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2018-06-18T17:16:13.767Z
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{"feed":"Health-or-The-Atlantic","feedTitle":"Health | The Atlantic","feedLink":"/feed/Health-or-The-Atlantic","catTitle":"Fitness","catLink":"/cat/fitness"}

Claire is a 14-year-old girl with short auburn hair and a broad smile. She lives outside Philadelphia with her mother and father, both professional scientists. Claire can come across as an introvert, but she quickly opens up, and what seemed like shyness reveals itself to be quiet self-assuredness. Like many kids her age, she is a bit overscheduled. During the course of the evening I spent with Claire and her mother, Heather—these aren’t their real names—theater, guitar, and track tryouts all came up. We also discussed the fact that, until recently, she wasn’t certain she was a girl.

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Sixth grade had been difficult for her. She’d struggled to make friends and experienced both anxiety and depression. “I didn’t have any self-confidence at all,” she told me. “I thought there was something wrong with me.” Claire, who was 12 at the time, also felt uncomfortable in her body in a way she couldn’t quite describe. She acknowledged that part of it had to do with puberty, but she felt it was more than the usual preteen woes. “At first, I started eating less,” she said, “but that didn’t really help.”

Around this time, Claire started watching YouTube videos made by transgender young people. She was particularly fascinated by

“Altering someone’s microbiome is as complicated as changing a rainforest or a coral reef,” The Atlantic’s Ed Yong told an audience at the National Institutes of Health on Tuesday. “It’s not easy.”

In conversation with Francis Collins, the director of the NIH, Yong discussed the future of microbial medicine. He argued that doctors should focus on an “ecological type of thinking” instead of the more simplistic approach behind “medically underwhelming” probiotic treatments. “It’s not just thinking of microbes as a pill that you could give to someone to fix a lack of something,” Yong said.

One recent study that Yong praised for taking a “careful” and “clever” approach to probiotics involved preventatively treating newborns in India with a carefully selected cocktail of bacteria along with sugar to help the microbes colonize their new environment in the infants’ guts. That two-pronged approach—called a synbiotic—was extremely successful. Rates of sepsis among the babies after just a week of daily doses were 40 percent lower than in the control group. Yong called the trial “an important step in the right direction.”

Probiotics that are less attentively designed, Yong said, are likely to have little effect on the balance of bacterial strains living in your gut. “Taking probiotics,” he said, “is a little bit like raising a small number of captive, zoo-born animals and then releasing them into the jungle and hoping that they’ll do well.” For this reason, as Yong has written in his recent book, I Contain Multitudes, haphazard...

In my daily life as an East Coast journalist, pretty much all I eat is lentils, salad, and lentil salads. The thing is, I recently returned to my homeland, Texas, for a reporting trip. Before you ask, hipster, I’m not from Austin, or even Houston. I’m from the gosh-dang suburbs of Dallas, where lentils and salads are less plentiful, and beef and cheese are ... more so.

Midway through it, I traveled to the small town of Wichita Falls, in central Texas, where my stomach microbes were further exposed to things they’ve never witnessed in their precious, coddled, organic Washington, D.C., lives. I’m talking ice cream that isn’t Halo Top and tap water from a La Quinta bathroom.

I have returned with, for now, a brief travelogue of things I ate. I had limited time, limited cash, and limited options. Some of my stops were quintessentially Texas; others were maybe a standard deviation more Texas than the average fast-food meal, yet might be accessible in your impersonal, master-planned suburban home. But they were all delicious, and I’m not dead, so I can only assume the same experience would hold for you.

I say this not as a health reporter, but as a friend: Here is what you should eat if you ever find yourself in North-Central Texas.

Square Burger—My hometown of McKinney has not many outstanding non-chain restaurants, but this is one of them. Very good hamburgers, and even—in a surprise move for Texas—a salmon one. They were out of the pea soup...

Updated on June 7, 2018

CEDARVILLE, Calif.—Beau Gertz faced a crowd of worried locals at the town senior center, hoping to sell them on his vision for their long-beloved—but now bankrupt—hospital.

