and adjusted for treatment with other glucose-lowering medications and a history of pancreatitis.
TAKEAWAY:
- During the study period, 33,377 patients (6.1%) used GLP-1 RAs and 106,849 (19.7%) used basal insulin, with 1665 of all patients diagnosed with pancreatic cancer.
- There was no evidence that GLP-1 RA use increased pancreatic cancer risk compared with basal insulin.
- The estimated hazard ratio (HR) for pancreatic cancer associated with incremental use of one defined daily dose per day of GLP-1 RA compared with basal insulin in years 5-7 was 0.50 (95% CI, 0.15-1.71).
- New-user and prevalent new-user analyses showed HRs from year 5 onward following initiation of a GLP-1 RA vs basal insulin was 0.52 (95% CI, 0.19-1.41) and 0.75 (95% CI, 0.37-1.53), respectively.
IN PRACTICE:
Using several analytical approaches, these findings do not suggest an increase in pancreatic cancer incidence over 7 years following the start of GLP-1 RA treatment, according to the investigation. “However, monitoring for pancreatic cancer risk beyond 7 years following initiation of treatment is still required,” the authors wrote.
SOURCE:
The study, with first author Rachel Dankner, MD, MPH, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel, was published online on January 4, 2024, in JAMA Network Open.
LIMITATIONS:
Data on the exact type of GLP-1 RA were not available. The analyses accounted for history of pancreatitis but not alcohol use or exposure to pesticides/chemicals. Because of the risk for bias due to reverse causation, an emphasis was placed on drug effects several years after their initiation. However, this reduced the number of pancreatic cancer cases available and led to estimated HRs with wider CIs.
DISCLOSURES:
The study received no specific funding. The authors disclosed no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
New data provide no support for an increased risk for pancreatic cancer with use of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) for up to 7 years, although longer-term data are needed, researchers said.
METHODOLOGY:
- Some studies have raised concern about a possible increased risk for pancreatitis and pancreatic cancer in patients taking a GLP-1 RA.
- Investigators behind this population-based cohort study assessed the association of GLP-1 RA treatment with pancreatic cancer incidence over a median of 7 years in 543,595 adults (mean age, 59.9 years; 51% women) with type 2 diabetes.
- Treatment with basal insulin was used as an active comparator.
- The analyses accounted for major confounding factors and time-related biases and adjusted for treatment with other glucose-lowering medications and a history of pancreatitis.
TAKEAWAY:
- During the study period, 33,377 patients (6.1%) used GLP-1 RAs and 106,849 (19.7%) used basal insulin, with 1665 of all patients diagnosed with pancreatic cancer.
- There was no evidence that GLP-1 RA use increased pancreatic cancer risk compared with basal insulin.
- The estimated hazard ratio (HR) for pancreatic cancer associated with incremental use of one defined daily dose per day of GLP-1 RA compared with basal insulin in years 5-7 was 0.50 (95% CI, 0.15-1.71).
- New-user and prevalent new-user analyses showed HRs from year 5 onward following initiation of a GLP-1 RA vs basal insulin was 0.52 (95% CI, 0.19-1.41) and 0.75 (95% CI, 0.37-1.53), respectively.
IN PRACTICE:
Using several analytical approaches, these findings do not suggest an increase in pancreatic cancer incidence over 7 years following the start of GLP-1 RA treatment, according to the investigation. “However, monitoring for pancreatic cancer risk beyond 7 years following initiation of treatment is still required,” the authors wrote.
SOURCE:
The study, with first author Rachel Dankner, MD, MPH, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Israel, was published online on January 4, 2024, in JAMA Network Open.
LIMITATIONS:
Data on the exact type of GLP-1 RA were not available. The analyses accounted for history of pancreatitis but not alcohol use or exposure to pesticides/chemicals. Because of the risk for bias due to reverse causation, an emphasis was placed on drug effects several years after their initiation. However, this reduced the number of pancreatic cancer cases available and led to estimated HRs with wider CIs.
DISCLOSURES:
The study received no specific funding. The authors disclosed no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
High and Low Body Mass Indices Promote Respiratory Symptoms
TOPLINE:
Individuals with either high or low body mass index (BMI) showed an increased risk for respiratory symptoms and diseases than those with BMI in the normal range.
METHODOLOGY:
- The researchers reviewed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012; the study population included 12,719 adults older than 40 years with data on respiratory symptoms; 51% were female, and 53.3% were non-Hispanic White individuals.
- The study population was divided into quartiles based on BMI as follows: 3180 individuals with BMI of 13.2-24.9 kg/m2, 3175 with BMI of 24.9-28.4 kg/m2, 3180 with BMI of 28.4-32.5 kg/m2, and 3184 with BMI of 32.5-82.0 kg/m2.
- The study sought to assess the correlation between BMI and respiratory symptoms (cough, wheezing, and dyspnea), chronic obstructive pulmonary disease (COPD), and asthma in unadjusted and adjusted models based on sex, race, marital status, poverty-income ratio (PIR), education level, and smoking status.
TAKEAWAY:
- In a logistic regression and curve fitting analysis, BMI showed a U-shaped relationship with respiratory symptoms, asthma, and COPD, with increased risk in individuals with high or low BMI than those with BMIs in the middle quartiles.
- In a stratified analysis by race, the risk for cough was significantly higher among non-Hispanic Black individuals than other races (P < .0001), and a higher BMI was associated with an increased risk for COPD in non-Hispanic Black individuals (odds ratio, 1.053; P < .0001).
- The researchers found no significant impact of biological sex on the relationship between BMI and respiratory symptoms, COPD, or asthma.
- The results support previous studies showing that a BMI that is too low can be detrimental to health.
IN PRACTICE:
“These results suggest that the risk of small airway obstruction in underweight individuals deserves more attention and that excessive wasting may also affect the prognosis of patients with COPD,” the researchers wrote.
SOURCE:
The lead author on the study was Yuefeng Sun of Shandong University of Traditional Chinese Medicine, Jinan, China. The study was published online on January 10, 2024, in Scientific Reports.
LIMITATIONS:
The cross-sectional NHANES database prevented conclusions of causality, and potential confounding factors that were not accounted for could have affected the results.
DISCLOSURES:
The study was supported by the Shandong Province Taishan Scholar Project. The researchers had no financial conflicts to disclose.
A version of this article appeared on Medscape.com.
TOPLINE:
Individuals with either high or low body mass index (BMI) showed an increased risk for respiratory symptoms and diseases than those with BMI in the normal range.
METHODOLOGY:
- The researchers reviewed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012; the study population included 12,719 adults older than 40 years with data on respiratory symptoms; 51% were female, and 53.3% were non-Hispanic White individuals.