In worn blue jeans and an untucked shirt, the bearded entrepreneur from Denver pledged at a town-hall meeting in March to revive the Surprise Valley Community Hospital—a place many in the audience counted on to set their broken bones, stitch up cattle-tagging cuts, and tend to aging loved ones.

Gertz said that if they voted this week to let him buy their tiny public hospital, he would retain such vital services. Better still, he said, he’d like to open a “wellness center” to attract well-heeled outsiders—one that would offer telehealth, addiction treatment, physical therapy, genetic testing, intravenous vitamin infusions, and even massages. Cedarville’s failing hospital, now at least $4 million in debt, would not just bounce back but thrive, he said.

Gertz, 34, a former weightlifter who runs clinical-lab and nutraceutical companies, unveiled his plan to pay for it: He’d use the 26-bed hospital to bill insurers for lab tests regardless of where patients lived. Through telemedicine technology, doctors working for Surprise Valley could order tests for people who’d never set foot there.

To some of the 100 or so people at the meeting that night, Gertz’s plan offered hope. To others, it sounded suspiciously familiar: Just months before, another out-of-towner had proposed a similar deal—only to disappear.

Outsiders “come in and promise the moon,” says Jeanne...

Image above: Kiarra Boulware and her niece at Penn North, an addiction-recovery center in Baltimore


One morning this past September, Kiarra Boulware boarded the 26 bus to Baltimore’s Bon Secours Hospital, where she would seek help for the most urgent problem in her life: the 200-some excess pounds she carried on her 5-foot-2-inch frame.

To Kiarra, the weight sometimes felt like a great burden, and at other times like just another fact of life. She had survived a childhood marred by death, drugs, and violence. She had recently gained control over her addiction to alcohol, which, last summer, had brought her to a residential recovery center in the city’s Sandtown neighborhood, made famous by the Freddie Gray protests in 2015. But she still struggled with binge eating—so much so that she would eat entire plates of quesadillas or mozzarella sticks in minutes.

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As the bus rattled past rowhouses and corner stores, Kiarra told me she hadn’t yet received the Cpap breathing machine she needed for her sleep apnea. The extra fat seemed to constrict her airways while she slept, and a sleep study had shown that she stopped breathing 40 times an hour. She remembered one doctor saying, “I’m scared you’re going to die in your sleep.” In the...

The head of the Environmental Protection Agency faced renewed scrutiny this week—with the latest allegations of unethical behavior veering, at times, into the utterly absurd.

For example, Scott Pruitt reportedly attempted to use his position to secure a Chick-Fil-A franchise for his wife; dispatched an aide look into purchasing a mattress from Trump International Hotel; and had security agents drive him multiple places in search of a moisturizing lotion available at Ritz-Carlton Hotels.

It is strictly prohibited for public servants to ask subordinates to do personal errands, so this Mad Lib menagerie of ethical breaches is notably high-risk, low-reward. Together these stories paint a picture of a man who is not simply misusing his office—misappropriating taxpayer funded resources for personal convenience and profit—but appears to not even appreciate that this is wrong. If you’re going to abuse your power in such a way that could get you fired, at least go big.

Pruitt’s apparent habits are more like conspicuously unbuckling his seatbelt only when he’s about to pass a police car. Which is why the lotion story is particularly compelling. Did he think this was big? Is moisturizer so important as to risk one’s career to procure the perfect bottle?

I did some investigative work and found that Ritz-Carlton sells a product called “The Ritz-Carlton Moisturizer” on its website for $27.20 (16-ounce bottle, on sale). The information was available to me using Google.com. The deployment of taxpayer-funded resources for personal errands is only more galling...

If you are having thoughts of suicide, please know that you are not alone. If you are in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text 741-741 for the Crisis Text Line.

Suicide is on the rise in the United States, but people still don’t know quite how to talk about it.

According to data released this week by the Centers for Disease Control and Prevention, suicide has risen by 30 percent in the United States between 1999 and 2016. It is the tenth leading cause of death in the country. This news happened to come out the same week that two high-profile figures—the fashion designer Kate Spade, and the chef and food journalist Anthony Bourdain—died, apparently of suicide.