- The study population was divided into quartiles based on BMI as follows: 3180 individuals with BMI of 13.2-24.9 kg/m2, 3175 with BMI of 24.9-28.4 kg/m2, 3180 with BMI of 28.4-32.5 kg/m2, and 3184 with BMI of 32.5-82.0 kg/m2.
- The study sought to assess the correlation between BMI and respiratory symptoms (cough, wheezing, and dyspnea), chronic obstructive pulmonary disease (COPD), and asthma in unadjusted and adjusted models based on sex, race, marital status, poverty-income ratio (PIR), education level, and smoking status.
TAKEAWAY:
- In a logistic regression and curve fitting analysis, BMI showed a U-shaped relationship with respiratory symptoms, asthma, and COPD, with increased risk in individuals with high or low BMI than those with BMIs in the middle quartiles.
- In a stratified analysis by race, the risk for cough was significantly higher among non-Hispanic Black individuals than other races (P < .0001), and a higher BMI was associated with an increased risk for COPD in non-Hispanic Black individuals (odds ratio, 1.053; P < .0001).
- The researchers found no significant impact of biological sex on the relationship between BMI and respiratory symptoms, COPD, or asthma.
- The results support previous studies showing that a BMI that is too low can be detrimental to health.
IN PRACTICE:
“These results suggest that the risk of small airway obstruction in underweight individuals deserves more attention and that excessive wasting may also affect the prognosis of patients with COPD,” the researchers wrote.
SOURCE:
The lead author on the study was Yuefeng Sun of Shandong University of Traditional Chinese Medicine, Jinan, China. The study was published online on January 10, 2024, in Scientific Reports.
LIMITATIONS:
The cross-sectional NHANES database prevented conclusions of causality, and potential confounding factors that were not accounted for could have affected the results.
DISCLOSURES:
The study was supported by the Shandong Province Taishan Scholar Project. The researchers had no financial conflicts to disclose.
A version of this article appeared on Medscape.com.
TOPLINE:
Individuals with either high or low body mass index (BMI) showed an increased risk for respiratory symptoms and diseases than those with BMI in the normal range.
METHODOLOGY:
- The researchers reviewed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012; the study population included 12,719 adults older than 40 years with data on respiratory symptoms; 51% were female, and 53.3% were non-Hispanic White individuals.
- The study population was divided into quartiles based on BMI as follows: 3180 individuals with BMI of 13.2-24.9 kg/m2, 3175 with BMI of 24.9-28.4 kg/m2, 3180 with BMI of 28.4-32.5 kg/m2, and 3184 with BMI of 32.5-82.0 kg/m2.
- The study sought to assess the correlation between BMI and respiratory symptoms (cough, wheezing, and dyspnea), chronic obstructive pulmonary disease (COPD), and asthma in unadjusted and adjusted models based on sex, race, marital status, poverty-income ratio (PIR), education level, and smoking status.
TAKEAWAY:
- In a logistic regression and curve fitting analysis, BMI showed a U-shaped relationship with respiratory symptoms, asthma, and COPD, with increased risk in individuals with high or low BMI than those with BMIs in the middle quartiles.
- In a stratified analysis by race, the risk for cough was significantly higher among non-Hispanic Black individuals than other races (P < .0001), and a higher BMI was associated with an increased risk for COPD in non-Hispanic Black individuals (odds ratio, 1.053; P < .0001).
- The researchers found no significant impact of biological sex on the relationship between BMI and respiratory symptoms, COPD, or asthma.
- The results support previous studies showing that a BMI that is too low can be detrimental to health.
IN PRACTICE:
“These results suggest that the risk of small airway obstruction in underweight individuals deserves more attention and that excessive wasting may also affect the prognosis of patients with COPD,” the researchers wrote.
SOURCE:
The lead author on the study was Yuefeng Sun of Shandong University of Traditional Chinese Medicine, Jinan, China. The study was published online on January 10, 2024, in Scientific Reports.
LIMITATIONS:
The cross-sectional NHANES database prevented conclusions of causality, and potential confounding factors that were not accounted for could have affected the results.
DISCLOSURES:
The study was supported by the Shandong Province Taishan Scholar Project. The researchers had no financial conflicts to disclose.
A version of this article appeared on Medscape.com.
Certain Gut Microbes Tied to Cognitive Function in Children
TOPLINE:
Cognitive function in children aged 18 months to 10 years is associated with the enrichment or depletion of specific species of gut microbes, new research reveals.
METHODOLOGY:
- Researchers analyzed the relationship between the microbiome, neuroanatomy, and cognition (ie, the microbiome-gut-brain axis) in stool samples from 381 neurotypically developing children aged 40 days to 10 years (mean age, 2 years and 2 months).
- Stool samples were taken within a week of age-appropriate cognitive and behavioral assessments.
- Shotgun metagenomic sequencing was used to analyze the DNA of the organisms present in each sample.
- MRI data were obtained, with machine models then used to predict whether participants’ brain region volume was influenced by microbial profiles.
TAKEAWAY:
- Researchers found increasing variation in microbial species and microbial gene functions in children older than 18 months, and the overall variation was significantly associated with variation in cognitive function scores.
- Several microbial species were significantly enriched in children with higher cognitive function scores (eg, Alistipes obesi, Asaccharobacter celatus, Eubacterium eligens, and Faecalibacterium prausnitzii), with Sutterella wadsworthensis being the only species significantly negatively associated with these scores.
- Machine models indicated that taxa key in predicting cognitive function were similarly important for predicting individual brain regions and subscales of cognitive function.
IN PRACTICE:
“Understanding the gut-brain-microbiome axis in early life is particularly important since differences or interventions in early life can have outsized and longer-term consequences than those at later ages,” the authors wrote.
SOURCE:
The study, led by Kevin S. Bonham, PhD, Wellesley College, Wellesley, Massachusetts, was published online on December 22, 2023, in Science Advances.
LIMITATIONS:
Use of multiple age-appropriate cognitive assessments enabled analysis across multiple developmental periods, but test-retest reliability and differences between test administrators may have introduced noise into these observations, particularly in the youngest children. The study period overlapped with the beginning of the pandemic, and score reductions due to the lockdowns were more pronounced in some age groups than during the recruitment period.
DISCLOSURES:
The study was funded by the US National Institutes of Health and Wellcome: LEAP 1kD. The authors declared no competing interests.
A version of this article appeared on Medscape.com.
TOPLINE:
Cognitive function in children aged 18 months to 10 years is associated with the enrichment or depletion of specific species of gut microbes, new research reveals.