Any celebrity death, regardless of cause, leads to a predictable pattern of behavior on social media, a unique and uncomfortable blend of public mourning, attention seeking, and “grief policing.” When a famous person’s death is a suicide, there are more layers—distribution of resources and hotlines, speculation about the deceased’s mental state, the sharing of personal struggles with mental illness, along with calls for destigmatization.

Much of this is well intentioned, just people processing the news together on the platforms we’ve grown accustomed to using for the processing of all things. But inevitably there are crass responses, too.

When it comes to suicide, the perverse incentives of the internet combined with human callousness can sometimes lead to incidents...

If you are having thoughts of suicide, please know that you are not alone. If you are in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text 741-741 for the Crisis Text Line.

Since 1999, the suicide rate in the U.S. has gone up across all racial and ethnic groups, in both men and women, in both cities and rural areas, and across all age groups below 75. These stunningly consistent trends come from a new Centers for Disease Control and Prevention report. Overall, the suicide rate has increased nearly 30 percent.

Suicide was the tenth leading cause of death in the country in 2016, accounting for the deaths of nearly 45,000 Americans over the age of 10.

The CDC report does not conclude exactly why suicide rates have risen so much and so consistently across the country. But, when the information was available, the agency did break down the deaths by method and by circumstances preceding the suicide, suggesting  a few noteworthy trends.

The detailed information comes from the National Violent Death Reporting System, which collects data from death certificates, coroner and medical examiner reports, and law enforcement in 27 states.

Nearly half of the suicides reported through this system in 2015 involved firearms, making this the most common method. The CDC, meanwhile, has been hampered in its ability to study guns as a public health issue because of restrictions placed by Congress.

Less than 5 percent of the...

Late last month, the Trump administration proposed a new rule that could prohibit doctors who receive a type of federal funding called Title X from explicitly referring their patients to abortion providers. Under the new rule, only a pregnant woman who has already decided she wants an abortion—rather than one who is simply weighing her options—could be given a list of medical providers, and not all of the providers can be abortion providers. The rule might still be changed before it goes into effect.

The move is the latest in a series of conservative regulatory changes the Trump administration has made to women’s health. Last year, President Trump restored the global gag rule on abortion and allowed states to withhold family-planning funds to abortion providers. More recently, changes have been made to other programs to emphasize sexual abstinence.

Eight doctors’ groups have criticized the Title X change as “dangerously intrud[ing]” on the patient-provider relationship. What’s more, it might disproportionately affect poor and uninsured women, who visit Title X clinics because they can’t afford or don’t have regular doctors. Nearly two-thirds of Title X patients have income below the federal poverty line.

To find out what impact this change would have on the ground, I recently spoke with Kami Geoffray, the CEO of the Women’s Health and Family Planning Association of Texas. It’s the nonprofit organization that disburses Title X funds to a network of about 100 clinics throughout the state. The program serves about 200,000...

In the Oval Office on Wednesday the president kissed a small boy with muscular dystrophy. Behind them were two men who Trump described as battling ALS. He thanked them for their bravery. He took up his pen for the camera and announced that by signing the controversial legislation—known as “right to try”—he would be saving hundreds of thousands of lives.

“We will be saving—I don’t even want to say thousands, because I think it’s going to be much more. Thousands and thousands. Hundreds of thousands. We’re going to be saving tremendous numbers of lives.”

In fact it’s unclear if the law will save a single life, especially when weighed against how many lives it could shorten. There’s no way to know, and that is exactly the point. The law allows pharmaceutical companies to provide medications to patients that have not been tested for effectiveness, and with only minimal evidence of safety. On the long list of ways the United States could improve access to quality health care—including affordable, safe, effective medication—nowhere does “right to try” appear.

It is rather a step in the wrong direction, but one that is easy to misrepresent and to sell as good. Typically only drugs that have been deemed safe and effective by the Food and Drug Administration, based on three-phase clinical trials, can be sold to patients. “Right to try” allows that process to be circumvented—though in news coverage this often receives a more congratulatory slant. CNBC announced that Trump’s signature would “allow gravely...