METHODOLOGY:
- Researchers analyzed the relationship between the microbiome, neuroanatomy, and cognition (ie, the microbiome-gut-brain axis) in stool samples from 381 neurotypically developing children aged 40 days to 10 years (mean age, 2 years and 2 months).
- Stool samples were taken within a week of age-appropriate cognitive and behavioral assessments.
- Shotgun metagenomic sequencing was used to analyze the DNA of the organisms present in each sample.
- MRI data were obtained, with machine models then used to predict whether participants’ brain region volume was influenced by microbial profiles.
TAKEAWAY:
- Researchers found increasing variation in microbial species and microbial gene functions in children older than 18 months, and the overall variation was significantly associated with variation in cognitive function scores.
- Several microbial species were significantly enriched in children with higher cognitive function scores (eg, Alistipes obesi, Asaccharobacter celatus, Eubacterium eligens, and Faecalibacterium prausnitzii), with Sutterella wadsworthensis being the only species significantly negatively associated with these scores.
- Machine models indicated that taxa key in predicting cognitive function were similarly important for predicting individual brain regions and subscales of cognitive function.
IN PRACTICE:
“Understanding the gut-brain-microbiome axis in early life is particularly important since differences or interventions in early life can have outsized and longer-term consequences than those at later ages,” the authors wrote.
SOURCE:
The study, led by Kevin S. Bonham, PhD, Wellesley College, Wellesley, Massachusetts, was published online on December 22, 2023, in Science Advances.
LIMITATIONS:
Use of multiple age-appropriate cognitive assessments enabled analysis across multiple developmental periods, but test-retest reliability and differences between test administrators may have introduced noise into these observations, particularly in the youngest children. The study period overlapped with the beginning of the pandemic, and score reductions due to the lockdowns were more pronounced in some age groups than during the recruitment period.
DISCLOSURES:
The study was funded by the US National Institutes of Health and Wellcome: LEAP 1kD. The authors declared no competing interests.
A version of this article appeared on Medscape.com.
TOPLINE:
Cognitive function in children aged 18 months to 10 years is associated with the enrichment or depletion of specific species of gut microbes, new research reveals.
METHODOLOGY:
- Researchers analyzed the relationship between the microbiome, neuroanatomy, and cognition (ie, the microbiome-gut-brain axis) in stool samples from 381 neurotypically developing children aged 40 days to 10 years (mean age, 2 years and 2 months).
- Stool samples were taken within a week of age-appropriate cognitive and behavioral assessments.
- Shotgun metagenomic sequencing was used to analyze the DNA of the organisms present in each sample.
- MRI data were obtained, with machine models then used to predict whether participants’ brain region volume was influenced by microbial profiles.
TAKEAWAY:
- Researchers found increasing variation in microbial species and microbial gene functions in children older than 18 months, and the overall variation was significantly associated with variation in cognitive function scores.
- Several microbial species were significantly enriched in children with higher cognitive function scores (eg, Alistipes obesi, Asaccharobacter celatus, Eubacterium eligens, and Faecalibacterium prausnitzii), with Sutterella wadsworthensis being the only species significantly negatively associated with these scores.
- Machine models indicated that taxa key in predicting cognitive function were similarly important for predicting individual brain regions and subscales of cognitive function.
IN PRACTICE:
“Understanding the gut-brain-microbiome axis in early life is particularly important since differences or interventions in early life can have outsized and longer-term consequences than those at later ages,” the authors wrote.
SOURCE:
The study, led by Kevin S. Bonham, PhD, Wellesley College, Wellesley, Massachusetts, was published online on December 22, 2023, in Science Advances.
LIMITATIONS:
Use of multiple age-appropriate cognitive assessments enabled analysis across multiple developmental periods, but test-retest reliability and differences between test administrators may have introduced noise into these observations, particularly in the youngest children. The study period overlapped with the beginning of the pandemic, and score reductions due to the lockdowns were more pronounced in some age groups than during the recruitment period.
DISCLOSURES:
The study was funded by the US National Institutes of Health and Wellcome: LEAP 1kD. The authors declared no competing interests.
A version of this article appeared on Medscape.com.
Tackling Sexism in Medicine
This interview was recorded Dec. 8, 2023. The transcript has been edited for clarity.
Kathrin LaFaver, MD: I have the pleasure of talking with Dr. Elizabeth Loder today. Dr. Loder is the vice chair of academic affairs in the department of neurology and a staff physician at Graham Headache Center at Brigham and Women’s Hospital in Boston. She’s also a professor of neurology at Harvard Medical School and has been a mentor to many headache specialists in the field.
We’ll be talking about the topic of sexism in medicine.
Elizabeth W. Loder, MD, MPH: Thank you so much, Dr. LaFaver. I’m very pleased to be here to talk about something that I think is very important.
Dr. LaFaver: Dr. Loder, you were a speaker at our Women in Neurology third annual conference in Florida, giving a talk on this very topic, sexism in medicine. It was very helpful, especially for many younger women entering the field of neurology, to hear that some of the experiences they’re having are not unique to them, but unfortunately remain a more systemic issue.
To get us started, could you define sexism in medicine for us, and how you got interested in this topic?
Sexism Can Be Subtle
Dr. Loder: You’re absolutely right. It’s nice for women, particularly those entering the field, to know that they’re not alone.
What is sexism? Well, it’s generally considered to be prejudice or discrimination against someone based on their sex or gender. One thing that’s important to remember is it’s not always extremely obvious. It’s not always intentional. I think most of us, I’d include myself in that, have sexist views. We may not always be aware of them. This is part of the unconscious bias that many of us have been trained to think.
As one example, we’re socialized — or I certainly was — to think of doctors as male. When a patient says, “I saw a cardiologist,” in my mind, I think that that person might have been male. Sometimes, I will ask, “What did he say?” That’s an example of sexism.
Sexism can be internalized. It can come from any source. We’re all implicated in it. I think that’s very important to remember. This is not a case of them doing something to us. This is something that is much more widespread and engendered in the society that we live in.
Dr. LaFaver: I think that’s really important to realize. Could you mention some other examples, specifically in the field of neurology, that you have encountered?
Dr. Loder: Certainly, looking over my own career — and I’m at a point now where I can look at early, mid, and late career — things were, of course, very different when I began. I would say that sexism was much more overt.
Very early in my career, I experienced a large amount of hostility from a boss. I ended up having to leave. This was, I believe, based on my sex. It turned out that leaving was a good thing for me, but it was a very unpleasant experience.
I also became a leader in my professional society. During my path to leadership and seeing other women attempt to make progress within the organization, I certainly saw behavior that I would characterize as rooted in sexism. To its credit, though, the professional society to which I belong, I think, has become one of the most progressive societies out there. The women within have been able to affect quite a bit of change in that professional organization.
I dealt with a case of sexual harassment in my own division when I was a division chief, which gave me insight into institutional policies and procedures meant to deal with situations like that, which, I think, leave something to be desired. That’s changing.
Now, I work in academic affairs, and I see how likely or unlikely people, based on their sex, are to put themselves forward for promotion, how likely they are to believe in their own capabilities. I also work as a medical journal editor, and I see generally that women are more hesitant to proclaim themselves experts and to accept invitations to provide or write editorial commentary. Sometimes, they do not perceive themselves as being expert enough to do so. I have seen many of these things over my career.
Dr. LaFaver: Thank you for sharing. I think it’s important to realize that it›s not just unidirectional but sometimes affects women and kind of goes both ways.
As you mentioned, these issues are not always overt. In recent years, microaggressions has become more of a term that has been used. Could you talk a bit about that? What are the microaggressions and how do they affect women?
Microaggressions and Migraine Mavens
Dr. Loder: The term microaggression has become very popular, and I think many people find it somewhat irritating. That, to me, is inherent in what a microaggression is. Microaggressions, by definition, are small things. It’s hard to prove that they were rooted in sexism. Sometimes, there’s a large amount of ambiguity about it. It can be as simple as inviting a pregnant woman to sit down because you perceive that she needs to sit, commenting on somebody’s shoes, or things like that.
Often, they’re unintentional. Sometimes, they come from a place of what we might term benevolent sexism, people trying to be helpful to a woman because they perceive that she’s weaker or she might not be able to do something, or maybe she has family responsibilities. They think that they’re being helpful. These things happen when we perceive people to be different in some way, as women are perceived to be different in terms of their responsibilities in the home or different in terms of what we expect from them in the workplace.
The problem with microaggressions is because they’re small, each one of them, I think the temptation is often to say, “Oh you know, they didn’t mean it. It’s not that big a deal. It was just a comment on your shoes.” If a woman brings that up, she’s often made to feel, sometimes by other women, that she should just chill out. This isn’t a big deal.
The problem is that they may not be a big deal in and of themselves, but when they are repeated over a long period of time, they can really sap somebody’s confidence in herself, make her question her own competence, and can have a cumulative effect that is very negative.
Although I think many people are skeptical about microaggressions as an important contribution to how women do in the workplace and in other settings, they are, in my opinion, important. I’ll just emphasize again that they come from everywhere, including other women and colleagues who mean to be helpful.
Dr. LaFaver: I know you have led a team of headache specialists and wrote a fantastic article about navigating sexism at work and what not to say to your female colleagues. Could you share some tips for them to navigate sexism at work and, specifically, as it applies to our careers in medicine.
Dr. Loder: Thank you for calling out that article. It actually grew organically out of a Facebook group that I started called Migraine Mavens. I’ve worked in the headache field throughout my career, and I experienced something that, to me, was kind of discouraging that I felt was sexist within our field. I just thought, What can I do? I thought, Well, maybe there’s some strength to be had in sharing this with other women, and maybe we should have our own social media community, so I formed this group.
After I gave a talk at the American Headache Society about sexism in the headache field, one of the members sent me a message saying, “Your talk was very timely. Immediately after you gave this talk, somebody stopped me in the hall and said, ‘Congratulations on your leadership position in the society, but are you really sure you can do this because you’ve got young children at home?’ Your talk was very needed.”
People started just discussing within the group, “Oh, this happened to me,” “That happened to me.” We began to brainstorm what we could have done differently. When these things happen, people are not necessarily prepared for them, and later on, you lie awake thinking of what you could have said.
We decided to write a paper. It ended up being published in The Journal of Head and Face Pain, and it was based on real vignettes from people in the group. We anonymized them so that people would not recognize themselves necessarily, but they’re all real. They’re things that really happened to women in the group.
We first describe the vignette — what happened. Then we explain, for those who need the explanation, what’s wrong with it. Why is it wrong to tell somebody to smile, for example. What could you do differently? What could somebody who sees this happen do, the so-called bystander or upstander? If you witness something like that, can you help the person toward whom this problematic behavior is directed? We came up with some examples. The all-purpose thing is to say, “What did you just say?” Make them repeat it, which often helps people to realize how inappropriate it is.
This got published as an article. It became quite the subject of attention on X [formerly Twitter] and elsewhere. I guess the term going viral would apply to this. It included a large amount of real-world advice. The thing I really loved about it was that it was written by the women in the group who had experienced these things. I would characterize it as having been somewhat therapeutic. We got many messages from women in other disciplines, outside medicine, saying that this happens in oceanography, for example. I think what we described really resonated beyond the field of headache medicine and neurology.
Institutional Sexism
Dr. LaFaver: Looking beyond the individual person, do you have any recommendations for medical institutions to share in order to do better and maybe create an environment that is less sexist?
Dr. Loder: Yes. I think many institutions try to deal with the problem of lack of diversity, whether it›s women or other underrepresented groups, by hiring. That’s one way to go about it, but I think retention strategies are also very important, and they need to pay attention to the work environment.
Every institution now has guidelines about harassment, bullying, sexism, racism, and so on. In general though — and I’m not speaking about any particular institution — these policies and procedures are often crafted with an eye toward protecting the institution. I would advise institutions to be a bit more genuine about this, and not to think so quickly about what can we do to prevent the institution from facing a charge of sexism, or what can we do to deny or dismiss these allegations, toward thinking, what can we do to really and truly be helpful to these women? In other words, approach it from the point of view of trying to help the people involved instead of trying to help the institution. That will make a very big difference.
I also think that citizenship activities, serving on committees, doing thankless tasks behind the scenes, and clinical work, seeing patients ... Women are overrepresented among clinicians. Of course, we know that research and bringing in big grants is often prioritized over clinical care, despite what institutions may say about that in public. I think those activities should be valued more highly, both in terms of pay and in terms of academic recognition.
In regard to the issue of salary, I would encourage institutions to publish salaries or at least make them easily findable by people within the institution. I think there should be objective criteria for salary determinations. The most important thing is that I do not think that women should be expected to negotiate their salaries. Women are judged differently than men when they attempt to negotiate salaries. It often backfires for them. It also is something that many women do not feel comfortable doing.
Waiting until somebody tries to negotiate a higher salary really guarantees, embeds, and operationalizes sex differences in salaries. We need to move away from the idea that you have to be a go-getter and that you have to ask for this raise. There should be objective criteria, salaries should be revisited on a regular basis, and the kinds of activities that women do that are undervalued should be more recognized in terms of money and advancement within academia.