Taking a page, perhaps, from Jamie Foxx and T-Pain, Roseanne Barr blamed it on the a-a-a-a-Ambien.

On Tuesday, the controversial TV star tweeted, regarding the Obama aide Valerie Jarrett, an African American woman, that “muslim brotherhood & planet of the apes had a baby=vj.” (The tweet was soon deleted.)

When her show was canceled as a result, Barr attributed the remark to the sedative sleep drug Ambien.

“Guys I did something unforgiveable so do not defend me. It was 2 in the morning and I was ambien tweeting—it was memorial day too—i went 2 far & do not want it defended—it was egregious Indefensible. I made a mistake I wish I hadn’t but...don’t defend it please,” she wrote later on Twitter. She added, “Not giving excuses for what I did (tweeted) but I’ve done weird stuff while on ambien—cracked eggs on the wall at 2am etc.”

Could the sleep medication have prompted Barr to tweet racist sentiments? “It seems unlikely that Ambien is the full culprit here,” said Els van der Helm, the founder of the sleep consultancy Shleep, via email. “Although it can make you act more impulsive/disinhibited.”

People on Ambien have been known to sleep-walk or even sleep-eat. (“We’ve had people eat buttered cigarettes,” Mark Mahowald, of the Minnesota Regional Sleep Disorders Center, told News.com.au. “We’ve had people make salt sandwiches.”) There’s an entire sub-Reddit devoted to Ambien and the wacky texts and emails people sometimes write while on it. One guy even claims to have...

Just five years ago, with the best medical therapies available, the odds of curing a person infected with hepatitis C were no better than a coin toss. Eliminating the disease from a whole country was unthinkable.

But today, Egypt is wiping the disease from its population at an unprecedented pace. The effort was made possible by revolutionary new drugs—but no country, including the United States, has come close to deploying them at equivalent scale. Egypt has shown that dramatic improvements in public health are possible when drugs are priced affordably—and a government makes an effort to systematically deploy them. But Egypt is also the exception that proves the rule that while modern society has proven capable of developing transformative medical innovations, it’s far less proficient at maximizing their use.

The hepatitis C epidemic in Egypt—the country with the highest prevalence of the disease in the world—started around 50 years ago, when the government was attempting to get rid of one plague and ended up substituting it for another. For millennia the Nile Delta has been an ideal breeding ground for schistosomiasis, a parasite spread to humans by freshwater snails. In the mid-20th century, the Egyptian government conducted multiple mass-treatment campaigns using an injectable emetic—and needles were repeatedly reused. Hepatitis C virus, not yet known but transmitted efficiently by blood, was inadvertently spread to many citizens. By 2008, one in 10 Egyptians had chronic hepatitis C.

The virus causes progressive liver damage that only becomes apparent over a decade...

Despite everything I read as a health reporter, some statistics still floor me. Last year, it was the news that half of all murdered women are killed by their romantic partners.

Here’s another: A fifth of all deaths among Americans aged 24 to 35 were due to opioids in 2016, a new study finds, up from just 4 percent in 2001, before this latest opioid epidemic began. Granted, 20- and 30-somethings are not a group that is very prone to death. But the study, published today in JAMA Network Open, found that the percentage of deaths attributable to opioids in the United States increased overall by nearly three-fold between 2001 to 2016.

Young adults aged 24 to 35 were hit hardest by opioid deaths, and men represented more than two-thirds of all opioid deaths. One in every 65 deaths in all were related to opioid use in 2016, according to the study, which was conducted by researchers from St. Michael’s Hospital in Toronto.

The authors also found that 1.68 million years of life were lost prematurely to opioid-related causes in 2016, which is more than the number lost annually to hypertension, HIV, and pneumonia. It’s about one-tenth of the years of life lost to cancer.

Other severe health conditions seem to produce a much more robust public-health response than opioids have. One in five Americans gets skin cancer before age 70, for example. Therefore, many states ban the use of tanning beds among...

Discussion about the great American baby bust often seems meant to induce fear. The concern is that with fewer babies, economic growth will plummet, and too-few workers will have to shoulder the burden of an aging population. But if I’m being honest, the latest news about the drop in American births did not raise my blood pressure much.