Dr. LaFaver: I couldn’t agree more. One of the other topics discussed at the Women in Neurology conference was mid-career development, retention, and career paths. I think it’s known that many women leave academic medicine mid-career. I think these are excellent suggestions and hopefully will help to make careers successful for men and women, without needing to worry about being treated differently or unfairly.
Thank you so much. This was a wonderful overview of this topic.
Dr. Loder: You’re welcome, Dr. LaFaver. Thank you so much for asking me to speak on this topic. I really appreciate it.
Dr. LaFaver: Thanks, everyone.
Dr. LaFaver is a neurologist at Saratoga Hospital Medical Group, Saratoga Springs, New York. Dr. LaFaver and Dr. Loder disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
This interview was recorded Dec. 8, 2023. The transcript has been edited for clarity.
Kathrin LaFaver, MD: I have the pleasure of talking with Dr. Elizabeth Loder today. Dr. Loder is the vice chair of academic affairs in the department of neurology and a staff physician at Graham Headache Center at Brigham and Women’s Hospital in Boston. She’s also a professor of neurology at Harvard Medical School and has been a mentor to many headache specialists in the field.
We’ll be talking about the topic of sexism in medicine.
Elizabeth W. Loder, MD, MPH: Thank you so much, Dr. LaFaver. I’m very pleased to be here to talk about something that I think is very important.
Dr. LaFaver: Dr. Loder, you were a speaker at our Women in Neurology third annual conference in Florida, giving a talk on this very topic, sexism in medicine. It was very helpful, especially for many younger women entering the field of neurology, to hear that some of the experiences they’re having are not unique to them, but unfortunately remain a more systemic issue.
To get us started, could you define sexism in medicine for us, and how you got interested in this topic?
Sexism Can Be Subtle
Dr. Loder: You’re absolutely right. It’s nice for women, particularly those entering the field, to know that they’re not alone.
What is sexism? Well, it’s generally considered to be prejudice or discrimination against someone based on their sex or gender. One thing that’s important to remember is it’s not always extremely obvious. It’s not always intentional. I think most of us, I’d include myself in that, have sexist views. We may not always be aware of them. This is part of the unconscious bias that many of us have been trained to think.
As one example, we’re socialized — or I certainly was — to think of doctors as male. When a patient says, “I saw a cardiologist,” in my mind, I think that that person might have been male. Sometimes, I will ask, “What did he say?” That’s an example of sexism.
Sexism can be internalized. It can come from any source. We’re all implicated in it. I think that’s very important to remember. This is not a case of them doing something to us. This is something that is much more widespread and engendered in the society that we live in.
Dr. LaFaver: I think that’s really important to realize. Could you mention some other examples, specifically in the field of neurology, that you have encountered?
Dr. Loder: Certainly, looking over my own career — and I’m at a point now where I can look at early, mid, and late career — things were, of course, very different when I began. I would say that sexism was much more overt.
Very early in my career, I experienced a large amount of hostility from a boss. I ended up having to leave. This was, I believe, based on my sex. It turned out that leaving was a good thing for me, but it was a very unpleasant experience.
I also became a leader in my professional society. During my path to leadership and seeing other women attempt to make progress within the organization, I certainly saw behavior that I would characterize as rooted in sexism. To its credit, though, the professional society to which I belong, I think, has become one of the most progressive societies out there. The women within have been able to affect quite a bit of change in that professional organization.
I dealt with a case of sexual harassment in my own division when I was a division chief, which gave me insight into institutional policies and procedures meant to deal with situations like that, which, I think, leave something to be desired. That’s changing.
Now, I work in academic affairs, and I see how likely or unlikely people, based on their sex, are to put themselves forward for promotion, how likely they are to believe in their own capabilities. I also work as a medical journal editor, and I see generally that women are more hesitant to proclaim themselves experts and to accept invitations to provide or write editorial commentary. Sometimes, they do not perceive themselves as being expert enough to do so. I have seen many of these things over my career.
Dr. LaFaver: Thank you for sharing. I think it’s important to realize that it›s not just unidirectional but sometimes affects women and kind of goes both ways.
As you mentioned, these issues are not always overt. In recent years, microaggressions has become more of a term that has been used. Could you talk a bit about that? What are the microaggressions and how do they affect women?
Microaggressions and Migraine Mavens
Dr. Loder: The term microaggression has become very popular, and I think many people find it somewhat irritating. That, to me, is inherent in what a microaggression is. Microaggressions, by definition, are small things. It’s hard to prove that they were rooted in sexism. Sometimes, there’s a large amount of ambiguity about it. It can be as simple as inviting a pregnant woman to sit down because you perceive that she needs to sit, commenting on somebody’s shoes, or things like that.
Often, they’re unintentional. Sometimes, they come from a place of what we might term benevolent sexism, people trying to be helpful to a woman because they perceive that she’s weaker or she might not be able to do something, or maybe she has family responsibilities. They think that they’re being helpful. These things happen when we perceive people to be different in some way, as women are perceived to be different in terms of their responsibilities in the home or different in terms of what we expect from them in the workplace.
The problem with microaggressions is because they’re small, each one of them, I think the temptation is often to say, “Oh you know, they didn’t mean it. It’s not that big a deal. It was just a comment on your shoes.” If a woman brings that up, she’s often made to feel, sometimes by other women, that she should just chill out. This isn’t a big deal.
The problem is that they may not be a big deal in and of themselves, but when they are repeated over a long period of time, they can really sap somebody’s confidence in herself, make her question her own competence, and can have a cumulative effect that is very negative.
Although I think many people are skeptical about microaggressions as an important contribution to how women do in the workplace and in other settings, they are, in my opinion, important. I’ll just emphasize again that they come from everywhere, including other women and colleagues who mean to be helpful.
Dr. LaFaver: I know you have led a team of headache specialists and wrote a fantastic article about navigating sexism at work and what not to say to your female colleagues. Could you share some tips for them to navigate sexism at work and, specifically, as it applies to our careers in medicine.
Dr. Loder: Thank you for calling out that article. It actually grew organically out of a Facebook group that I started called Migraine Mavens. I’ve worked in the headache field throughout my career, and I experienced something that, to me, was kind of discouraging that I felt was sexist within our field. I just thought, What can I do? I thought, Well, maybe there’s some strength to be had in sharing this with other women, and maybe we should have our own social media community, so I formed this group.
After I gave a talk at the American Headache Society about sexism in the headache field, one of the members sent me a message saying, “Your talk was very timely. Immediately after you gave this talk, somebody stopped me in the hall and said, ‘Congratulations on your leadership position in the society, but are you really sure you can do this because you’ve got young children at home?’ Your talk was very needed.”
People started just discussing within the group, “Oh, this happened to me,” “That happened to me.” We began to brainstorm what we could have done differently. When these things happen, people are not necessarily prepared for them, and later on, you lie awake thinking of what you could have said.
We decided to write a paper. It ended up being published in The Journal of Head and Face Pain, and it was based on real vignettes from people in the group. We anonymized them so that people would not recognize themselves necessarily, but they’re all real. They’re things that really happened to women in the group.
We first describe the vignette — what happened. Then we explain, for those who need the explanation, what’s wrong with it. Why is it wrong to tell somebody to smile, for example. What could you do differently? What could somebody who sees this happen do, the so-called bystander or upstander? If you witness something like that, can you help the person toward whom this problematic behavior is directed? We came up with some examples. The all-purpose thing is to say, “What did you just say?” Make them repeat it, which often helps people to realize how inappropriate it is.
This got published as an article. It became quite the subject of attention on X [formerly Twitter] and elsewhere. I guess the term going viral would apply to this. It included a large amount of real-world advice. The thing I really loved about it was that it was written by the women in the group who had experienced these things. I would characterize it as having been somewhat therapeutic. We got many messages from women in other disciplines, outside medicine, saying that this happens in oceanography, for example. I think what we described really resonated beyond the field of headache medicine and neurology.
Institutional Sexism
Dr. LaFaver: Looking beyond the individual person, do you have any recommendations for medical institutions to share in order to do better and maybe create an environment that is less sexist?
Dr. Loder: Yes. I think many institutions try to deal with the problem of lack of diversity, whether it›s women or other underrepresented groups, by hiring. That’s one way to go about it, but I think retention strategies are also very important, and they need to pay attention to the work environment.
Every institution now has guidelines about harassment, bullying, sexism, racism, and so on. In general though — and I’m not speaking about any particular institution — these policies and procedures are often crafted with an eye toward protecting the institution. I would advise institutions to be a bit more genuine about this, and not to think so quickly about what can we do to prevent the institution from facing a charge of sexism, or what can we do to deny or dismiss these allegations, toward thinking, what can we do to really and truly be helpful to these women? In other words, approach it from the point of view of trying to help the people involved instead of trying to help the institution. That will make a very big difference.
I also think that citizenship activities, serving on committees, doing thankless tasks behind the scenes, and clinical work, seeing patients ... Women are overrepresented among clinicians. Of course, we know that research and bringing in big grants is often prioritized over clinical care, despite what institutions may say about that in public. I think those activities should be valued more highly, both in terms of pay and in terms of academic recognition.
In regard to the issue of salary, I would encourage institutions to publish salaries or at least make them easily findable by people within the institution. I think there should be objective criteria for salary determinations. The most important thing is that I do not think that women should be expected to negotiate their salaries. Women are judged differently than men when they attempt to negotiate salaries. It often backfires for them. It also is something that many women do not feel comfortable doing.
Waiting until somebody tries to negotiate a higher salary really guarantees, embeds, and operationalizes sex differences in salaries. We need to move away from the idea that you have to be a go-getter and that you have to ask for this raise. There should be objective criteria, salaries should be revisited on a regular basis, and the kinds of activities that women do that are undervalued should be more recognized in terms of money and advancement within academia.
Dr. LaFaver: I couldn’t agree more. One of the other topics discussed at the Women in Neurology conference was mid-career development, retention, and career paths. I think it’s known that many women leave academic medicine mid-career. I think these are excellent suggestions and hopefully will help to make careers successful for men and women, without needing to worry about being treated differently or unfairly.
Thank you so much. This was a wonderful overview of this topic.
Dr. Loder: You’re welcome, Dr. LaFaver. Thank you so much for asking me to speak on this topic. I really appreciate it.
Dr. LaFaver: Thanks, everyone.
Dr. LaFaver is a neurologist at Saratoga Hospital Medical Group, Saratoga Springs, New York. Dr. LaFaver and Dr. Loder disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
This interview was recorded Dec. 8, 2023. The transcript has been edited for clarity.
Kathrin LaFaver, MD: I have the pleasure of talking with Dr. Elizabeth Loder today. Dr. Loder is the vice chair of academic affairs in the department of neurology and a staff physician at Graham Headache Center at Brigham and Women’s Hospital in Boston. She’s also a professor of neurology at Harvard Medical School and has been a mentor to many headache specialists in the field.
We’ll be talking about the topic of sexism in medicine.
Elizabeth W. Loder, MD, MPH: Thank you so much, Dr. LaFaver. I’m very pleased to be here to talk about something that I think is very important.
Dr. LaFaver: Dr. Loder, you were a speaker at our Women in Neurology third annual conference in Florida, giving a talk on this very topic, sexism in medicine. It was very helpful, especially for many younger women entering the field of neurology, to hear that some of the experiences they’re having are not unique to them, but unfortunately remain a more systemic issue.
To get us started, could you define sexism in medicine for us, and how you got interested in this topic?
Sexism Can Be Subtle
Dr. Loder: You’re absolutely right. It’s nice for women, particularly those entering the field, to know that they’re not alone.
What is sexism? Well, it’s generally considered to be prejudice or discrimination against someone based on their sex or gender. One thing that’s important to remember is it’s not always extremely obvious. It’s not always intentional. I think most of us, I’d include myself in that, have sexist views. We may not always be aware of them. This is part of the unconscious bias that many of us have been trained to think.
As one example, we’re socialized — or I certainly was — to think of doctors as male. When a patient says, “I saw a cardiologist,” in my mind, I think that that person might have been male. Sometimes, I will ask, “What did he say?” That’s an example of sexism.
Sexism can be internalized. It can come from any source. We’re all implicated in it. I think that’s very important to remember. This is not a case of them doing something to us. This is something that is much more widespread and engendered in the society that we live in.
Dr. LaFaver: I think that’s really important to realize. Could you mention some other examples, specifically in the field of neurology, that you have encountered?
Dr. Loder: Certainly, looking over my own career — and I’m at a point now where I can look at early, mid, and late career — things were, of course, very different when I began. I would say that sexism was much more overt.
Very early in my career, I experienced a large amount of hostility from a boss. I ended up having to leave. This was, I believe, based on my sex. It turned out that leaving was a good thing for me, but it was a very unpleasant experience.
I also became a leader in my professional society. During my path to leadership and seeing other women attempt to make progress within the organization, I certainly saw behavior that I would characterize as rooted in sexism. To its credit, though, the professional society to which I belong, I think, has become one of the most progressive societies out there. The women within have been able to affect quite a bit of change in that professional organization.
I dealt with a case of sexual harassment in my own division when I was a division chief, which gave me insight into institutional policies and procedures meant to deal with situations like that, which, I think, leave something to be desired. That’s changing.