Maybe it’s because I, myself, am kind of “eh” on kids in general. Maybe I’ve just been watching too many men beseech women to do their feminine duties on Handmaid’s Tale. So American women are opting out of parenting? Good for them! More time for Netflix, making money, reading my articles—to name just three very pleasurable activities that don’t cause stretch marks.

Or at least, so I thought. I recently came across something that’s made me sit up and pay attention to fertility rates: There is research linking falling fertility to rising populism.

Definitions of populism vary, but it’s often thought to be a political philosophy in which “the people” are pitted against elites and outsiders in a struggle for domination. The rhetoric of President Trump is often considered to be populist.

Here’s how Philip Auerswald, a George Mason University professor, and Joon Yun, a hedge-fund manager, explain this connection in a recent New York Times op-ed:

In the world’s largest cities, where populations are densely concentrated and growing, economies are generally thriving and cosmopolitanism is embraced. Where populations are sparse or shrinking, usually in rural places and small cities, economies are...

A couple years ago, I was taking a swim with my very pregnant friend when I asked her if it was hard to keep straight all of the doctors’ health recommendations for expectant mothers.

Not really. For practically every symptom, she said, their recommendations were roughly the same: “Take a walk, eat a yogurt.”

It was another example of the Cult of Yogurt. Even though some varieties have more sugar than a Twinkie, perhaps no other man-made food is so often recommended by medical professionals—and to treat such a wide variety of ailments.

Whenever I’ve been prescribed antibiotics, I’ve always been told to eat a yogurt so that the antibiotics don’t eat up all the “good” bacteria in my system and leave me with a yeast infection. (Recently, I interviewed a doctor who suggested this is bogus; there’s no way for the yogurt cultures to make it all the way down there.)

Breath bad? According to a 2005 study, you should eat six ounces of yogurt a day. If you, like “87 percent of Americans, suffer from digestive issues like irregularity,” have some yogurt and you’ll soon be like Jamie Lee Curtis, spritely and unclogged with the help of Activia. (As a later FTC complaint showed, this was not quite true either.)

But now, a pair of new studies suggest there might be something about yogurt after all. In the female subjects, at least, it appears to help with markers of inflammation—and that, in turn, can keep other types...

President Trump has a signature handshake. It hit the world stage at the United Nations meeting last year when he grabbed Emmanuel Macron’s hand and appeared to aggressively pull the French president closer. Ever since, he’s shown a consistent tendency to loom into other people’s personal space, or pull them toward him.

Everyone has a personal space, an instinctive protective zone. We’re always jostling to maintain our own space and to navigate around others’, and the honeycomb of abutting spaces forms the scaffold of our social world. Violating it as a means of social communication, a means of bullying, is common behavior. But we usually don’t do it in a calculated way. The rules of personal space run deep under the surface of consciousness. We act and react in an elaborate, animal dance, and only extreme examples—like the Trump handshake—catch our conscious attention.

The instinctive dance of personal space was first studied scientifically by a zoo curator, Heini Hediger, who directed the Zürich Zoo in the 1950s. Zoo animals tend to be comfortable only if their cages are properly shaped and sized to form a protective territory. But when studying animals in the wild, Hediger noticed a second kind of territory, a smaller, portable bubble of space attached to the body. He called it an escape distance, or a flight zone.

When a wildebeest sees a potentially dangerous animal—a lion, or perhaps...

Stella Rae looks back at her old YouTube videos and cringes. These are the videos that built her career: At 19, she has hundreds of thousands of subscribers to her main channel, which she has dedicated to promoting veganism for several years. But her approach has changed dramatically. Today, she says, she wants to show people “that you can be vegan and just live your normal life.” But her earliest work was much less sympathetic.

Rae is one of dozens of young “influencers” who have amassed followings by chronicling their lives as vegans. Across platforms like YouTube, Instagram, and Facebook, they share vegan recipes, beauty products that weren’t tested on animals, and even recommendations for vegan leather handbags. Like many people in this online community, Rae entered into veganism with evangelical flair: After struggling with an eating disorder in her early teens, she came to see veganism as morally righteous, and took to aggressively “spreading the vegan message,” in her words, by posting confrontational videos like “Dumb Things Meat Eaters Say,” in which she tells non-vegans, “Eggs are literal chicken periods. Why would you want to eat that? That is so disgusting!”