Now, I work in academic affairs, and I see how likely or unlikely people, based on their sex, are to put themselves forward for promotion, how likely they are to believe in their own capabilities. I also work as a medical journal editor, and I see generally that women are more hesitant to proclaim themselves experts and to accept invitations to provide or write editorial commentary. Sometimes, they do not perceive themselves as being expert enough to do so. I have seen many of these things over my career.
Dr. LaFaver: Thank you for sharing. I think it’s important to realize that it›s not just unidirectional but sometimes affects women and kind of goes both ways.
As you mentioned, these issues are not always overt. In recent years, microaggressions has become more of a term that has been used. Could you talk a bit about that? What are the microaggressions and how do they affect women?
Microaggressions and Migraine Mavens
Dr. Loder: The term microaggression has become very popular, and I think many people find it somewhat irritating. That, to me, is inherent in what a microaggression is. Microaggressions, by definition, are small things. It’s hard to prove that they were rooted in sexism. Sometimes, there’s a large amount of ambiguity about it. It can be as simple as inviting a pregnant woman to sit down because you perceive that she needs to sit, commenting on somebody’s shoes, or things like that.
Often, they’re unintentional. Sometimes, they come from a place of what we might term benevolent sexism, people trying to be helpful to a woman because they perceive that she’s weaker or she might not be able to do something, or maybe she has family responsibilities. They think that they’re being helpful. These things happen when we perceive people to be different in some way, as women are perceived to be different in terms of their responsibilities in the home or different in terms of what we expect from them in the workplace.
The problem with microaggressions is because they’re small, each one of them, I think the temptation is often to say, “Oh you know, they didn’t mean it. It’s not that big a deal. It was just a comment on your shoes.” If a woman brings that up, she’s often made to feel, sometimes by other women, that she should just chill out. This isn’t a big deal.
The problem is that they may not be a big deal in and of themselves, but when they are repeated over a long period of time, they can really sap somebody’s confidence in herself, make her question her own competence, and can have a cumulative effect that is very negative.
Although I think many people are skeptical about microaggressions as an important contribution to how women do in the workplace and in other settings, they are, in my opinion, important. I’ll just emphasize again that they come from everywhere, including other women and colleagues who mean to be helpful.
Dr. LaFaver: I know you have led a team of headache specialists and wrote a fantastic article about navigating sexism at work and what not to say to your female colleagues. Could you share some tips for them to navigate sexism at work and, specifically, as it applies to our careers in medicine.
Dr. Loder: Thank you for calling out that article. It actually grew organically out of a Facebook group that I started called Migraine Mavens. I’ve worked in the headache field throughout my career, and I experienced something that, to me, was kind of discouraging that I felt was sexist within our field. I just thought, What can I do? I thought, Well, maybe there’s some strength to be had in sharing this with other women, and maybe we should have our own social media community, so I formed this group.
After I gave a talk at the American Headache Society about sexism in the headache field, one of the members sent me a message saying, “Your talk was very timely. Immediately after you gave this talk, somebody stopped me in the hall and said, ‘Congratulations on your leadership position in the society, but are you really sure you can do this because you’ve got young children at home?’ Your talk was very needed.”
People started just discussing within the group, “Oh, this happened to me,” “That happened to me.” We began to brainstorm what we could have done differently. When these things happen, people are not necessarily prepared for them, and later on, you lie awake thinking of what you could have said.
We decided to write a paper. It ended up being published in The Journal of Head and Face Pain, and it was based on real vignettes from people in the group. We anonymized them so that people would not recognize themselves necessarily, but they’re all real. They’re things that really happened to women in the group.
We first describe the vignette — what happened. Then we explain, for those who need the explanation, what’s wrong with it. Why is it wrong to tell somebody to smile, for example. What could you do differently? What could somebody who sees this happen do, the so-called bystander or upstander? If you witness something like that, can you help the person toward whom this problematic behavior is directed? We came up with some examples. The all-purpose thing is to say, “What did you just say?” Make them repeat it, which often helps people to realize how inappropriate it is.
This got published as an article. It became quite the subject of attention on X [formerly Twitter] and elsewhere. I guess the term going viral would apply to this. It included a large amount of real-world advice. The thing I really loved about it was that it was written by the women in the group who had experienced these things. I would characterize it as having been somewhat therapeutic. We got many messages from women in other disciplines, outside medicine, saying that this happens in oceanography, for example. I think what we described really resonated beyond the field of headache medicine and neurology.
Institutional Sexism
Dr. LaFaver: Looking beyond the individual person, do you have any recommendations for medical institutions to share in order to do better and maybe create an environment that is less sexist?
Dr. Loder: Yes. I think many institutions try to deal with the problem of lack of diversity, whether it›s women or other underrepresented groups, by hiring. That’s one way to go about it, but I think retention strategies are also very important, and they need to pay attention to the work environment.
Every institution now has guidelines about harassment, bullying, sexism, racism, and so on. In general though — and I’m not speaking about any particular institution — these policies and procedures are often crafted with an eye toward protecting the institution. I would advise institutions to be a bit more genuine about this, and not to think so quickly about what can we do to prevent the institution from facing a charge of sexism, or what can we do to deny or dismiss these allegations, toward thinking, what can we do to really and truly be helpful to these women? In other words, approach it from the point of view of trying to help the people involved instead of trying to help the institution. That will make a very big difference.
I also think that citizenship activities, serving on committees, doing thankless tasks behind the scenes, and clinical work, seeing patients ... Women are overrepresented among clinicians. Of course, we know that research and bringing in big grants is often prioritized over clinical care, despite what institutions may say about that in public. I think those activities should be valued more highly, both in terms of pay and in terms of academic recognition.
In regard to the issue of salary, I would encourage institutions to publish salaries or at least make them easily findable by people within the institution. I think there should be objective criteria for salary determinations. The most important thing is that I do not think that women should be expected to negotiate their salaries. Women are judged differently than men when they attempt to negotiate salaries. It often backfires for them. It also is something that many women do not feel comfortable doing.
Waiting until somebody tries to negotiate a higher salary really guarantees, embeds, and operationalizes sex differences in salaries. We need to move away from the idea that you have to be a go-getter and that you have to ask for this raise. There should be objective criteria, salaries should be revisited on a regular basis, and the kinds of activities that women do that are undervalued should be more recognized in terms of money and advancement within academia.
Dr. LaFaver: I couldn’t agree more. One of the other topics discussed at the Women in Neurology conference was mid-career development, retention, and career paths. I think it’s known that many women leave academic medicine mid-career. I think these are excellent suggestions and hopefully will help to make careers successful for men and women, without needing to worry about being treated differently or unfairly.