Her tone changed once she started getting harassed online by many of the people she thought would most agree with her views. “A lot of people would expect comments from people who aren’t vegan, like, ‘Oh, you need to be eating meat,’” Rae says. “But the majority of the negative comments or comments critiquing my diet,...

One evening last March, Nancy Bacon saw a stranger die. She had just touched down in Toronto and set off for a business meeting, chatting on her phone as she navigated the rush-hour traffic of the financial district. She was jaywalking, hurrying across a particularly busy street, when a fire extinguisher seemed to fall from the sky, smashing to the ground just a few feet away from her.

“I was actually annoyed,” she says. Her first thought was that some mischievous kid had thrown the extinguisher through a window high above. But when she lifted her gaze, Bacon’s annoyance turned to horror. What she witnessed next would haunt her for months. “I saw the guy falling,” she says. “I saw him hit the ground.”

Bacon looked on as the police arrived and attempted CPR. She noticed that the man’s shoe had come off.

A suicide can be dangerous to those closest to the victim, leaving family and friends vulnerable to depression and self-harm. When the act is committed in public, any incidental observers are left to grapple with it, too. While studies on witnessing strangers’ suicide are scarce, a small body of research—alongside a larger body of anecdotes—has begun to show that the experience can be damaging, even traumatic.

Each year in the United States, approximately 45,000 people kill themselves. There’s little data on how many of these suicides occur in public view, and even less on how many people witness them when they do. One study...

Three people who had been infected with Ebola recently left an isolation ward at Wangata Hospital against medical advice, according to the Democratic Republic of the Congo’s Ministry of Health. The hospital lies in Mbandaka, a city of 1.2 million, where health workers are trying to contain the Congo’s ninth Ebola outbreak. One patient was on the mend, but decided to leave on Sunday and didn’t come back. Two more left with their families on Monday and went to church. One died at home, before his body was returned to the hospital for safe burial. The other returned voluntarily, before passing away at the hospital.

Choices like these make it harder to control this outbreak, which had already spread to 58 possible cases, as of Wednesday evening. But they are also understandable.

On a recent trip to the Congo, I met several survivors of past Ebola outbreaks, several of which had left hospitals and gone home. Partly, that’s because an isolation ward can be a horrendous place, with walls and floors sometimes covered with vomit, feces, and urine. But partly, it’s also because the very concept of an isolation ward is an anathema to many Congolese people.

In the Congo, if you’re sick, you’re usually surrounded. Medical services are thin, so family members shoulder the burden of nursing their loved ones back to health. At one hospital I visited (well before the current outbreak), a family had camped outside a treatment building, waiting for their relatives inside to recuperate. Their laundry...

Women in the United States are having children at record low rates, according to the latest statistical release from the Centers for Disease Control and Prevention. In 2017, births were down 2 percent from 2016 and were at their lowest in 30 years. In fact, the only American women who are consistently having more babies than before are those over 40.

Births among Hispanic and white women declined slightly, according to the CDC, but among black women, they remained steady.

Fertility has generally been declining among women in their 20s and rising among women in their 30s and 40s for several years. The fertility rate was around replacement level—the rate at which a generation can replicate itself—until 2008, and it’s been declining since.

One factor behind the decline might be declines or delays in marriage: Births to never-married women are down more than births to women who have been married, as Lyman Stone points out at the Institute for Family Studies.


Birth Rates by the Age of the Mother

The rise of screen time might be another factor that has caused Americans to have less sex, said W. Bradford Wilcox, a sociologist at the University of Virginia, at a recent roundtable discussion for reporters at the American Enterprise Institute, the free-market think tank in Washington. Think of a couple, he said, “and it’s Wednesday night, and they start Netflix going, and they keep watching Netflix and they don’t do ... anything else.”

Birth rates also declined last year...