Thank you so much. This was a wonderful overview of this topic.
Dr. Loder: You’re welcome, Dr. LaFaver. Thank you so much for asking me to speak on this topic. I really appreciate it.
Dr. LaFaver: Thanks, everyone.
Dr. LaFaver is a neurologist at Saratoga Hospital Medical Group, Saratoga Springs, New York. Dr. LaFaver and Dr. Loder disclosed no relevant financial relationships.
A version of this article appeared on Medscape.com.
Tirzepatide: A ‘Rising Star’ in T2D Renal Protection
TOPLINE:
in patients with type 2 diabetes (T2D).
METHODOLOGY:
- A meta-analysis of eight randomized controlled trials compared the effects of tirzepatide and control treatment (placebo or any active comparator) on albuminuria levels and renal function in patients with T2D.
- The pooled data included 6226 patients with T2D who received tirzepatide (5, 10, or 15 mg) and 3307 participants in the control group who received placebo, semaglutide, or insulin.
- The primary outcome was the difference in absolute change in urinary albumin-creatinine ratio (UACR) from baseline between the tirzepatide and control groups.
- The secondary efficacy endpoint was the comparative change in estimated glomerular filtration rate (eGFR) between the two groups.
TAKEAWAY:
- Overall, tirzepatide reduced UACR by ~27% (mean difference [MD], −26.9%; P < .001) compared with controls.
- The reduction in UACR was consistent across all tirzepatide doses (5 mg: MD, −23.12%; 10 mg: MD, −27.87%; 15 mg: MD, −27.15).
- Benefits of tirzepatide were even more pronounced in patients with increased albuminuria levels (UACR ≥ 30 mg/g) at baseline (MD, −41.42%; P < .001) than in controls.
- However, tirzepatide vs control treatment did not have a significant effect on eGFR levels (P = .46), which indicated no negative effect of tirzepatide on renal function.
IN PRACTICE:
“Tirzepatide seems to be a ‘rising star’ for the prevention and delaying of chronic kidney disease and related, surrogate renal outcomes in patients with T2DM,” the authors wrote.
SOURCE:
Paschalis Karakasis, MD, Aristotle University of Thessaloniki, Thessaloniki, Greece, led this study, which was published online December 20, 2023, in the journal Diabetes, Obesity and Metabolism.
LIMITATIONS:
There was significant heterogeneity between the studies. Bias may have come from the open-label design in the included randomized controlled trials. The pathophysiological mechanisms underlying the effect of tirzepatide on chronic kidney disease pathogenesis are speculative.
DISCLOSURES:
The paper did not receive any specific funding. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
in patients with type 2 diabetes (T2D).
METHODOLOGY:
- A meta-analysis of eight randomized controlled trials compared the effects of tirzepatide and control treatment (placebo or any active comparator) on albuminuria levels and renal function in patients with T2D.
- The pooled data included 6226 patients with T2D who received tirzepatide (5, 10, or 15 mg) and 3307 participants in the control group who received placebo, semaglutide, or insulin.
- The primary outcome was the difference in absolute change in urinary albumin-creatinine ratio (UACR) from baseline between the tirzepatide and control groups.
- The secondary efficacy endpoint was the comparative change in estimated glomerular filtration rate (eGFR) between the two groups.
TAKEAWAY:
- Overall, tirzepatide reduced UACR by ~27% (mean difference [MD], −26.9%; P < .001) compared with controls.
- The reduction in UACR was consistent across all tirzepatide doses (5 mg: MD, −23.12%; 10 mg: MD, −27.87%; 15 mg: MD, −27.15).
- Benefits of tirzepatide were even more pronounced in patients with increased albuminuria levels (UACR ≥ 30 mg/g) at baseline (MD, −41.42%; P < .001) than in controls.
- However, tirzepatide vs control treatment did not have a significant effect on eGFR levels (P = .46), which indicated no negative effect of tirzepatide on renal function.
IN PRACTICE:
“Tirzepatide seems to be a ‘rising star’ for the prevention and delaying of chronic kidney disease and related, surrogate renal outcomes in patients with T2DM,” the authors wrote.
SOURCE:
Paschalis Karakasis, MD, Aristotle University of Thessaloniki, Thessaloniki, Greece, led this study, which was published online December 20, 2023, in the journal Diabetes, Obesity and Metabolism.
LIMITATIONS:
There was significant heterogeneity between the studies. Bias may have come from the open-label design in the included randomized controlled trials. The pathophysiological mechanisms underlying the effect of tirzepatide on chronic kidney disease pathogenesis are speculative.
DISCLOSURES:
The paper did not receive any specific funding. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
in patients with type 2 diabetes (T2D).
METHODOLOGY:
- A meta-analysis of eight randomized controlled trials compared the effects of tirzepatide and control treatment (placebo or any active comparator) on albuminuria levels and renal function in patients with T2D.
- The pooled data included 6226 patients with T2D who received tirzepatide (5, 10, or 15 mg) and 3307 participants in the control group who received placebo, semaglutide, or insulin.
- The primary outcome was the difference in absolute change in urinary albumin-creatinine ratio (UACR) from baseline between the tirzepatide and control groups.
- The secondary efficacy endpoint was the comparative change in estimated glomerular filtration rate (eGFR) between the two groups.
TAKEAWAY:
- Overall, tirzepatide reduced UACR by ~27% (mean difference [MD], −26.9%; P < .001) compared with controls.
- The reduction in UACR was consistent across all tirzepatide doses (5 mg: MD, −23.12%; 10 mg: MD, −27.87%; 15 mg: MD, −27.15).
- Benefits of tirzepatide were even more pronounced in patients with increased albuminuria levels (UACR ≥ 30 mg/g) at baseline (MD, −41.42%; P < .001) than in controls.
- However, tirzepatide vs control treatment did not have a significant effect on eGFR levels (P = .46), which indicated no negative effect of tirzepatide on renal function.
IN PRACTICE:
“Tirzepatide seems to be a ‘rising star’ for the prevention and delaying of chronic kidney disease and related, surrogate renal outcomes in patients with T2DM,” the authors wrote.
SOURCE:
Paschalis Karakasis, MD, Aristotle University of Thessaloniki, Thessaloniki, Greece, led this study, which was published online December 20, 2023, in the journal Diabetes, Obesity and Metabolism.
LIMITATIONS:
There was significant heterogeneity between the studies. Bias may have come from the open-label design in the included randomized controlled trials. The pathophysiological mechanisms underlying the effect of tirzepatide on chronic kidney disease pathogenesis are speculative.
DISCLOSURES:
The paper did not receive any specific funding. The authors declared no conflicts of interest.
A version of this article appeared on Medscape.com.